Infusing the use of seasonal climate forecasting into crop management practice in North East Australia using discussion support software

Seasonal climate forecasting offers potential for improving management of crop production risks in the cropping systems of NE Australia. But how is this capability best connected to management practice? Over the past decade, we have pursued participative systems approaches involving simulation-aided discussion with advisers and decision-makers. This has led to the development of discussion support software as a key vehicle for facilitating infusion of forecasting capability into practice. In this paper, we set out the basis of our approach, its implementation and preliminary evaluation. We outline the development of the discussion support software Whopper Cropper, which was designed for, and in close consultation with, public and private advisers. Whopper Cropper consists of a database of simulation output and a graphical user interface to generate analyses of risks associated with crop management options. The charts produced provide conversation pieces for advisers to use with their farmer clients in relation to the significant decisions they face. An example application, detail of the software development process and an initial survey of user needs are presented. We suggest that discussion support software is about moving beyond traditional notions of supply-driven decision support systems. Discussion support software is largely demand-driven and can compliment participatory action research programs by providing cost-effective general delivery of simulation-aided discussions about relevant management actions. The critical role of farm management advisers and dialogue among key players is highlighted. We argue that the discussion support concept, as exemplified by the software tool Whopper Cropper and the group processes surrounding it, provides an effective means to infuse innovations, like seasonal climate forecasting, into farming practice. Crown Copyright (C) 2002 Published by Elsevier Science Ltd. All rights reserved.

An overview of drugs and ancillary equipment for the dentist's emergency kit

The concept of a basic (i.e., essential) medical emergency kit suitable for a general dental practitioner varies somewhat between different authorities. A practitioner's choice is also dependant on the proximity of medical aid and the nature of the dental practice. Over recent years the trend has been to restrict the items to a minimum, in the interest of both common sense and safety, for example, just oxygen, adrenaline 1:1000, an oral carbohydrate source, glyceryl trinitrate and aspirin as first options. Ancillary equipment should include an oxygen therapy facemask, a pocket mask and a set of oral (Guedel) airways. Two further medication options for consideration are an aerosol bronchodilator and, in certain circumstances, an injectable antihypoglycaemic agent. This paper provides a selective overview of the subject. An absolute necessity is for dentists to be competent in Basic Life Support skills, and to maintain a complete and current medical history for all patients.

Diagnosis and management of unusual dental abscesses in children

Although the majority of dental abscesses in children originate from dental caries or trauma, a few are associated with unusual conditions which challenge diagnosis and management. Recent research findings have shed light on these unusual entities and greatly improved understanding of their clinical implications. These conditions include developmental abnormalities such as dens invaginatus in which there is an invagination of dental tissues into the pulp chamber and dens evaginatus in which a tubercle containing pulp is found on the external surface of a tooth crown. In addition, inherited conditions which show abnormal dentine such as dentine dysplasia, dentinogenesis imperfecta, and osteogenesis imperfecta predispose the dentition to abscess formation. Furthermore, 'spontaneous' dental abscesses are frequently encountered in familial hypophosphataemia, also known as vitamin D-resistant rickets, in which there is hypomineralization of dentine and enlargement of the pulp. In addition to developmental conditions, there are also acquired conditions which may cause unusual dental abscesses,. These include pre-eruptive intracoronal resorption which was previously known as 'pre-eruptive caries' or the 'fluoride bomb'. In addition, some undiagnosed infections associated with developing teeth are now thought to be the mandibular infected buccal cysts which originate from infection of the developing dental follicles. In the present paper, these relatively unknown entities Which cause unusual abscesses in children are reviewed with the aim of updating the general practitioner in their diagnosis and management.

Clinicians' attitudes to clinical practice guidelines

To the Editor: In their systematic review of clinicians' attitudes to clinical practice guidelines, Farquhar et al1 found that, although healthcare providers reported high satisfaction with guidelines, a significant number also expressed concerns about their practicality, their role in cost-cutting and their potential for increasing litigation. The review, however, did not address other potentially significant concerns of clinicians regarding the perceived validity of guidelines and the influence of external agencies (such as the pharmaceutical industry) on treatment recommendations.

Beliefs and attitudes about endemic dental fluorosis among adolescents in rural Brazil

OBJECTIVE: To understand beliefs and attitudes about fluorosis among young people living in a rural area. METHODOLOGICAL PROCEDURES: Qualitative study consisting of semi-structured interviews with 23 adolescents with dental fluorosis, 14 teachers and three health authorities in the city of São Francisco, Southeastern Brazil, in 2002. Content analysis and social representation theory were applied. ANALYSIS OF RESULTS: The organoleptic characteristics of carbonates that affect groundwater (salty flavor, whitish coloration, and turbidity) associated with negative aspects of household use of this water are considered a cause of mottled enamel. Even after contact with researchers who investigated this phenomenon and helped find a solution for this condition, the local population is still unwilling to accept fluoride as the cause of the problem and does not fully agree to use water from other sources because they are afraid of the quality of water. CONCLUSIONS: Misperceptions of the causes of dental fluorosis and water treatment costs compromise the implementation of uncontaminated surface water supplies. Health education strategies are required in parallel with solutions for securing water supply in drought-ravaged areas.

Occupational stress and coping resources in physiotherapists: a survey of physiotherapists in three general hospitals

Objectives - To identify occupational stressors and coping resources in a group of physiotherapists, and to analyse interactions between subjective levels of stress, efficacy in stress resolution and coping resources used by these professionals. Design - A sample of 55 physiotherapists working in three general hospitals in Portugal completed the Coping Resources Inventory for Stress, the Occupational Stressors Inventory and two subjective scales for stress and stress resolution. Main results - Most physiotherapists perceived that they were moderately stressed (19/55, 35%) or stressed (20/55, 36%) due to work, and reported that their efficacy in stress resolution was moderate (25/54, 46%) or efficient (23/54, 42%). Issues related to lack of professional autonomy, lack of organisation in the hierarchical command chain, lack of professional and social recognition, disorganisation in task distribution and interpersonal conflicts with superiors were identified as the main sources of stress. The most frequently used coping resources were social support, stress monitoring, physical health and structuring. Perceived efficacy in stress resolution was inversely related to perceived level of occupational stress (r = −0.61, P < 0.01). Significant correlations were found between several coping resources and the perceived level of stress and efficacy in stress resolution. Associations between problem solving, cognitive restructuring and stress monitoring and both low levels of perceived stress and high levels of perceived efficacy were particularly strong. Implications for practice - The importance of identifying stressors and coping resources related to physiotherapists’ occupational stress, and the need for the development of specific training programmes to cope with stress are supported.

Nonlinear dynamics of the patient’s response to drug effect during general anesthesia

In today’s healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are related to their effect in the bispectral index, a measure of EEG signal. In this paper wavelet time–frequency analysis is used to extract useful information from the clinical signals, since they are time-varying and mark important changes in patient’s response to drug dose. Model based predictive control algorithms are employed to regulate the depth of sedation by manipulating these two drugs. The results of identification from real data and the simulation of the closed loop control performance suggest that the proposed approach can bring an improvement of 9% in overall robustness and may be suitable for clinical practice.

Nonlinear dynamics of the patient’s response to drug effect during general anesthesia

In today’s healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are related to their effect in the bispectral index, a measure of EEG signal. In this paper wavelet time–frequency analysis is used to extract useful information from the clinical signals, since they are time-varying and mark important changes in patient’s response to drug dose. Model based predictive control algorithms are employed to regulate the depth of sedation by manipulating these two drugs. The results of identification from real data and the simulation of the closed loop control performance suggest that the proposed approach can bring an improvement of 9% in overall robustness and may be suitable for clinical practice.

BIWiki - Using a Business Intelligence Wiki to Form a Virtual Community of Practice for Portuguese Master's Students

Web 2.0 software in general and wikis in particular have been receiving growing attention as they constitute new and powerful tools, capable of supporting information sharing, creation of knowledge and a wide range of collaborative processes and learning activities. This paper introduces briefly some of the new opportunities made possible by Web 2.0 or the social Internet, focusing on those offered by the use of wikis as learning spaces. A wiki allows documents to be created, edited and shared on a group basis; it has a very easy and efficient markup language, using a simple Web browser. One of the most important characteristics of wiki technology is the ease with which pages are created and edited. The facility for wiki content to be edited by its users means that its pages and structure form a dynamic entity, in permanent evolution, where users can insert new ideas, supplement previously existing information and correct errors and typos in a document at any time, up to the agreed final version. This paper explores wikis as a collaborative learning and knowledge-building space and its potential for supporting Virtual Communities of Practice (VCoPs). In the academic years (2007/8 and 2008/9), students of the Business Intelligence module at the Master's programme of studies on Knowledge Management and Business Intelligence at Instituto Superior de Estatistica e Gestao de Informacao of the Universidade Nova de Lisboa, Portugal, have been actively involved in the creation of BIWiki - a wiki for Business Intelligence in the Portuguese language. Based on usage patterns and feedback from students participating in this experience, some conclusions are drawn regarding the potential of this technology to support the emergence of VCoPs; some provisional suggestions will be made regarding the use of wikis to support information sharing, knowledge creation and transfer and collaborative learning in Higher Education.

Effects of a mental health training program on health care worker's knowledge and attitude and practice in Belize

ABSTRACT This study was conducted to assess mental health knowledge, attitude and practices among health care workers in Belize before and immediately after a competency based training program in mental health. A baseline Knowledge, Attitudes and Practices (KAP) survey was given to health personnel, mainly nurses, working primary and secondary care. The intervention was a 13-week face-to-face training course for health care professionals with the objective of increasing their competency in mental health and reducing stigma. After the training a post intervention KAP survey was conducted among the original respondents. 88 health care workers completed the baseline survey and 61 of those respondents completed the post-intervention questionnaire. The results showed that the level of knowledge of the participants had improved by the training intervention and that in general, the intervention was effective in correcting some misconceptions about mental illness and reducing stigmatizing attitudes among the participants.

Knowledge and practices of general practitioners of district Peshawar about schizophrenia

ABSTRACT: Schizophrenia with its disabling features has been placed in the top ten of global burden of disease and is associated with long-term decline in functional ability. General Practitioners not only have an important role in treating patients with an established diagnosis of schizophrenia but they can also contribute significantly by identifying people in early stages of psychosis as they are the first hand medical help available and the duration of untreated psychosis is a good indicator of patient’s prognosis. This cross sectional survey, conducted at the clinics of General Practitioners, was designed to assess the knowledge and practices of general practitioners in Peshawar on diagnosis and treatment of schizophrenia. A semi structured questionnaire was used to assess their knowledge and practices regarding schizophrenia. The Knowledge/Practice was then categorized as good or poor based on their responses to the questions of the administered questionnaire. Overall, the results showed that the knowledge and practices of general practitioners of district Peshawar were poor regarding schizophrenia and may be responsible for delayed diagnosis, inadequate treatment and poor prognosis.

Clinical practice guidelines in Portugal : quantitative and qualitative evaluation

RESUMO: Introdução As normas de orientação clínica são ferramentas úteis na translação de conhecimentos desde a investigação para a prática clínica diária. Estratégias ativas de implementação de normas de orientação clínica requerem elevado esforço organizacional e financeiro. Quando os recursos são escassos, as estratégias passivas podem ser a única opção de disseminação. Desde 2011 a Direção Geral da Saúde publicou cento e cinquenta e nove normas de orientação clínica. Nesta Tese é feita uma avaliação do impacto que estratégias de disseminação de normas de orientação clínica têm no padrão de prescrição dos médicos e uma avaliação qualitativa do processo das normas de orientação clínica em Portugal. Métodos: O primeiro artigo é um estudo quasi experimental usando uma série de análises temporais interrompida para comparar os níveis observados e esperados de prescrição de inibidores da ciclooxigenasa-2, antes e depois da publicação da norma de orientação clínica sobre a utilização de anti-inflamatórios não esteroides. O segundo estudo é um artigo de opinião e debate no qual numa primeira parte contextualiza o processo das normas da Direcção Geral da Saúde, na segunda parte aponta virtudes e defeitos no processo e a terceira parte constitui uma contribuição com vista à melhoria do processo. Discussão A produção de normas de orientação clínica requer metodologia rigorosa e complexa. A literatura médica revela que a translação de conhecimento é uma tarefa árdua. Estratégias de implementação ativas requerem recursos financeiros e organizacionais sólidos. Estratégias de implementação passivas podem representar uma solução aceitável se os recursos financeiros e organizacionais escasseiam. Pouco é conhecido sobre a eficácia destas estratégias fora do contexto de investigação. Com esta Tese pretendo contribuir para a clarificação desta resposta, outros países e instituições podem ver utilidade nesta informação, bem como pretendo contribuir para a discussão e melhoria do processo das normas de orientação clínica em Portugal. ------------------ ABSTRACT: Introduction Clinical practice guidelines can help address the failure to translate research findings into clinical practice. Active clinical practice guidelines implementation strategies require active efforts from organizations and are resource and financially demanding. Passive implementation strategies may represent the only option if resources are scarce. Out of research environment, real world efficacy of passive implementation strategies is still undetermined. Since 2011 the Portuguese General Health Directorate published one hundred and fifty nine guidelines. In this Thesis I evaluate the impact of passive dissemination of clinical practice guideline in clinician’s prescription behavior and review, from a qualitative point of view, the Portuguese clinical practice guideline process. Methods The first study is a quasi-experimental study using a retrospective interrupted time-series analysis design to compare the observed and expected prescription of cyclooxygenase-2 before and after the non steroidal antiinflammatory guideline publication. The second study is an opinion and debate article in which I firstly review the General Health Directorate guideline process. The second part states positive and negative aspects in the process and the third part is a contribution aimed at improving the process in the future. Discussion Clinical practice guidelines production demands a rigorous and complex methodology. medical iterature reveals that knowledge translation is a difficult task. Active implementation strategies demand solid financial and organizational resources. Passive implementation strategies may represent an acceptable solution if financial and organizational resources are scarce. Little is known about the efficacy of these strategies out of the research context. With this Thesis I intend to contribute to clarify this question, other countries and institutions with similar conditions may find this information useful, and also to contribute for the discussion and general improvement of national clinical practice guidelines process.

Rifapentine for latent tuberculosis infection treatment in the general population and human immunodeficiency virus-positive patients: summary of evidence

AbstractLatent tuberculosis infection (LTBI) and human immunodeficiency virus (HIV)-coinfection are challenges in the control of tuberculosis transmission. We aimed to assess and summarize evidence available in the literature regarding the treatment of LTBI in both the general and HIV-positive population, in order to support decision making by the Brazilian Tuberculosis Control Program for LTBI chemoprophylaxis. We searched MEDLINE, Cochrane Library, Centre for Reviews and Dissemination, Embase, LILACS, SciELO, Trip database, National Guideline Clearinghouse, and the Brazilian Theses Repository to identify systematic reviews, randomized clinical trials, clinical guidelines, evidence-based synopses, reports of health technology assessment agencies, and theses that investigated rifapentine and isoniazid combination compared to isoniazid monotherapy. We assessed the quality of evidence from randomized clinical trials using the Jadad Scale and recommendations from other evidence sources using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The available evidence suggests that there are no differences between rifapentine + isoniazid short-course treatment and the standard 6-month isoniazid therapy in reducing active tuberculosis incidence or death. Adherence was better with directly observed rifapentine therapy compared to self-administered isoniazid. The quality of evidence obtained was moderate, and on the basis of this evidence, rifapentine is recommended by one guideline. Available evidence assessment considering the perspective of higher adherence rates, lower costs, and local peculiarity context might support rifapentine use for LTBI in the general or HIV-positive populations. Since novel trials are ongoing, further studies should include patients on antiretroviral therapy.