How well do midwives use skills and knowledge in examining newborns?

Physical examination of the newborn (PEN) was established as part of postnatal care in the late 1960s. The role of discharging babies within the first 72 hours of birth was traditionally undertaken by junior doctors. Currently midwives, nurses, advanced nurse practitioners, and health visitors are being trained to undertake the PEN (NHS Screening Programmes, 2010). However, only a fraction of midwives utilize their acquired skills in clinical practice. A survey by Townsend et al (2004) showed that 2% of babies in England were examined by midwives while 83% were examined by junior doctors.This study aimed to evaluate how well midwives who undertook the PEN course between 2002 and 2005 (n = 40) at a large London University utilized the skills acquired on the course. Questionnaires with a series of open and closed questions were sent out by post followed by phone and email reminders. The eight that responded were midwives. All respondents said they were appropriately trained and felt well prepared for their role to examine babies. However, they felt they were not provided with opportunities to use the skills. Guidelines based on this extended role are available in the workplace but only a few midwives seemed to have negotiated time to implement these and may need greater managerial support for the role.

Accumulating research: a systematic account of how cumulative meta-analyses would have provided knowledge, improved health, reduced harm and saved resources

BACKGROUND: "Cumulative meta-analysis" describes a statistical procedure to calculate, retrospectively, summary estimates from the results of similar trials every time the results of a further trial in the series had become available. In the early 1990 s, comparisons of cumulative meta-analyses of treatments for myocardial infarction with advice promulgated through medical textbooks showed that research had continued long after robust estimates of treatment effects had accumulated, and that medical textbooks had overlooked strong, existing evidence from trials. Cumulative meta-analyses have subsequently been used to assess what could have been known had new studies been informed by systematic reviews of relevant existing evidence and how waste might have been reduced.

METHODS AND FINDINGS: We used a systematic approach to identify and summarise the findings of cumulative meta-analyses of studies of the effects of clinical interventions, published from 1992 to 2012. Searches were done of PubMed, MEDLINE, EMBASE, the Cochrane Methodology Register and Science Citation Index. A total of 50 eligible reports were identified, including more than 1,500 cumulative meta-analyses. A variety of themes are illustrated with specific examples. The studies showed that initially positive results became null or negative in meta-analyses as more trials were done; that early null or negative results were over-turned; that stable results (beneficial, harmful and neutral) would have been seen had a meta-analysis been done before the new trial; and that additional trials had been much too small to resolve the remaining uncertainties.

CONCLUSIONS: This large, unique collection of cumulative meta-analyses highlights how a review of the existing evidence might have helped researchers, practitioners, patients and funders make more informed decisions and choices about new trials over decades of research. This would have led to earlier uptake of effective interventions in practice, less exposure of trial participants to less effective treatments, and reduced waste resulting from unjustified research.

Sources of patient knowledge and financing of cataract surgery in rural China: the Sanrao Study of Cataract Outcomes and Up-Take of Services (SCOUTS), report 6.

AIM: To study patient sources of knowledge about cataract surgical services, and strategies for financing surgery in rural China. DESIGN: Cross-sectional case series. METHODS: Patients undergoing cataract surgery by local surgeons in a government, village-level facility in Sanrao, Guangdong between 8 August and 31 December 2005 were examined and had standardised interviews an average of 12 months after surgery. RESULTS: Of 313 eligible patients, 239 (76%) completed the questionnaire. Subjects had a mean (SD) age of 69.9 (10.2) years, 36.4% (87/239) were male, and 87.0% (208/239) had been blind (presenting visual acuity < or = 6/60) before surgery. Word-of-mouth advertising was particularly important: 198 (85.0%) of the subjects knew a person who had undergone cataract surgery, of whom 191 (96.5%) had had cataract surgery at Sanrao itself. Over 70% of subjects (166/239) watched TV daily, whereas 80.0% (188/239) "never" read the newspaper. Nearly two-thirds of suggestions from participants (n = 211, 59.6%) favoured either TV advertisements or word-of-mouth to publicise the programme. While the son or daughter had paid for surgery in over 70% of cases (164/233), the patient's having paid without help was the sole predictor of undergoing second-eye surgery (OR 2.27 (95% CI 1.01 to 5.0, p = 0.04)). DISCUSSION: Strategies to increase uptake of cataract surgery in rural China may benefit from enhancing word-of-mouth advertising (such as with pseudophakic motivators), using television advertising where affordable, and micro-credit or other programmes to enable patients to pay their own fees, thus increasing uptake of second-eye surgery.

Integrating Social Knowledge and Collaboration Tools into Dispersed Product Development

Employee collaboration and knowledge sharing is vital for manufacturing organisations wishing to be successful in an ever-changing global market place; Product Development (PD) teams, in particular, rely heavily on these activities to generate innovative designs and enhancements to existing product ranges. To this end, the purpose of this paper is to present the results of a validation study carried out during an Engineering Education Scheme project to confirm the benefits of using bespoke Web 2.0-based groupware to improve employee collaboration and knowledge sharing between dispersed PD teams. The results of a cross-sectional survey concluded that employees would welcome greater usage of social computing technologies. The study confirmed that groupware offers the potential to deliver a more effective collaborative and knowledge sharing environment with additional communication channels on offer. Furthermore, a series of recommended guidelines are presented to show how PD teams, operating in globally dispersed organisations, may use Web 2.0 tools to improve employee collaboration and knowledge sharing.

The effects of estimating good vs. poor knowledge of results during acquisition of a spatial motor task

Recent studies have shown that providing learners Knowledge of Results (KR) after “good trials” rather than “poor trials” is superior for learning. The present study examined whether requiring participants to estimate their three best or three worst trials in a series of six trial blocks before receiving KR would prove superior to learning compared to not estimating their performance. Participants were required to push and release a slide along a confined pathway using their non-dominant hand to a target distance (133cm). The retention and transfer data suggest those participants who received KR after good trials demonstrated superior learning and performance estimations compared to those receiving KR after poor trials. The results of the present experiment offer an important theoretical extension in our understanding of the role of KR content and performance estimation on motor skill learning.

BP BLOGGER: DESCRIPTIVE STUDY OF ELECTRONIC KNOWLEDGE DISSEMINATION IN LONG TERM CARE

Little is known of the uptake and use of knowledge disseminated in electronic formats, especially in Long Term Care (LTC) settings. The purpose of this descriptive study was to examine the dissemination of the BP Bloggers, a series of brief, evidence summaries designed to meet the knowledge needs of LTC staff. Guided by Rogers’ (2003) Diffusion of Innovations theory, the study documents dissemination of the BP Blogger and examines factors affecting dissemination, awareness, perceptions and its use. The survey of BP Blogger recipients was conducted electronically (n=114) online (n=10), by telephone (n=55), and print (n=144). Managers usually received the newsletter electronically while staff in LTC were more likely to receive printed copies. Participants disseminated the newsletter through paper, email, or posting in the workplace. Most participants rated the content, format, and usefulness of the BP Blogger as good or excellent. Time and lack of email access were barriers to dissemination.

The really useful science book : a framework of knowledge for primary teachers.

Este recurso no ofrece un material que pueda ser utilizado en las aulas, está diseñado para apoyar y ampliar la comprensión de la ciencia de los profesores en formación y los profesores de aula. Consta de tres secciones: la vida y los procesos vivos; materiales y sus propiedades; procesos físicos. En cada sección se sugieren ideas clave que se amplían posteriormente en el texto. Proporciona un conocimiento exhaustivo de la ciencia en la etapa clave 1 y 2 (Key Stage 1 y 2), así como la preparación para la enseñanza y el aprendizaje en la etapa clave 3 (Key Stage 3).

Can knowledge of the state of the stratosphere be used to improve statistical forecasts of the troposphere?

Recent analysis of the Arctic Oscillation (AO) in the stratosphere and troposphere has suggested that predictability of the state of the tropospheric AO may be obtained from the state of the stratospheric AO. However, much of this research has been of a purely qualitative nature. We present a more thorough statistical analysis of a long AO amplitude dataset which seeks to establish the magnitude of such a link. A relationship between the AO in the lower stratosphere and on the 1000 hPa surface on a 10-45 day time-scale is revealed. The relationship accounts for 5% of the variance of the 1000 hPa time series at its peak value and is significant at the 5% level. Over a similar time-scale the 1000 hPa time series accounts for 1% of itself and is not significant at the 5% level. Further investigation of the relationship reveals that it is only present during the winter season and in particular during February and March. It is also demonstrated that using stratospheric AO amplitude data as a predictor in a simple statistical model results in a gain of skill of 5% over a troposphere-only statistical model. This gain in skill is not repeated if an unrelated time series is included as a predictor in the model. Copyright © 2003 Royal Meteorological Society