Factors influencing sustainability of health service innovation, emergency nurse practitioner service

Escalating health care delivery costs and consumer expectations have led to a range of health service and workforce innovations in the provision of high quality cost effective patient care. This research has operationalised a theoretical framework to examine factors that influence sustainability of health service innovations, in particular, emergency nurse practitioner service. The results of this research will inform health service policy and practice for future implementation of innovative workforce models and add to the understanding of factors that influence sustainability.

General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

Gandhi,Mahatma And The Working Scientist - A Reconciliation

IMAGINE a scientist who is a follower of Mahatma Gandhi. What kind of science can he practice? Would it be different from the kind of science that is being practised? I believe it would be and will illustrate this by constructing Mahatma Gandhi's view on science and scientific research based on his writings on related subjects. To me this implies that science is affected by the scientist's subjective values. I will then trace some of the values behind science as practised today and examine their implications for .he relationship between the scientist and the society. I will also present a case for abandoning the belief that science must be universal and show the relevance of Gandhian concepts to scientists.

Information science and the scientist. A look at information requirements and the technologies available to scientists in the pursuit of information

A review article looking at the type of information requirements commonly shared by scientists and their use of traditional information services. Areas covered include primary requirements of IFE (Institute of Freshwater Ecology) staff, pure versus applied research, informal and personal sources of information, and traditional library and information services. It goes on to describe how research into information systems and technology may improve the wider accessibility and use of information to the scientific community. Technologies covered include online databases, telecommunications, gateways, expert systems, optical technology and applications of CDROM.

Biographic Memoir of Ernest Ingersoll: Naturalist, Shellfish Scientist, and Author

The name Ernest Ingersoll is well-known to many shellfishery biologists as the author of two outstanding monographs on the shellfisheries of the United States and Canada in the 1880's. The first (Ingersoll, 1881a), entitled "A Report on the Oyster-Industry of the United States," was a 252-page description of historical and contemporary oyster fishing' marketing methods, and statistical data in the eastern provinces of Canada and the coastal states of the United States. The second (Ingersoll, 1887), entitled "The Oyster, Scallop, Clam, Mussel, and Abalone Industries," was a l20-page summary of the first monograph about oysters as well as a history and description of contemporary methods and statistical data of the other shellfisheries. Although Ingersoll was, by profession, a naturalist and author but only briefly a shellfish scientist, these monographs are regarded as benchmarks, providing the principal descriptions of shellfisheries in North America in the 1700's and 1800's.

Farmer-scientist research partnerships for integrated agriculture-aquaculture

A realistic alternative to traditional technology development and transfer has been utilized by the International Center for Living Aquatic Resources Management (ICLARM) to integrate pond fish culture into low-input farming systems in Malawi. Resource mapping was used to assess farm resources and constraints and introduce the concept of integrated resource management (IRM), the synergistic movement of resources between and among farm and household enterprises. Farmer-led IRM research projects are conducted on-farm and monitored by researchers through direct observation and on-station simulation of constraints and management practices. Technology-adoption rates by farmers involved in a pilot activity was 65% compared to 0% by farmers exposed only to top-down extension approaches. Within two years of adoption, every participating farmer had transferred the technology to an average of four other farmers without the involvement of the extension services.