Ethical dilemmas confronting dentists in Queensland, Australia

Background: This paper details contemporary ethical dilemmas encountered by Queensland dentists. Methods: An age-stratified sample of 499 dentists resident in Queensland was surveyed. The questionnaire contained scenarios of five common ethical dilemmas. In addition, open-ended questions sought the respondent's most frequent, difficult and recent ethical dilemmas, and where they would seek guidance in dealing with ethical problems. Results: Respondents acknowledged the patient's rights in treatment decisions and the dentist's right to refuse demands for inappropriate treatment. However, responses varied in the extent to which dentists may influence treatment decisions. Few respondents would ignore evidence of poor dental treatment but they are evenly divided in choosing to inform the patient, the dentist or both. Poor quality treatment is the most frequent and difficult dilemma, and half have experienced this problem recently. Requests by patients for fraudulent receipts occur in a third of responses. Dentists develop ethical values from multiple sources but for help with dental ethical problems, 90 per cent of respondents would consult another dentist. Conclusions: Of the ethical dilemmas discussed in this survey, those relating to poor quality treatment confronted most respondents. Also the actions of dentists in dealing with these dilemmas were most varied.

Brandin vahvistaminen matkailualalla

Tutkimuksen tavoitteena on selvittää brandin vahvistamista palvelualalla. Palvelubrandit eivät periaatteellisesti eroa varsinaisten tuotebrandien luomisesta ja vahvistamisesta. Käytännössä kuitenkin palvelubrandien kehittämisessä yrityksen henkilöstön palveluvalmius on keskeisin asiakkaan palvelukokemukseen vaikuttava tekijä. Henkilöstön palvelukykyyn ja –haluun vaikutetaan yrityksen avoimella, suunnitellulla ja tehokkaalla sisäisellä viestinnällä ja markkinoinnilla. Palveluyritykseen tulisi luoda ”asiakasta ilahduttava palvelukulttuuri”. Tutkimusmetodi on kvalitatiivinen ja yritysesimerkkinä on Katinkullan lomakeskus. Tutkimuksessa palvelubrandia tarkastellaan seuraavista neljästä brandiomaisuuden keskeisestä näkökulmasta: brandin tunnettuus, jonka tärkeä tekijä on mainonta. Brandin identiteettiin kuuluvat palvelutuote, sen persoona sekä brandin symboli. Brandin laadun tekijöitä ovat hinnoittelu, palvelupuitteet sekä itse palveluprosessi. Ne luovat asiakkaille odotuksia, joiden täyttyminen näkyy asiakastyytyväisyytenä. Se puolestaan johtaa neljänteen brandiomaisuuden tekijään eli asiakasuskollisuuteen.

Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department

Introduction C-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality. Objective To determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED. Methods Data regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010. Results From 2007 to 2009, there were 11 786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests. Discussion Inexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.

Blowing the virtue-ethics whistle: Response to Faunce

The author elaborates some issues raised in the theoretical basis of whistleblowing put forward by Faunce. The author considers the relationship between bioethics teaching and professional behaviour and the role of principlism in teaching bioethics and medical ethics.

Assessing professionalism: theory and practice

Professional attitudes and behaviours have only recently been explicitly recognized by medical educators as legitimate and necessary components of global competence, although the idea of Fitness to Practice has always presupposed acceptable professional behaviour. Medical schools have recently begun to introduce teaching and assessment of professionalism, including attitudes and behaviours. Partly as a result of the difficulty of assessment in this area, selection of students is receiving greater attention, in the pursuit of globally competent graduates. However, selection processes may be overrated for this purpose. Assessing actual attitudes and behaviour during the course is arguably a better way of ensuring that medical graduates are competent in these areas. I argue that judgments about attitudinal and behavioural competence are legitimate, and need be no more arbitrary than those made about scientific or clinical knowledge and skills, but also that these judgments should be restricted to what is agreed to be unacceptable behaviour, rather titan attempting to rate attitudes and behaviour positively. This model introduces students to the way in which their behaviours will be judged in their professional lives by registration authorities. These theoretical positions are illustrated by a recent case of academic failure based on inadequate attitudes and behaviours.

Translating with the Web. Professional translators' information-seeking behaviour in translation with online resources

Tämän tutkielman aiheena on ammattikääntäjien tiedonhaku, kun käytettävissä on ainoastaan verkkolähteitä. Tutkimuksessa on tarkasteltu, mistä ja miten ammattikääntäjät etsivät tietoa internetistä kääntäessään lähtötekstiä englannista suomeen. Lisäksi tutkimuksen tarkoituksena on osoittaa, että tiedonhakutaidot ja lähdekriittisyys ovat käännöskompetensseja, joita tulisi sekä ylläpitää että opettaa osana kääntäjäkoulutusta. Tutkimuksen aineisto kerättiin empiirisesti käyttämällä kolmea metodia. Käännösprosessi ja sen aikana tapahtunut tiedonhaku tallennettiin käyttäen Camtasia-näyttövideointiohjelmaa ja Translog-II -näppäilyntallennusohjelmaa. Lisäksi tutkimukseen osallistuneet kääntäjät täyttivät kaksi kyselyä, joista ensimmäinen sisälsi taustatietokysymyksiä ja toinen itse prosessiin liittyviä retrospektiivisiä kysymyksiä. Kyselyt toteutettiin Webropol-kyselytyökalulla. Aineistoa kerättiin yhteensä viidestä koetilanteesta. Tutkimuksessa tarkasteltiin lähemmin kolmen ammattikääntäjän tiedon-hakutoimintoja erottelemalla käännösprosesseista ne tauot, joiden aikana kääntäjät etsivät tietoa internetistä. Käytettyjen verkkolähteiden osalta tutkimuksessa saatiin vastaavia tuloksia kuin aiemmissakin tutkimuksissa: eniten käytettyjä olivat Google, Wikipedia sekä erilaiset verkkosanakirjat. Tässä tutkimuksessa kuitenkin paljastui, että ammattikääntäjien tiedonhaun toimintamallit vaihtelevat riippuen niin kääntäjän erikoisalasta kuin hänen tiedonhakutaitojensa tasosta. Joutuessaan työskentelemään tutun työympäristönsä ja oman erikoisalansa ulkopuolella turvautuu myös osa ammattikääntäjistä alkeellisimpiin tiedonhakutekniikoihin, joita käännöstieteen opiskelijoiden on havaittu yleisesti käyttävän. Tulokset paljastivat myös, että tiedonhaku voi viedä jopa 70 prosenttia koko käännösprosessiin kuluvasta ajasta riippuen kääntäjän aiemmasta lähtötekstin aihepiiriin liittyvästä tietopohjasta ja tiedonhaun tehokkuudesta. Tutkimuksessa saatujen tulosten pohjalta voidaan sanoa, että myös ammattikääntäjien tulisi kehittää tiedonhakutaitojaan pitääkseen käännösprosessinsa tehokkaana. Lisäksi kääntäjien pitäisi muistaa arvioida kriittisesti käyttämiään tietolähteitä: lähdekritiikki on tarpeen erityisesti verkkolähteitä käytettäessä. Tästä syystä tiedonhakutaitoja ja lähdekriittisyyttä tulisikin opettaa ja harjoitella jo osana kääntäjäkoulutusta. Kääntäjien ei myöskään pidä jättää tiedonhakua pelkkien verkkolähteiden varaan, vaan jatkossakin käyttää hyväkseen niin painettuja tietolähteitä kuin myös henkilölähteitä.

The last taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes ILC-UK

The International Longevity Centre - UK��launched a new paper (Wednesday, 6th July 2011). The last taboo: A guide to dementia, sexuality, intimacy and sexual behaviour in care homes, provides care home workers and managers with information and practical advice on this complex, controversial and sensitive issue.The need for affection, intimacy and relationships for people with dementia in care homes has too often been ignored and side-lined in policy and practice. The onset of old age or a cognitive impairment does not erase the need for affection, intimacy and/or relationships. While the issues involved can be complex, controversial and sensitive and may challenge our own beliefs and value system, it is essential that we understand more about them to foster a more person-centred approach to dementia care. Care home residents with dementia often have complex care needs and trying to understand and respond to the more intimate and sexual aspects of a resident’s personality can be challenging.Aimed at care home workers and managers, the guide not only provides essential information on this aspect of dementia care but offers practical advice to support current work-based practices. Set out in an accessible and easy-to-read format, this guide includes case studies, questions, suggestions and a self assessment quiz to promote easy learning. It also provides a possible pathway for care home managers to develop a guiding policy on sexual expression in dementia.The guide for care staff is summarised in 10 key points:1. Some residents with dementia will have sexual or sensual needs.2. Affection and intimacy contribute to overall health and wellbeing for residents.3. Some residents with dementia will have the capacity to make decisions about their needs.4. If an individual in care is not competent to decide, the home has a duty of care towards the individual to ensure they are protected from harm.5. There are no hard and fast rules. Assess each situation on an individual basis6. Remember not everyone with dementia is heterosexual.7. Inappropriate sexual behaviour is not particularly common in dementia.8. Confront your own attitudes and behaviour towards older people and sex generally.9. Communicate – look at how you can improve communication with your colleagues, managers, residents and carers on this subject10. Look after yourself and remember your own needs as a care professional��The full paper is available: The Last Taboo

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes.

BACKGROUND: Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting the doctor to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. OBJECTIVES: To evaluate the effects of reminders automatically generated through a computerized system and delivered on paper to healthcare professionals on processes of care (related to healthcare professionals' practice) and outcomes of care (related to patients' health condition). SEARCH METHODS: For this update the EPOC Trials Search Co-ordinator searched the following databases between June 11-19, 2012: The Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Library (Economics, Methods, and Health Technology Assessment sections), Issue 6, 2012; MEDLINE, OVID (1946- ), Daily Update, and In-process; EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ); EPOC Specialised Register, Reference Manager, and INSPEC, Engineering Village. The authors reviewed reference lists of related reviews and studies.  SELECTION CRITERIA: We included individual or cluster-randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals on processes and/or outcomes of care. DATA COLLECTION AND ANALYSIS: Review authors working in pairs independently screened studies for eligibility and abstracted data. We contacted authors to obtain important missing information for studies that were published within the last 10 years. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median absolute improvement and interquartile range (IQR) in process adherence across included studies using the primary outcome or median outcome as representative outcome. MAIN RESULTS: In the 32 included studies, computer-generated reminders delivered on paper to healthcare professionals achieved moderate improvement in professional practices, with a median improvement of processes of care of 7.0% (IQR: 3.9% to 16.4%). Implementing reminders alone improved care by 11.2% (IQR 6.5% to 19.6%) compared with usual care, while implementing reminders in addition to another intervention improved care by 4.0% only (IQR 3.0% to 6.0%) compared with the other intervention. The quality of evidence for these comparisons was rated as moderate according to the GRADE approach. Two reminder features were associated with larger effect sizes: providing space on the reminder for provider to enter a response (median 13.7% versus 4.3% for no response, P value = 0.01) and providing an explanation of the content or advice on the reminder (median 12.0% versus 4.2% for no explanation, P value = 0.02). Median improvement in processes of care also differed according to the behaviour the reminder targeted: for instance, reminders to vaccinate improved processes of care by 13.1% (IQR 12.2% to 20.7%) compared with other targeted behaviours. In the only study that had sufficient power to detect a clinically significant effect on outcomes of care, reminders were not associated with significant improvements. AUTHORS' CONCLUSIONS: There is moderate quality evidence that computer-generated reminders delivered on paper to healthcare professionals achieve moderate improvement in process of care. Two characteristics emerged as significant predictors of improvement: providing space on the reminder for a response from the clinician and providing an explanation of the reminder's content or advice. The heterogeneity of the reminder interventions included in this review also suggests that reminders can improve care in various settings under various conditions.

Chaotic dynamics and team effectiveness: evidence from professional basketball

Considering teams as complex adaptive systems (CAS) this study deals with changes in team effectiveness over time in a specific context: professional basketball. The sample comprised 23 basketball teams whose outcomes were analysed over a 12-year period according to two objective measures. The results reveal that all the teams showed chaotic dynamics, one of the key characteristics of CAS. A relationship was also found between teams showing low-dimensional chaotic dynamics and better outcomes, supporting the idea of healthy variability in organizational behaviour. The stability of the squad was likewise found to influence team outcomes, although it was not associated with the chaotic dynamics in team effectiveness. It is concluded that studying teams as CAS enables fluctuations in team effectiveness to be explained, and that the techniques derived from nonlinear dynamical systems, developed specifically for the study of CAS, are useful for this purpose.

Chaotic dynamics and team effectiveness: evidence from professional basketball

Considering teams as complex adaptive systems (CAS) this study deals with changes in team effectiveness over time in a specific context: professional basketball. The sample comprised 23 basketball teams whose outcomes were analysed over a 12-year period according to two objective measures. The results reveal that all the teams showed chaotic dynamics, one of the key characteristics of CAS. A relationship was also found between teams showing low-dimensional chaotic dynamics and better outcomes, supporting the idea of healthy variability in organizational behaviour. The stability of the squad was likewise found to influence team outcomes, although it was not associated with the chaotic dynamics in team effectiveness. It is concluded that studying teams as CAS enables fluctuations in team effectiveness to be explained, and that the techniques derived from nonlinear dynamical systems, developed specifically for the study of CAS, are useful for this purpose.

Neuro-mechanical and metabolic adjustments to the repeated anaerobic sprint test in professional football players.

PURPOSE: This study aimed to determine the neuro-mechanical and metabolic adjustments in the lower limbs induced by the running anaerobic sprint test (the so-called RAST). METHODS: Eight professional football players performed 6 × 35 m sprints interspersed with 10 s of active recovery on artificial turf with their football shoes. Sprinting mechanics (plantar pressure insoles), root mean square activity of the vastus lateralis (VL), rectus femoris (RF), and biceps femoris (BF) muscles (surface electromyography, EMG) and VL muscle oxygenation (near-infrared spectroscopy) were monitored continuously. RESULTS: Sprint time, contact time and total stride duration increased from the first to the last repetition (+17.4, +20.0 and +16.6 %; all P < 0.05), while flight time and stride length remained constant. Stride frequency (-13.9 %; P < 0.001) and vertical stiffness decreased (-27.2 %; P < 0.001) across trials. Root mean square EMG activities of RF and BF (-18.7 and -18.1 %; P < 0.01 and 0.001, respectively), but not VL (-1.2 %; P > 0.05), decreased over sprint repetitions and were correlated with the increase in running time (r = -0.82 and -0.90; both P < 0.05). Together with a better maintenance of RF and BF muscles activation levels over sprint repetitions, players with a better repeated-sprint performance (lower cumulated times) also displayed faster muscle de- (during sprints) and re-oxygenation (during recovery) rates (r = -0.74 and -0.84; P < 0.05 and 0.01, respectively). CONCLUSION: The repeated anaerobic sprint test leads to substantial alterations in stride mechanics and leg-spring behaviour. Our results also strengthen the link between repeated-sprint ability and the change in neuromuscular activation as well as in muscle de- and re-oxygenation rates.

An exploration of interdisciplinary practice through an examination of specific disciplinary interpretations of stereotypic behaviour

As identified in the literature, a lack of understanding of the functional properties and triggers of stereotypic behaviour exists. When looking at this behaviour from an Applied Behaviour Analysis (ABA) framework, limitations are evident around identifying specific sensory modalities and functional properties of such behaviour. Antecedents particularly are difficult to identify and interpret. Therefore an interdisciplinary approach to assessment using two types of professional services commonly received by individuals with autism was proposed. However before this approach could be investigated the current interpretations of Stereo typic behaviour by each professional must be examined along with perceptions of interdisciplinary collaboration. The purpose of this study was to use an in-depth qualitative analysis to reveal the interpretations of stereotypy and collaboration from the perspectives of two particular professionals. The results of the study demonstrated that occupational therapists and behaviour analysts likely have different interpretations of the same behaviour,that consultation is the common model used to interact with other disciplines, and that professionals may have mixed feelings toward interdisciplinary practices as an approach to stereotypic behaviour. Strengths and limitations of the study were highlighted along with specific directions for future research.

Training on the use of a bespoke continuing professional development framework improves the quality of CPD records

BACKGROUND: Using continuing professional development (CPD) as part of the revalidation of pharmacy professionals has been proposed in the UK but not implemented. We developed a CPD Outcomes Framework (‘the framework’) for scoring CPD records, where the score range was -100 to +150 based on demonstrable relevance and impact of the CPD on practice. OBJECTIVE: This exploratory study aimed to test the outcome of training people to use the framework, through distance-learning material (active intervention), by comparing CPD scores before and after training. SETTING: Pharmacy professionals were recruited in the UK in Reading, Banbury, Southampton, Kingston-upon-Thames and Guildford in 2009. METHOD: We conducted a randomised, double-blinded, parallel-group, before and after study. The control group simply received information on new CPD requirements through the post; the active intervention group also received the framework and associated training. Altogether 48 participants (25 control, 23 active) completed the study. All participants submitted CPD records to the research team before and after receiving the posted resources. The records (n=226) were scored blindly by the researchers using the framework. A subgroup of CPD records (n=96) submitted first (before-stage) and rewritten (after-stage) were analysed separately. MAIN OUTCOME MEASURE: Scores for CPD records received before and after distributing group-dependent material through the post. RESULTS: Using a linear-regression model both analyses found an increase in CPD scores in favour of the active intervention group. For the complete set of records, the effect was a mean difference of 9.9 (95% CI = 0.4 to 19.3), p-value = 0.04. For the subgroup of rewritten records, the effect was a mean difference of 17.3 (95% CI = 5.6 to 28.9), p-value = 0.0048. CONCLUSION: The intervention improved participants’ CPD behaviour. Training pharmacy professionals to use the framework resulted in better CPD activities and CPD records, potentially helpful for revalidation of pharmacy professionals. IMPACT: • Using a bespoke Continuing Professional Development outcomes framework improves the value of pharmacy professionals’ CPD activities and CPD records, with the potential to improve patient care. • The CPD outcomes framework could be helpful to pharmacy professionals internationally who want to improve the quality of their CPD activities and CPD records. • Regulators and officials across Europe and beyond can assess the suitability of the CPD outcomes framework for use in pharmacy CPD and revalidation in their own setting.

Evaluation of the fretting fatigue behaviour of commercially pure titanium

Fretting fatigue occurs when the contact surfaces of two components undergo small oscillatory movement while they are subjected to a clamping force. A cyclic external load gives rise to the early initiation of fatigue cracks, thus reducing their service life. In this paper, the fretting fatigue behaviour of commercially pure titanium flat samples (1.5 mm thick) is evaluated. A fretting device composed of a frame, load cell, and two screw-mounted cylindrical fretting pads with convex extremities was built and set to a servo-hydraulic testing machine. The fatigue tests were conducted under load control at a frequency of 10 Hz and stress ratio R = 0.1, with various contact load values applied to the fretting pads. Additional tests under inert environment allowed assessing the role of oxidation on the wear debris formation. The fracture surfaces and fretting scars were analysed via scanning electron microscopy in order to evaluate the surface damage evolution and its effect on the fatigue crack features. The effect of the fretting condition on the S-N curve of the material in the range of 10(4)-10(6) cycles is described. Fatigue crack growth calculations allowed estimating the crack initiation and propagation lives under fretting conditions. The effect of the fretting condition in fatigue life is stronger for the lower values of cyclic stress and does not seem to depend on the contact loading value.