Achievement Of Best Practice Research Articles

A broken link: Knowledge of carbohydrate requirements do not predict carbohydrate intake around competition in endurance athletes.

Endurance athletes fail to meet carbohydrate (CHO) guidelines for competition, which may be due to limited knowledge. However, the relationship between knowledge and practice in this population is unknown. To investigate this, we assessed the dietary intake in 50 athletes (37 females) who completed endurance events ≥2.5h in duration and compared CHO intake against the carbohydrates for endurance athletes in competition questionnaire validated nutrition knowledge questionnaire, with specific questions related to CHO loading, pre-competition meal and during-competition intake. CHO-loading guidelines (10-12g·kg-1·day-1) were met in practice by n=5 (10%), but there was no relationship between identified requirements (range 0-12g·kg-1·day-1) and actual intake (rs=0.133, p=0.358), with the n=18 (36%) who correctly identified requirements, ingesting 6.1±1.9g·kg-1·day-1. CHO intake for pre-competition meal guidelines (1-4g·kg-1) was met in practice by n=40 (80%), but there was no relationship between identified requirements (range 0 to >4g·kg-1) and actual intake (rs=0.101, p=0.487), with n=19 (38%) who correctly identified guidelines requirements, ingesting 1.4±0.6g·kg-1. CHO intake during-competition guidelines (60-90g·h-1) was met in practice by n=18 (36%), but there was no relationship between the amounts of CHO required (range 30 to >90g/h) and actual intake (rs=0.028, p=0.849), with n=32 (64%) who correctly identified guidelines requirements, ingesting 56±20g·h-1. Results show no relationship between the knowledge of CHO recommendations and practice, suggesting that theoretical knowledge does not guarantee the achievement of best practice and other important factors may ultimately determine practice.

Examining Differences in Achievement of Physical Activity Best Practices Between Urban and Rural Child Care Facilities by Age

Go Nutrition and Physical activity Self Assessment in Child Care (NAP SACC) is an evidence based intervention developed to positively impact childhood obesity in early childhood education (ECE) facilities. One focus of Go NAP SACC is the development of physical activity best practices. However, little research has examined differences in achievement of best practices based on age of child and geographic location. The purpose of this study was to examine differences in the achievement of physical activity best practices between urban and rural childcare facilities by age-specific recommendations (infants, toddlers, and preschoolers) and in the overall physical activity environment. Urban (n = 207) and rural (n = 218) ECE facilities completed the Go NAP SACC process. Data were analyzed using an ANCOVA. A majority of facilities reported exceeding best practices (79.5%), however significant differences were found on 18 best practices with urban facilities outscoring their rural counterparts on 17 of these items. A comparison by age found that urban facilities reported higher achievement of best practices among infants (60%) in comparison to toddlers (40%) or preschoolers (30%). Future studies should continue to explore the rural–urban context of physical activity practices across the early childhood age groups to ensure healthy physical development of children.

Comparison of Urban and Rural Physical Activity and Outdoor Play Environments of Childcare Centers and Family Childcare Homes.

The purpose of this study was to examine the physical activity environment in childcare programs across type (childcare centers [CCCs] and family childcare homes [FCCHs]) and geographic location (urban and rural) as assessed by physical activity best practices according to the Go Nutrition and Physical Activity Self-assessment in Child Care. Results showed CCCs compared with FCCHs reported higher achievement of best practices. Further, urban childcare programs (CCCs and FCCHs) reported higher achievement of best practices in comparison to rural childcare programs. There is a need to deliver targeted interventions that promote children's physical activity in FCCHs and CCCs in rural areas.

Using scoping review methods to describe current capacity and prescribe change in Canadian SCI rehabilitation service delivery

ObjectiveTo describe the methodology used to conduct a scoping review of spinal cord injury (SCI) rehabilitation service delivery in Canada, and to explain the reporting process intended to advance future service delivery.Evidence acquisitionA SCI rehabilitation framework derived from the International Classification of Function, Disability and Health was developed to describe the goals and interprofessional processes of rehabilitation. An adapted Arksey and O'Malley (2005) methodological framework was used to conduct a scoping review of SCI rehabilitation services in Canada. Data were obtained from multiple relevant sources via survey (N = 3572 data fields) from 13 of 15 Canadian tertiary SCI rehabilitation sites, systematic reviews, white papers, literature reviews, clinical practice resources, and clinicians. Multidisciplinary teams of content experts (n = 17), assisted with data interpretation and validation by articulating practice trends, gaps, and priorities.Evidence synthesisThe findings will be presented in an atlas, which includes aggregate national data regarding impairment and demographic characteristics, service utilization, available resources (staff and capital equipment), specialized services, local expertise, and current best practice indicators, outcome measures, and clinical guidelines. Data were collated and synthesized relative to specific rehabilitation goals. The current state of SCI rehabilitation service delivery (specific to each rehabilitation goal) is summarized in a report card within three domains, knowledge generation, clinical application, and policy change, and specifies key 2020 priorities.ConclusionThese findings should prompt critical evaluation of current Canadian SCI rehabilitation service delivery while specifying enhancements in knowledge generation, clinical application and policy change domains likely to assist with achievement of best practices by 2020.

Venous thromboembolism risk factors and practices of prophylaxis: ENDORSE study results in Portugal.

Venous thromboembolism (VTE) risk assessment is a cornerstone for the achievement of best practices and outcomes. Epidemiologic data and practices related to venous thromboprophylaxis as considered by the global ENDORSE study, (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), enrolled 68,183 patients from 32 countries, in which Portugal. Within ENDORSE, data from all participant countries analyzed to determine their risk of VTE and to evaluate the suitability of prophylaxis. European patients were enrolled from randomly selected hospitals in Portugal (European Hospital Register), according to ENDORSE study inclusion/exclusion criteria. The Seventh ACCP evidence-based consensus guidelines were employed to evaluate VTE risk and prophylaxis use. From a total of 3,145 beds assessed, 2,183 were considered eligible and 1,632 met all criteria. Of these, 860 (52.7%; 95% CI 50.3-55.1) were at risk of VTE: 525 surgical patients (68.9%; 95% CI 65.5-72.1) and 335 medical patients (38.5%; 95% CI 35.3-41.2). The rate of prophylaxis according to ACCP guidelines in overall patients at risk was 58.5% (503 patients). The prophylaxis rate for VTE was 59% (310 patients) in surgical patients and 57.6% (n=193) in medical patients. 39.7% of surgical patients and 39.4 % of medical patients who did not meet the criteria for prophylaxis were also on prophylaxis with an anticoagulant, which was considered to be inappropriate. More than a half of these hospitalized patients in Portugal were deemed at risk of VTE and less than two-thirds of them received appropriate prophylaxis. New strategies are required for implementation of venous thromboprophylaxis in Portuguese hospitals.

Exploring the Role of Touch in the First Year of Life: Mothers' Perspectives of Tactile Interactions with Their Infants

Introduction:Touch is a basic instinctual interaction between a parent and his or her infant and has a vital role in the infant's early development. Parents provide a variety of tactile stimulation while addressing their infant's daily care routines. This paper reports on research findings, exploring the nature of this tactile interaction and how it is influenced by personal and contextual factors.Method:A qualitative study, employing a phenomenological approach, was conducted to explore the experiential nature of tactile interaction. Data were collected from six mothers of typically developing infants through single semi-structured interviews, and analysed thematically. Credibility and trustworthiness were addressed throughout the research process through peer checking, an audit trail and the completion of a reflexive diary.Findings:The mothers described the importance of tactile interaction as a medium through which to bond with their infant and also discussed the influence that the infant's development has on this dyadic relationship. Personal and contextual factors were identified as affecting engagement in tactile interaction.Conclusion:Based on these findings, recommendations are made for occupational therapists who work with infants. The consideration of personal and contextual factors that influence mother-infant tactile interaction will contribute to a family-centred approach to therapy and support the achievement of best practice in this area.

Fever Management Practices of Neuroscience Nurses, Part II

Fever is frequently encountered by neuroscience nurses in patients with neurological insults and often results in worsened patient outcomes when compared with similar patients who do not have fever. Best practices in fever management are then essential to optimizing patient outcomes. Yet the topic of best nursing practices for fever management is largely ignored in the clinical and research literature, which can complicate the achievement of best practices. A national survey to gauge fever management practices and decision making by neuroscience nurses was administered to members of the American Association of Neuroscience Nurses. Results of the questionnaire portion of the survey were previously published. This report presents a content analysis of the responses of neuroscience nurses to the open-ended-question portion of the survey (n = 106), which revealed a dichotomous primary focus on nursing- or patient-related issues. In addition, respondents described barriers and issues in the provision of fever-management care to neuroscience patients. In order to advance national best practices for fever management in neurologically vulnerable patients, further work needs to be conducted, particularly with regard to necessary continuing education for staff, facilitation of interdisciplinary communication, and development of patient care protocols. Neuroscience nurses are in an excellent position to provide leadership in these areas.

Defining best practice in waste minimisation

The Radioactive Substances Act 1993 requires operators to be authorised to dispose of radioactive wastes from their sites. Furthermore, the Act places a statutory duty on operators to demonstrate that they are applying the Best Practicable Means (BPM) to prevent, and where this is not practicable, minimise waste arisings and discharges. The proposed UKAEA Harwell Authorisation and recently issued AWE Authorisation have placed a series of Improvement Requirements on the operator with respect to several aspects of waste management. One of these requires the operators to review best practice in waste minimisation. RM Consultants, under contract to UKAEA Harwell and AWE, have developed a methodology that provides a basis for responding to this requirement. This paper explains the sets of Best Practice Principles which were defined and points out that they may have wider application to other nuclear radioactive waste producers, in developing a common achievement of best practice across the industry.

Developing ethical guidelines for pharmaceutical company support in an academic mental health center.

Introduction by the column editor: Interactions between the pharmaceutical industry and clinicians have important consequences for patient care. So a practices look at this topic is welcomed. The authors of this month's column have initiated a quality-assurance process in their organization by developing ethical guidelines for such interactions. Guidelines are an early step toward the ultimate achievement of best practices. Over time, with monitoring of the impact of their guidelines on their institution, these authors will understand more about this vital theme. Attempts by other clinical organizations to develop guidelines will be needed to add to a generalized strategy for interactions between the pharmaceutical industry and the clinician.

Developing nursing practice through work-based learning

Developing nursing practice in any area demands skills, knowledge, support and a long term commitment to the achievement of best practice. It is easy to become overwhelmed by the competing demands for client care and service delivery. It is not always easy to see how good ideas, clinical concerns and professionally led objectives, can be realised in practice. Ongoing professional development activities, including formal educational programmes can contribute to individual staff members’ ability to take on practice development projects. Too often however, educational programmes are seen as making little real difference to clinical practice. Work-based learning, a relatively new approach in higher education in the United Kingdom, presents opportunities for Universities and healthcare providers to work in partnership to realise the shared aims of developing nursing practice. Specific examples, drawn from the personal experiences of one of the authors, will examine the contribution of a work-based learning approach to integrating learning and developing practice in the field of cancer care. The work-based learning approach can bring about tangible benefits for patients, practitioners and organisations, but only if the organisational and contextual factors which impact on practice and its development are properly considered and managed through effective partnerships.

National recommendations and guidelines.

Clinical guidelines and recommendations from organizations such as the National Institute for Clinical Excellence provide clinicians with information, based on an appraisal of the current evidence, regarding specific therapeutic interventions and conditions. These are designed to guide practice and to move towards achievement of best practice based on clinical and cost-effectiveness. The provision of such guidelines are potentially beneficial in developing health care practice. However, they also lead to potential problems or dilemmas for nurses. These include the conflict between standardization of service and client choice, the tension between professional autonomy and prescribed actions, and the balance between clinical and cost-effectiveness.

Quality care outcomes in cardiac surgery: the role of evidence-based practice.

An internal database and research methods were used to evaluate the impact of clopidogrel on cardiac surgical bleeding. This quality improvement initiative, led by the clinical nurse specialist, showed that preoperative exposure to clopidogrel was associated with significant increases in chest tube output, blood product use, and reoperation for bleeding rates that were 10-fold higher than for control patients (0.85% versus 8.3%, P = 0.027). Acute care costs averaged $2,680 more for patients who received clopidogrel (P = 0.1936). After implementation of an interdepartmental clinical practice guideline, preoperative exposure to clopidogrel dropped from 39% to 6.3% (P = 0.0000). This drop was accompanied by reductions in chest tube output, blood product use, and bleeding complications, with improved achievement of clinical benchmarks. The availability of internal evidence to support achievement of best practices was an essential factor in the implementation of this interdepartmental change. Comprehensive database systems and advanced practice nurses are highlighted as essential components of evidence-based programs.

Best practice in psychogeriatric care.

This paper presents a best practice model for psychogeriatric care. Best practice is becoming one of the most common expressions used in the area of health care, and is often referred to in government reports and documents. The definition of 'best practice', however, is still evolving. What then, is best practice? And how can the principles of best practice be applied and integrated into the clinical speciality of psychogeriatrics? The article emphasizes the importance of evidence-based interventions and the need to focus on the pragmatic aspects of providing best practice in the clinical area of psychogeriatrics; that is, what works best in practice? The position taken by the authors of this paper is that the conceptualization of a best practice model in psychogeriatrics is necessary in order to describe and explain the different components involved in the service provided. This conceptualization also communicates and articulates the role of the major stakeholders, and the key players in the achievement of best practice. A psychogeriatric service may become more coherent, more goal-orientated and more efficient if a model is utilized. This paper outlines a proposed model of best practice in psychogeriatrics, and discusses the potential implications for achieving desirable clinical outcomes.

Management changes facing librarianship in Australia

Five challenges for leadership and management skills were identified by the Karpin Report, “Enterprising Nation”. These were: to develop a positive enterprise culture; to upgrade the capabilities of the vocational training and education sector, capitalising on the talents of diversity, best practice management development and achievement of best practice. Each challenge is related to Australian librarianship in the 1990s and relevant issues for management education and professional development discussed.

Policy Implementation: Monitoring Progress Towards Best Practice in Primary Health Care

Rigorous assessment of strategic policy implementation is difficult and as a result, is relatively rare in Australia. This paper examines the value of, and issues associated with, developing a set of core performance indicators to monitor primary health care policy implementation as part of the quest for best practice. A model to facilitate the use of monitoring information as part of quality improvement practices, including benchmarking towards best practice, is introduced. Because of its practical implications for both formulating and monitoring the implementation of strategic health policy, this paper is believed to be a significant step in the study of policy development. What is sometimes regarded as the final phase in policy development and implementation�the evaluation of policy�should, if best practice is to be achieved, occur as part of policy development itself and be informed integrally by monitoring mechanisms. In this way, assessment of the process, impact and outcomes of a policy can be fed directly and systematically back into the policy development process. The paper concludes with recommendations for future work in this area to support the achievement of best practice in primary health care.