Use Of Best Practices Research Articles

Patient Safety and Physiotherapy: What Does it Mean for Your Clinical Practice?

Physiotherapists working in clinical settings must be aware of patient safety on a daily basis, but they may not understand the scope of the issue. For example, suppose that a physiotherapist is treating the patient of a colleague who has called in sick, and the treatment plan includes the use of ultrasound (US). Does the physiotherapist know all the patient safety concerns that are important for this clinical situation? These concerns include the safety of the US machine: Has it been maintained and calibrated regularly according to the manufacturer's guidelines? What about the US gel used? Does the clinic have a policy that follows Health Canada's December 2004 recommendations in order to minimize the health risks associated with the use of US gel?1 What are the infection control procedures? Are there hand-washing facilities or equipment within the clinical areas to facilitate frequent hand hygiene for staff and patients? Has the work area been cleaned appropriately? Does the patient need to be screened according to Ministry of Health guidelines for influenza-like illness?2 Have complete treatment records been maintained, including the correct dosage used for this patient?3 What is the practice for treating patients who have been treated by other physiotherapists? Are there policies in place for this type of handover? These are some of the many aspects of patient safety that a physiotherapist must be aware of in order to ensure the safety of patients. Patient safety has been defined as “the reduction and mitigation of unsafe acts within the health-care system, as well as through the use of best practices shown to lead to optimal patient outcomes.”4(p.12) This editorial focuses on increasing awareness and providing a better understanding of the principles of patient safety and of the role of physiotherapists in patient safety. As well, it introduces the Canadian inter-professional patient safety competencies,5 which can be integrated into practice, whether in clinical or academic settings, to improve physiotherapists' knowledge, skills, and attitudes about patient safety.

Ergonomic Best Practices in Masonry: Regional Differences, Benefits, Barriers, and Recommendations for Dissemination

Within construction the masonry trade has particularly high rates of musculoskeletal disorders (MSDs). A NIOSH-sponsored meeting of masonry stakeholders explored current and potential “Best Practices” for reducing MSDs in masonry and identified potential regional differences in use of practices. To verify and better understand the regional effects and other factors associated with differences in practice use, a national telephone survey of masonry contractors was conducted. The United States was divided into four regions for evaluation: Northeast, Southeast, Midwest, and West Coast. Nine practices with the potential to reduce MSDs in masonry workers were evaluated. Masonry contractors, owners, and foremen completed 183 surveys. The results verify regional differences in use of best practices in masonry. Half-weight cement bags and autoclave aerated concrete were rarely used anywhere, while lightweight block and mortar silos appear to be diffusing across the country. The Northeast uses significantly fewer best practices than other regions. This article examines reasons for regional differences in masonry best practice, and findings provide insight into use and barriers to adoption that can be used by safety managers, researchers, and other safety advocates to more effectively disseminate ergonomic solutions across the masonry industry.

Developing guidelines for postgraduate dental educators in the UK

Commissioned by the UK Committee of Postgraduate Dental Deans and Directors (COPDEND), the purpose of this work was to establish UK guidelines for dental educators. The final document comprises 79 statements, in eight domains. Each domain has four zones related to what dental educators (1) know, (2) do with members of the dental team as learners, (3) do with other dental educators as learners and (4) lead on. Launched in November 2008, the document provides a framework of good practice for use in the employment, development and management of dental educators in the UK. The guidelines are readily available from the COPDEND website. A key purpose of this paper is to report on the process of development and a central part of that was the integration of feedback and consultation on early drafts. These processes elicited a total of 102 responses. Issues raised in consultation included: (1) how the zones interrelate; (2) differentiation between domains; (3) measurability; and (4) implementation challenges. This paper includes our responses to these issues.

Using the knowledge to action process model to incite clinical change *

Knowledge translation (KT) has only recently emerged in the field of rehabilitation with attention on creating effective KT interventions to increase clinicians' knowledge and use of evidence-based practice (EBP). The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. This model provides a sequence of phases for researchers and clinicians to follow in order to optimize KT across various fields of practice. In this article we use an example from a series of national studies in stroke rehabilitation to demonstrate how the Knowledge to Action Process model is being used to increase the use of best practices in the management of a very prevalent poststroke impairment, unilateral spatial neglect. The series of research projects and actions described herein each address a specific phase of the model. The reader is introduced to a specific example with the goal of generalizing the process to his or her own domain of interest. Gaps in our research agenda are also highlighted and future initiatives to complete the process are described. It is important that KT is maximized in health care to improve patient outcomes. As demonstrated here, the Knowledge to Action Process model provides an excellent guide for clinicians, managers, and researchers who wish to incite change in patient care.

Scaling up beyond ‘pills and skills’: preventing parent‐to‐child HIV/AIDS transmission and the public/private divide in southern India

This paper argues that current HIV/AIDS intervention models in southern India--in particular, those targeting the prevention of parent-to-child transmission (PPTCT)--underutilize the private sector and thereby compromise an efficient integration of HIV/AIDS humanitarian responses into India's health development system. While PPTCT is a critical strategy for curbing the HIV/AIDS epidemic-particularly in countries like India, where prevalence rates among young women are escalating-the cascade of prepartum, intrapartum, and postpartum PPTCT interventions are often difficult for women and spouses to access as a result of socio-cultural, structural and economic obstacles. Recognizing the complex ecologies within which PPTCT interventions must take place, qualitative analysis focussed on current PPTCT gaps in southern India and how healthcare providers and policymakers are moving to scale-up PPTCT by integrating into maternal, child and reproductive health services. Fieldwork highlighted a particularly stark gap in PPTCT delivery-the divide in scale-up efforts between public facilities and the private sector, which provides over 50% of national antenatal services. The private sector often serves as women's first point of healthcare contact, as they will avoid reputably poor-quality public facilities; vulnerable groups (e.g. rural and urban poor, tribal communities) are also seeking out subsidized private care, notably in faith-based facilities. Recognizing the need to revise the current humanitarian and health response, this paper details initial efforts to integrate into private care, with aim to present practitioners' successes, challenges and good practices for use in cross learning and a foundation for future research. This paper's analysis makes recommendations for key PPTCT providers and emphasizes the need to: (a) saturate PPTCT services in the private sector, and (b) strengthen mechanisms for integrating PPTCT across sector (private, public, and civil society) and decentralizing deeper into rural India to access vulnerable women, infants and spouses.

How to manage patients with systemic lupus erythematosus who are also antiphospholipid antibody positive

Between 20% and 40% of patients with systemic lupus erythematosus (SLE) have positive blood tests for antiphospholipid antibodies (aPLs). This article explains what tests are used to detect these antibodies and outlines the complexities of interpreting and acting upon a positive result. If aPLs are persistently positive, the patient may develop antiphospholipid syndrome (APS) characterised by vascular thrombosis, pregnancy morbidity or both. In patients with SLE who are aPL-positive but have not developed APS, there is some evidence that low-dose aspirin should be used prophylactically, but it is not conclusive. APS in patients with SLE is clinically similar to primary APS and should be treated in the same way, with anticoagulation to prevent recurrent thrombosis or with aspirin and sometimes heparin to prevent pregnancy loss. Current best practice in use of these treatments is discussed. However, these treatments are not ideal as they can have major side effects such as haemorrhage. Research which may lead to better, more targeted therapy for APS is discussed at the end of the article.

Best Practices for Use of Historical Control Data of Proliferative Rodent Lesions

CHARLOTTE KEENAN, SUSAN ELMORE, SABINE FRANCKE-CARROLL, RAMON KEMP, ROY KERLIN, SHYAMAL PEDDADA, JOHN PLETCHER, MATTHIAS RINKE, STEPHEN PETER SCHMIDT, IAN TAYLOR, AND DOUGLAS C. WOLF GlaxoSmithKline, King of Prussia, Pennsylvania, USA National Toxicology Program (NTP), National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, North Carolina, USA Center for Food Safety and Applied Nutrition (CFSAN), U.S. Food and Drug Administration, College Park, Maryland, USA Merck Research Laboratories, Riom, France Pfizer Inc., Groton, Connecticut, USA NIEHS, Research Triangle Park, North Carolina, USA Charles River, Frederick, Maryland, USA Bayer Schering Pharma AG, Wuppertal, Germany Huntingdon Life Sciences, Eye, United Kingdom U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA

Prescrição e preparo de medicamentos sem formulação adequada para crianças: um estudo de base hospitalar

Este trabalho teve como objetivo identificar medicamentos cuja forma ou formulação farmacêutica representa um problema em pediatria (Medicamento Problema - MP), bem como analisar as estratégias empregadas pelos médicos, para sua utilização nas crianças e os riscos envolvidos. Trata-se de um estudo descritivo, que tem como base um inquérito com pediatras de um hospital de referência do SUS em Fortaleza-Ceará, conduzido para identificação dos MPs em julho-agosto de 2004; uma análise das prescrições contendo adaptação de formas sólidas e uma observação direta do preparo dos medicamentos, que foram conduzidas em dezembro de 2004 e janeiro de 2005, respectivamente. Os medicamentos foram agrupados pela classificação ATC e pelo cálculo de frequências das variáveis. Os pediatras (N=48, 98%) identificaram: 16 produtos sem forma injetável, 32 injetáveis necessários em concentrações menores e 30 MP sem formulação líquida para uso oral. Foram analisadas 89 prescrições contendo adaptação de formas sólidas, envolvendo 119 itens de medicamentos; todas continham inadequações, sendo a principal a partição de comprimidos. As doses prescritas corresponderam ao preconizado em 33,6% dos casos. Adaptações foram realizadas em local inadequado, por profissional não qualificado e sem as boas práticas. Concluindo, a carência de formulações apropriadas ao uso pediátrico repercute na prática médica e é agravada pela inexistência de condições adequadas para a manipulação de medicamentos por farmacêuticos, nos hospitais brasileiros.

Examining Strategies for Implementing Best Practices in Home Healthcare

Home healthcare agencies frequently strive to improve quality of care through the use of guidelines to promote best practices. A significant challenge is implementing new practices once they have been identified. Drawing on literature and interviews, this article reviews the effectiveness and feasibility of strategies used to disseminate evidence and how these interact with characteristics of the desired change and characteristics of the organization seeking to implement the change. Based on this review, suggestions are made about how agencies can promote the implementation of guidelines and how the use of best practices can be supported throughout the industry.

Community-Based Interventions for Addressing Alcohol and Tobacco Dependence in Latino Communities: Adapting Consensually Derived Guidelines

ABSTRACT Background: This article describes the development of culturally sensitive guidelines for an alcohol and tobacco use intervention model for Latino communities. Extensive research supports the fact that people who use alcohol also use tobacco. In fact, 80% to 95% of alcoholics smoke, with the heaviest alcohol consumers being the heaviest consumers of tobacco. Concurrent use of these substances poses numerous public health threats. The goals of this project are to increase the consistency of culturally appropriate treatment strategies for this population. Method: A consensus conference composed of nationally recognized experts in nicotine dependence, multiculturalism, treatment, research, and consumer advocacy were identified and convened. Results: The panel recommended and developed a community intervention model as a best practice for use in Latino communities. This consensually derived model incorporated promotores, or community health workers, as frontline interventionists. Following the consensus recommendations, the authors of this article describe how these models can be modified to address concomitant dependencies to alcohol and tobacco. Conclusion: The model presented is a promising and replicable approach to improve the health of nicotine- and alcohol-dependent Latino adults. Alcohol treatment providers need to be aware of these promising intervention approaches. This community-based model has the potential for reaching countless individuals who may not otherwise be exposed to alcohol- and tobacco-related interventions.

Shifts in Functions of a New Technology over Time: An Analysis of Logged Electronic Intensive Care Unit Interventions

A study of logged interventions at an electronic intensive care unit (e-ICU) was conducted to examine how functions changed over a two-year period. In total, 2301 log entries of e-ICU interventions from 2005 and 2007 were uniquely coded as to function. A Chi square goodness of fit analysis revealed that 7 out of 11 functions (64%) significantly changed over the two years that were measured. There were increases seen by the log data in the e-ICU nurses calling ICU nurses to supply missing information, recommend the use of best practices, and providing education to ICU nurses. Additionally, increases were seen for e-ICU physicians receiving requests for ordering actions to be taken on patients. Decreases were seen in e-ICU nurses communicating critical lab results and vital sign changes to ICU nurses. We discuss how these shifts relate to several of our predicted archetypical patterns for how new technologies change over time, both in terms of their primary functions as well as changes to positive and negative “unintended” consequences on secondary functions.

Quantities and units in analytical chemistry

Analytical chemistry is largely concerned with the determination of the composition of mixtures. The result of the analysis of a component in a mixture should comprise the product of a ‘numerical value’ and a ‘unit’ in order to express the value of the ‘quantity’ being measured (and an associated statement of uncertainty). The quantities and units which can be used to express these results are subtly different and can often be confused and misused. This article clarifies their meaning, presents a novel method of demonstrating the relationship between them, and discusses the advantages and drawbacks of their usage in analytical chemistry, particularly with respect to environmental analysis. Suggestions for best practice for use in analytical chemistry are also made.

Taking Chances: Evaluating Risk as a Guide to Better Use of Best Practices

Recent attention to best practices has resulted in a complex array of terminology and a number of compendia of effective practices that may be daunting to public policy makers and administrators seeking solutions to important public problems. This study clarifies these distinctions and builds on them to create a decision tool that will help policy makers as they use best practice information in program adoption or development. Decision makers must know their goals in seeking out best practices. As they evaluate potential practices, they should consider not only the quality of available evidence of effectiveness but also the risk of harm to constituents and the cost per unit of benefit generated. The study applies the rubric to an emerging practice in support services for individuals with disabilities known as Cash and Counseling, demonstrating that the practice is low risk, cost neutral, and improves effectiveness and consumer satisfaction. The tool highlights the judgmental elements of concern in the decision process while providing a means to assess multiple decision dimensions in a coherent fashion.

Fostering Labor Rights in Developing Countries: An Investors’ Approach to Managing Labor Issues

While private sector investment plays a key role in fostering sustainable economic development in developing countries, respect for internationally recognized worker rights is also a vital component. The paper presents a methodology to assist investors in large-scale private infrastructure and other industry sector projects to utilize internationally recognized core labor rights and related standards for fostering sound labor management. The methodology involves due diligence or analysis of labor conditions and subsequent supervision and monitoring of performance and promotes the use of best practices to complement existing minimum requirements. Case study examples are presented and challenges in applying the approach are discussed.

An Oedometer-Type Pressure Plate SWCC Apparatus

Abstract A new oedometer device for SWCC determination has been evaluated by testing a wide range of soil types, and recommendations for best practices for use of this device have been made. The new device allows application and control of the net normal stress, σ−ua, in addition to the matric suction, ua−uw. Thus it can be used to simulate a range of overburden stresses and various other stress states of interest. It also allows the measurement of specimen volume change and the use of a single specimen for determination of the SWCC. The evaluation includes issues of temperature control, air diffusion through high air entry ceramic disks, and study of potential sources of error in water content determination for the SWCC. It is concluded that the new oedometer device can be used to obtain an accurate SWCC for a single specimen up to 1500kPa. General recommendations for appropriate use of the equipment and corrections to SWCC data obtained using axis translation pressure plate-type devices are made.

Assessing Best Practice as a Means of Innovation

This paper argues that Best Practice and innovation are different, if related activities, with Best Practice being just one of the means by which organisations can innovate. After reviewing the literatures on innovation diffusion and policy transfer, this paper reports the findings of two surveys of Best Practice in English local authorities on, respectively, regeneration and community safety. The paper finds that innovation is related to the CPA, but use of Best Practice is not; that greater capacity affects both innovation and the use of Best Practice; and that there is little link within authorities in the degree of innovation between policy sectors. In evaluating the use of Best Practice, the paper finds that local authorities encounter problems with assessing whether Best Practice is appropriate for their authority and judging whether Best Practice is in fact best practice. With Best Practice guides, the key problem is the difficulty in assessing whether the practice is as effective as the guides suggest and whether it would really work in a particular authority. The paper concludes that more effort could be made to ensure that readers of Best Practice guides can find out how the innovations really work and how they can be adapted to local needs.

Potential of information technology in dental education

The use of information technology (IT) in dentistry is far ranging. In order to produce a working document for the dental educator, this paper focuses on those methods where IT can assist in the education and competence development of dental students and dentists (e.g. e-learning, distance learning, simulations and computer-based assessment). Web pages and other information-gathering devices have become an essential part of our daily life, as they provide extensive information on all aspects of our society. This is mirrored in dental education where there are many different tools available, as listed in this report. IT offers added value to traditional teaching methods and examples are provided. In spite of the continuing debate on the learning effectiveness of e-learning applications, students request such approaches as an adjunct to the traditional delivery of learning materials. Faculty require support to enable them to effectively use the technology to the benefit of their students. This support should be provided by the institution and it is suggested that, where possible, institutions should appoint an e-learning champion with good interpersonal skills to support and encourage faculty change. From a global prospective, all students and faculty should have access to e-learning tools. This report encourages open access to e-learning material, platforms and programs. The quality of such learning materials must have well defined learning objectives and involve peer review to ensure content validity, accuracy, currency, the use of evidence-based data and the use of best practices. To ensure that the developers' intellectual rights are protected, the original content needs to be secure from unauthorized changes. Strategies and recommendations on how to improve the quality of e-learning are outlined. In the area of assessment, traditional examination schemes can be enriched by IT, whilst the Internet can provide many innovative approaches. Future trends in IT will evolve around improved uptake and access facilitated by the technology (hardware and software). The use of Web 2.0 shows considerable promise and this may have implications on a global level. For example, the one-laptop-per-child project is the best example of what Web 2.0 can do: minimal use of hardware to maximize use of the Internet structure. In essence, simple technology can overcome many of the barriers to learning. IT will always remain exciting, as it is always changing and the users, whether dental students, educators or patients are like chameleons adapting to the ever-changing landscape.

Exploring 'best practice' for nucleic acid detection of Neisseria gonorrhoeae

Nucleic acid detection tests (NADT) have considerable benefits for the detection of Neisseria gonorrhoeae (GC), including high sensitivity across a range of specimen types and use under widely differing settings and conditions. However, sexual health practitioners and others who use data generated by NADT for GC should be aware of some important limitations of these tests. False-positive results caused by cross reaction with commensal Neisseria species have been observed in many assays, and have lead to unacceptably low positive-predictive values in some patient populations. Further, false-negative results can be caused by GC sequence variation, with some gonococci lacking certain NADT target sequences. This review examines the issues associated with gonococcal NADT and considers best practice for use of these assays based on current knowledge. We emphasise the need for supplementary testing and extensive assay validation, and suggest appropriate strategies for these requirements irrespective of the setting in which they are used. Further, we highlight the need to maintain culture-based testing for certain specimen sites as well as for antimicrobial resistance surveillance.

Ethical Considerations When Altering Digital Images

AbstractThe ubiquitous use of digital imaging has greatly simplified and accelerated life science research. However, the ease of manipulating digital images also presents serious ethical issues. This unit presents guidelines and cautions describing best practices for use, analysis, and presentation of digital image data.

Continuing medical education, professional development, and requirements for medical licensure: A white paper of the Conjoint Committee on Continuing Medical Education

To provide the best care to patients, a physician must commit to lifelong learning, but continuing education and evaluation systems in the United States typically require little more than records of attendance for professional association memberships, hospital staff privileges, or reregistration of a medical license. While 61 of 68 medical and osteopathic licensing boards mandate that physicians participate in certain numbers of hours of continuing medical education (CME), 17 of them require physicians to participate in legislatively mandated topics that may have little to do with the types of patients seen by the applicant physician. Required CME should evolve from counting hours of CME participation to recognizing physician achievement in knowledge, competence, and performance. State medical boards should require valid and reliable assessment of physicians' learning needs and collaborate with physician and CME communities to assure that legislatively mandated CME achieves maximal benefit for physicians and patients. To assure the discovery and use of best practices for continuing professional development and for maintenance of competence, research in CME and physician assessment should be raised as a national priority.