Treatment approaches for clients with a stroke‐affected upper limb: Are we following evidence‐based practice?

Stroke rehabilitation is an area of practice that many occupational therapists encounter during their career. The literature promotes a wide range of management techniques and support devices for people who have a stroke-affected upper limb, but little is known about the validity of those that occupational therapists actually use in practice. A questionnaire was sent to occupational therapists working in Queensland and northern New South Wales facilities (n = 35), in which adults with a stroke were likely to be treated. Eighteen respondents answered questions about the management techniques and support devices used in their facility, and their perception of the benefit of these devices in the reduction of hemiplegic shoulder pain. Results are discussed with reference to evidence-based practice and indicate an urgent need for the collation and dissemination of the best current evidence available for the management techniques and support devices used in this area, as well as further research to extend this evidence.     

Occupational therapists report a low level of knowledge,skill and involvement in evidence‐based practice

This study was conducted to collect information about Australian occupational therapists’ involvement in evidence‐based practice. The study aimed to document: (i) respondents’ level of knowledge and skills; (ii) their level of participation in continuing education; and (iii) perceived barriers to evidence‐based practice. A purposive sample of 85 occupational therapists was invited to complete a questionnaire prior to attending an introductory workshop on evidence‐based practice. Sixty‐seven questionnaires were returned and analysed (78.8% response rate). Half of the respondents rated their level of knowledge and skills required for evidence‐based practice as low (conducting database searches = 50.7%; critically appraising literature = 53.0%). The majority of respondents (79.1%) reported a low level of knowledge about electronic databases. Few respondents had attended education sessions on evidence‐based practice (15.0%). The six most commonly reported barriers to adopting evidence‐based practice were lack of time, a large caseload, limited searching skills, limited appraisal skills, difficulty accessing journals and a perceived lack of evidence to support occupational therapy intervention. The majority of occupational therapists in this sample were entering the first phase of continuing professional development in relation to evidence‐based practice.     

Assessment of continuing education needs and preferences of British Columbia dietitians and nutritionists.

A survey was conducted among members of the B.C. Dietitians' and Nutritionists' Association to determine their perceived continuing education needs and preferences. Responses were received from 68.3% of the membership. The self-administered questionnaire elicited information about preferred format and timing of continuing education activities, incentives and deterrents to participation, employers' contributions to continuing education, and perceived need for further study of 78 topics categorized as nutritional care sciences, behavioural/communicative sciences and managerial sciences. Respondents indicated a preference for workshops, seminars and lectures, held outside of working hours. Topic, time and location were the major incentives/deterrents to participation in continuing education. Most respondents reported receiving paid time off work, but few reported receiving paid time off work, but few reported receiving any financial contribution towards their continuing education from their employers. Learning needs were higher for topics in the nutritional care and communication areas than for the managerial sciences topics. The questionnaire developed for this study has provided valuable information for program planners and could be readily adapted for use with other groups of dietitians/nutritionists.     

Records: One Measure of Occupational Therapy Practice in the Field of Developmental Disabilities

This study examined whether occupational therapists working with adult clients with developmental disabilities in New South Wales maintain client records and whether such records can be used for research purposes. A records audit was conducted to examine record format, nature of assessment, evidence of goals and client consultation in goal setting and whether legal requirements were met in the records. The findings demonstrate that New South Wales occupational therapists working in developmental disabilities maintain records for their adult clients; however, record formats vary, goals are notably absent and generally there is inconsistent data collection. The implications of these findings for using occupational therapists' records for evaluation and research are discussed.     

Surgeons' participation in continuing medical education: is it evidence‐based?

BacKGROUND: Interactive forms of continuing medical education (CME) are more likely to improve clinical practice than traditional, passive approaches. This study investigated CME participation and preferences among surgeons. METHOD: Questionnaire survey of surgeons in New South Wales, Australia. RESULTS: On average, respondents (n = 418, 77% response rate) committed 364 hours (interquartile range 228-512 hours) to CME per year. Surgeons working at tertiary referral teaching hospitals were twice as likely as those working in other types of hospital to report spending more than 12 hours per month on CME (OR 2.1, 95% CI: 1.4-3.1). Overall, reading accounted for 17% of CME time and attending conferences a further 12%. Clinical audit accounted for significantly less CME time (3.5%) (both P < 0.001). Conferences were considered the single most useful form of CME by 28% (95% CI: 24-33%). Over half (55%, 95% CI: 50-59%) ranked reading as 1 of the 3 most useful types of CME, whereas significantly fewer so ranked clinical audit (6%, 95% CI: 4-9%) (chi2 = 230.8, 1 d.f., P < 0.001). CONCLUSION: Australian surgeons commit a considerable amount of time to CME, but much of this time is spent in passive educational activities. Development of acceptable and effective CME programmes will benefit both surgeons and their patients.     

关于优化科技期刊青年编辑培育路径的研究——基于全国东、中、西部六省/直辖市青年编辑的调查分析

【目的】 调查我国不同地区的科技期刊青年编辑的职业现状,针对地区差异提出科技期刊青年编辑的培育路径。【方法】 对我国六省/直辖市的科技期刊青年编辑发放问卷,对青年编辑的基本情况、参加培训/继续教育情况、参加比赛情况以及对编辑工作现状和未来发展的主观感受等内容进行调查,最终共获得371份有效问卷,并对问卷结果展开统计分析。【结果】 科技期刊青年编辑大多热爱编辑工作;东、中部地区青年编辑的薪酬待遇高于西部地区(P<0.05),但青年编辑对薪酬待遇的总体满意度仍不高;西部地区青年编辑参加编辑竞赛的比例高于其他两地区(P<0.05),但整体参赛比例仍然较低;东、中部地区参加继续教育培训学习的频率高于西部地区(P<0.05),仍有部分青年编辑未参加过入职培训;青年编辑的精神压力状况不存在地区差异(P>0.05),但约60%被调查者认为有工作压力,37.20%的编辑有改行想法。【结论】 应进一步提高低收入青年编辑的待遇;鼓励参赛比例不高地区的编辑积极参加行业内的比赛;加大青年编辑继续教育力度,优化培训内容和培训方式,注重“精准化培训”“差异化培训”及入职培训的普及;关心青年编辑身心健康,切身倾听青年编辑期许。     

Occupational therapy practice with children with perceptual motor dysfunction: Findings of a literature review and survey

The aim of this study was to determine the current assessment and management practices of occupational therapists working with children with perceptual motor dysfunction. Current practices were identified through a review of literature and a survey of occupational therapists in Sydney, New South Wales, and the surrounding area. It was found that standardized and non-standardized assessments are used by the respondents, and intervention is planned according to children's individual needs. Also, a variety of management practices are used with sensory integration being the predominant approach. Traditional research methods cannot be easily applied to these individualized occupational therapy programmes; either alternative methodologies need to be developed or homogeneous subgroups of children identified for investigation.     

Profile of the rural allied health workforce in northern New South Wales and comparison with previous studies

Objective: To survey allied health professionals in one region of New South Wales. Design: A questionnaire designed to give a profile of the allied health workforce was mailed to 451 practitioners from 12 health professions between July and September 2005. Setting: The region included the upper Hunter Valley, Liverpool Plains, New England Tablelands and North-west Slopes and Plains of New South Wales. Main outcome measures: The overall response was 49.8%, although the response rates varied between disciplines. Data were collected for a wide range of dependent variables. Results: Pharmacists were the most numerous respondents (21.8%), followed by physiotherapists (17.3%), psychologists (12.4%), radiographers (11.1%) and occupational therapists (10.6%). These five professions made up 73.3% of respondents. Approximately 75% of the sample worked in Rural, Remote and Metropolitan Areas (RRMA) 3 and 4 sized towns. The female to male ratio was 3:1. The mean age was 43 years, the average time since qualification was 20 years and the mean time in the current position was 10 years. Half of the respondents said they intended leaving within 5 years. Some 65% were of rural origin. The ratio of private to public sector employment was 0.75:1, with 64.0% working full-time. Conclusions: Comparison is made between this and previous studies. The results highlight the need for further regional allied health workforce profiling and for a recruitment and retention strategy that targets new graduates of rural origin and encourages them to stay.     

Factors associated with population risk perceptions of continuing drought in Australia

Objective: To determine factors associated with risk perception of continuing drought in Australia. Design and setting: Computer Assisted Telephone Interview survey. The sample was weighted to the New South Wales population. Participants: A total of 2004 adults aged 16 years and over. Results: Overall 55.9% of the respondents thought drought was extremely or very likely to continue, 60.1% were extremely or very concerned that they or their family would be affected, and 86.3% reported that they had made some level of change to the way that they lived their lives because of the perceived risk of continuing drought. After controlling for confounding factors, the odds of perceived drought being extremely or very likely to continue, concern for self or family and making changes to behaviour because of the possibility of continuing drought were significantly higher in women than men by 43%, 59% and 86%, respectively. Compared with those who lived in highly accessible geographical areas, respondents who lived in remote or very remote geographical areas were 3.22 (adjusted odds ratios = 3.22; 95% CI, 1.69–6.14) times more likely to think that drought would continue and were 3.72 (adjusted odds ratios = 3.72; 95% CI, 1.10–12.56) times more likely to have changed the way they lived their lives because of the possibility of continuing drought. Conclusion: Over half of the New South Wales population thought drought was very or extremely likely to continue. The baseline data collected in this survey will be useful for monitoring changes over time in the population's perceptions of continuing drought.     

Experiences and perceived roles of occupational therapists working with children with special learning needs during transition to school: A pilot study

Occupational therapists provide support to children with special learning needs and their families during the child's transition from early childhood to mainstream school. Little has been documented regarding the role and experiences of occupational therapists working with children, families and teachers during transition in an Australian context. Six paediatric occupational therapists from one geographical area in New South Wales were interviewed and asked to relay their role and experiences when providing a service to children with special learning needs during their transition to school. Participants described their role to include: preparing the child for school; working with school personnel; and providing parental support. Although participants described both positive and negative experiences, among the negative experiences were: limited time to provide a service; recommendations to school personnel not being followed; school personnel not being supportive; feeling uncomfortable in the classroom; and limited involvement in planning. Participants described a role which is consistent with current school-based occupational therapy practice; however, in the participants' experience, there was a gap between the ideal service and what participants were able to provide. This included limited collaboration with teachers.     

Geographical influences upon physical activity participation: evidence of a ''coastal effect''

OBJECTIVE: To examine the association between geographical proximity to the coast and physical activity participation levels. METHOD: Using stratified random sampling, a telephone survey was carried out in 1994 with 1,000 adults in each of the 16 health service regions in New South Wales (N = 16,178). Physical activity levels were measured through self-report of the frequency and duration of walking, moderate and vigorous activities in the two weeks preceding the survey. Logistic regression modelling was carried out to examine the association between physical activity and 'coastal' location of residence, adjusting for age, sex, employment status, education level and country of birth. RESULTS: After adjusting for other demographic factors, respondents who lived in a coastal postcode were 23% less likely to be classified as sedentary, 27% more likely to report levels of activity considered adequate for health, and 38% more likely to report high (vigorous) levels of physical activity than those who lived inland. Each of these associations was significant at the 0.05 level. CONCLUSIONS: Characteristics of the physical environment in coastal postcodes are related to physical activity participation. IMPLICATIONS: Physical environments may contribute to physical activity participation. Further efforts to conceptualise and measure these environmental influences is warranted. Public health efforts to promote physical activity should consider aspects of the physical environment as part of any intervention.     

Continuing medical education and career choice among graduates of problem-based and traditional curricula

A survey was conducted among graduates of two Canadian medical schools who have been in practice for more than 9 years. The purpose of the study was to test the hypothesis that graduates of a problem-based curriculum differ from graduates of a traditional curriculum in their attitude to and participation in continuing medical education (CME) activities. Differences were noted in the rate of participation in certain CME activities (attendance at national and international conferences and meetings) between specialists and family doctors in both groups of alumni. However, the data indicate that the differences in learning-teaching methods employed in the course of the undergraduate medical curriculum do not exert a decisive influence upon the learning habits of the graduates.     

What occupational and physical therapists know about farmers’ health

Farmers are at high risk for losing their occupation because of their susceptibility for developing chronic conditions and incurring injuries. Although, occupational and physical therapists have basic education in return-to-work methods, specialty training is needed to help farmers with disabilities. The North Carolina AgrAbility Partnership, part of the U.S. Department of Agriculture’s supported AgrAbility Program, implemented an exploratory survey of North Carolina occupational and physical therapists before developing training curricula for working with farmers. State occupational and physical therapy association members were surveyed on what types of conditions they could treat, how comfortable they were in treating these conditions and making recommendations for environmental modifications, and what resources are available for farmers related to work site accommodations. Findings showed that less than one third of therapists had farm exposure or had ever treated farmers. Significant differences in identifying farmers’ typical conditions were found between therapists who had treated and those who had not treated farmers. Physical therapists were more comfortable than occupational therapists in treating farmers for repetitive stress syndromes, work-related trauma, and musculoskeletal disorders while occupational therapists were more comfortable in treating farmers for social isolation and low vision. More physical therapists also rated themselves as competent in farm environmental assessment and adaptation. On the other hand, occupational therapists were aware of more agencies that aid farmers. Finally, few therapists had education on working with farmers or had heard of AgrAbility. To create farmer-centered intervention, therapists should take continuing education courses and investigate resources for helping farmers with chronic conditions and disabilities return to their chosen occupation.     

THE NURSE PRACTITIONER PROJECT, WILCANNIA: MOVING FROM ANECDOTES TO EVIDENCE

ABSTRACT: There has been much discussion and debate in the Western world, regarding the idea that some nurses, who are practising in certain contexts, should be recognised as nurse practitioners. The nursing profession and the New South Wales Department of Health have officially been involved in the debate since 1990. They have undertaken a two stage process in ascertaining the current status of the nurse practitioner in New South Wales and Australia. A recommendation from the 2nd Stage of the process was that a number of pilot projects be funded by the Department to look at the role of the nurse practitioner in New South Wales in three contexts: Area/District Health Services, General Practice Services and Remote Area Services. The implementation of these projects constitutes Stage 3 of the Project and is being jointly funded by the New South Wales and Commonwealth Health Departments. This paper describes one of these projects that has been operational since 1 September 1994. The Nurse Practitioner Pilot Project, Wilcannia will be continuing for 12 months. This paper outlines the steps taken to analyse the work undertaken by nurses working in one of New South Wales' remote hospital emergency locations. The expected outcomes will be acknowledgment, recognition, and appropriate policy and legislative change that will validate the role of nurse practitioners working in rural/remote Australia.     

New South Wales rural general practice from a Yank's perspective

ABSTRACT: The author, a family practice specialist from Minnesota in the United States, worked as a locum in rural New South Wales for 6months. This provided him with the opportunity to reflect on the differences between the specialty of family practice in his home state of Minnesota and general practice in New South Wales; and to recognise that general practice in New South Wales is at a crossroads. This paper highlights the need for general practitioners (GPs) to work together and support each other, to provide quality care and to lobby both State and Commonwealth governments on the importance of broadly trained GP specialists in rural communities. To influence the future of their profession, GPs in New South Wales need to focus on quality of care and on educating themselves, their colleagues and the communities in which they work.     

Evoked fear and effects of appeals on attitudes to performing breast self-examination: an information-processing perspective

The effect of fear arousal on attitude toward participating in early detection activities [i.e. breast self-examination (BSE)] was studied from an information-processing perspective. It was hypothesized that fear arousal motivates respondents to more argument-based processing of fear-relevant persuasive information. Respondents first read information about breast cancer in which fear was manipulated. After measuring fear arousal, respondents read a persuasive message about performing BSE. Analyses with reported fear, but not manipulated fear, found support for the hypothesis. Respondents who reported mild fear of breast cancer based their attitude toward BSE more on the arguments provided than respondents who reported low fear of breast cancer. This finding suggests that the use of fear arousal may be an efficient tool in health education practice. However, alternative interpretations are provided, in addition to the suggestion to be careful with using fear arousal in health education messages.     

Senior school students' experiences and opinions of school–based HIV–AIDS education

Abstract: This article reports the findings from the second part of a two–stage study that used both qualitative and quantitative methods to investigate the communication context of school–based HIV–AIDS education in state secondary schools in metropolitan and rural areas of New South Wales. The quantitative data are here described, focusing on a sample of 1005 Year 12 students' responses to a self–administered questionnaire. The data suggest that the students strongly supported the general idea of school–based HIV–AIDS education, but found current offerings lacking in several respects. Students identified a strong need for information about how HIV and AIDS affect the body, for more information about sexually transmissible diseases other than HIV–AIDS, for people with HIV themselves and experts in the field to provide education sessions, and for more small–group discussions. Rural students and those students from schools located in the outer western suburbs of Sydney in particular reported that they had insufficient access to the modes of information that they most preferred. There were some important differences between the responses of female and male students and between the responses of students from different ethnic groups, suggesting that these factors also need acknowledgment when school–based programs are designed for young people. ( Aust N Z J Public Health 1997; 21: 531–8)