The impact of continuing professional development on ophthalmic dispensing of progressive addition lenses in the Asia–Pacific region

Background: Discrepancies exist in optometric education, practice and regulation across the Asia–Pacific region and the competence of optometric practitioners in adopting new lens technologies may vary widely. Over the past 10 years, a continuing professional development program, Varilux Academy Asia–Pacific (VAAP), was implemented and conducted in countries across the Asia–Pacific region to improve practitioners' understanding of optometric fitting principles, with special emphasis on progressive addition lenses (PAL). The aim was to demonstrate the effectiveness of VAAP and to compare the competence of practitioners across the Asia–Pacific region in new lens fitting technologies. Methods: From 2002 to 2008, all VAAP participants from 12 countries across Asia–Pacific were invited to complete a pre‐ and a post‐program competency test and a post‐program survey. Results: A total of 5658 practitioners were trained, and 69.9 per cent (n = 3,957) of participants completed the pre‐ and post‐program competency test; 80.9 per cent (n = 4,580) of participants completed the post‐program survey. There was a significant improvement in competency after VAAP (mean change = 19.4 per cent ± 3.3, p < 0.01). Before VAAP was conducted the mean competency score was significantly lower in developing countries compared with developed countries (mean score of developed countries = 50.6 ± 10.3, mean score of developing countries = 45.0 ± 7.8, p < 0.05). After VAAP, these differences were not significant. Confidence in fitting PAL improved by 27.1 per cent. Most participants (91.6 per cent) intended to fit more PAL and 96.8 per cent of participants rated the program as excellent or good. Conclusion: Our findings highlight the need for further continuing education of practitioners across the Asia–Pacific region. The results of the training course indicate that, across Asia–Pacific, continuing education courses in ophthalmic optics and dispensing encompassing modern lens design and best practice fitting principles are warranted.     

Detection of group C rotavirus in children with acute gastroenteritis in Blantyre, Malawi.

Among 606 children who were treated for acute gastroenteritis at the Queen Elizabeth Central Hospital in Blantyre, Malawi, Group C rotavirus (Gp C RV) was detected by enzyme-linked immunosorbent assay in fecal specimens from 16 (3.9%) of 408 inpatients and in 4 (2.0%) of 198 outpatients. Thirteen (65%) children excreting Gp C RV were coinfected with Group A rotavirus.     

Non-compliance and professional power

The non-compliance of patients with prescribed treatments is considered as a barrier to effective health care. Non-compliance has implications for the health of patients, effective use of resources and assessments of the clinical efficacy of treatments. Research into non-compliance has increased over the last 30 years. This seems to indicate that it is seen as an important area of concern for all health care professionals. Definitions of non-compliance are problematic, as are methods of assessment of its nature and frequency. Many factors which may account for non-compliance have been proposed, as well as methods to improve compliance. Research into these factors however, mainly based on a positivist epistemology, has failed to provide any conclusive answers to the problem. Sound clinical reasons are suggested as the basis for the increase in interest in non-compliance. It is contended, however, that it is not only these reasons that account for the identification of non-compliance as a problem. Non-compliant behaviour is seen as problematic, because it contravenes professional beliefs, norms and expectations regarding the ‘proper’ roles of patients and professionals. These have formed the basis of an ideology that views patients as passive recipients of health care. It has led to an inherent tendency to ‘blame’ the patient and view non-compliance as irrational and deviant. The professional view of non-compliance as irrational, is exemplified in the case of individuals with mental illness, where there are inherent assumptions that non-compliance can be seen primarily as a symptom of illness. This denies the legitimacy of patient choice, and has led to attempts to control compliance via suggested legislative measures. Serious moral and ethical problems arise from such measures, and can be seen as the ultimate legitimization of an ideology of non-compliance. The maintenance of professional power and control is suggested as central to the debates surrounding non-compliance. The ideological assumptions underpinning the concept of non-compliance need questioning, and a re-conceptualization of the roles of patients and professionals is required. This must involve a view of patients as active participators in their own health care. Research based on an interpretative epistemology, aimed at understanding individual action, rather than control, would seem a more appropriate model to pursue.     

Participation in continuing professional education in nursing: findings of an interview study

The evidence suggests that enrolled nurses and those working part-time and on night duty consistently attend less continuing professional education than their more senior, full-time and day duty colleagues This was substantiated in the findings of this study which also highlighted the paucity of opportunities for continuing education among unqualified practitioners In the light of recent developments within the health services, this inequitable provision of continuing professional education to all nursing practitioners will need to be addressed and resolved Continuing professional education provided on an arbitrary and random basis will not afford maximum positive outcomes for clients, the service and practitioners and has the potential to increase the levels of frustration among disadvantaged groups of nursing staff     

Project 2000 students' perceptions of their training

This paper reports on the findings of a study conducted into the perceptions of final year Project 2000 pre-registration students towards their pre-registration education programme The aim of the research was to discover how students perceive their training in terms of value, relevance, intellectual potency, teaching methods and organization Data were collected using the Hoste scale which has been developed for the evaluation of educational courses A convenience sample of students (n = 131) within one college of nursing were invited to participate Findings include a particularly high level of satisfaction with Project 2000 in terms of value, breadth and relevance Organization and liveliness of the course were perceived much less satisfactorily There was a trend for a statistically significant difference between the mean scores of the theoretical and practical components of the course The findings are discussed with particular reference to the perceptions of theory and practice within the educational programme     

Measuring care: the case of district nursing

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty-three study participants were interviewed, eliciting opinion on whether care is more than just a hands-on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care.     

Evaluating the efficacy of reflective practice within the context of clinical supervision

This paper explores the efficacy of reflective practice within the context of clinical supervision. It examines some potential limitations that reflective practice has within the context of clinical supervision drawing upon the literature and the early stages of the author's empirical work. It concludes that whilst there is considerable congruence in the use of reflective practice within clinical supervision sessions, there are potential disadvantages in making the assumption that reflective practice should be an integral part of all forms of clinical supervision.     

Importance of information following myocardial infarction: a study of the self-perceived information needs of patients and their spouse/partner compared with the perceptions of nursing staff

A non-experimental research design using questionnaires, was undertaken to find out what information out of that commonly given following myocardial infarction (MI), patients and their spouse/partners rate as being most and least important. These results were then compared with the results obtained from nurse subjects, who were given the same instrument to complete. Eighteen subjects were recruited for each of the three subject groups. Results indicated that some congruency existed between the three groups in terms of what they perceived as the most and least important categories of information. Yet, the scores for some informational categories included on the instrument, were significantly different between the nursing and two other groups ( P <0·01). However, in relation to the patient and spouse/partner groups, only a weak difference ( P <0·10) was found for the category 'dietary information'. These findings and others are discussed, and recommendations are made for improving the information giving process post-MI.     

Quality of life as quality of being: an alternative to the subject–object dichotomy

The opening section of this paper is concerned with certain questions concerning the concept ‘quality of life’ Is it possible for one person to make judgements about the quality of life of another? If it is possible, then is it morally acceptable? Given that quality of life is a concept and therefore not amenable to direct observation, which visible phenomena will be chosen as its indicators, and how can their choice be justified? Do the components of a life of quality vary from person to person, or can features be identified which are common to all? Next, it is argued that instruments which have been developed to measure quality of life give clues to the ontological beliefs of their authors, those which address fragments of the human experience, or accept the artificial limits of the subjective/objective dichotomy, are expressive of a fractured and reductionist view of what it means to be a human being Finally, it is suggested that the adoption of insights drawn from Heidegger's work would enable us to develop a rather more unified view of quality of life as quality of being, and that this theoretical principle might constitute a common link between nurses of varying professional backgrounds