Determinants of guideline use in primary care physical therapy: a cross-sectional survey of attitudes, knowledge, and behavior

Background Understanding of attitudes, knowledge, and behavior related to evidence-based practice (EBP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics. Design This was a cross-sectional survey. Methods A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations Data were self-reported, which may have increased the risk of social desirability bias. Conclusions Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies

Propagation of the Heaviest UH-Cosmic Ray Nuclei

Our previous studies showed that the fragmentation cross sections of gold nuclei interacting in hydrogen have large variations between the values measured at 0.9 and 10.6 GeV/n, which has very significant implications on calculations of the propagation of the heaviest UH cosmic ray nuclei, such as Pb and Pt We have now completed a series of runs at the Brookhaven AGS using beams of gold nuclei of intermediate energy. The data from these runs will allow us to establish the excitation functions for these cross sections in a wide range of targets and hence model propagation more accurately than hitherto. In addition we will be able to study the energy dependence of nuclear charge pickup, electromagnetic dissociation and fission. Beams of gold nuclei with seven energies between 4.0 and 0.9 Ge V /n were studied interacting in targets ranging in mass from hydrogen to lead. We will present data on the cross sections derived from several of these beams and discuss some of the implications

Fragmentation cross sections of relativistic ^(84)_(36)Kr and ^(109)_(47)Ag nuclei in targets from hydrogen to lead

With the addition of krypton and silver projectiles we have extended our previous studies of the fragmentation of heavy relativistic nuclei in targets ranging in mass from hydrogen to lead. These projectiles were studied at a number of discrete energies between 450 and 1500A MeV. The total and partial charge-changing cross sections were determined for each energy, target, and projectile, and the values compared with previous predictions. A new parametrization of the dependence of the total charge-changing cross sections on the target and projectile is introduced, based on nuclear charge radii derived from electron scattering. We have also parametrized the energy dependence of the total cross sections over the range of energies studied. New parameters were found for a previous representation of the partial charge-changing cross sections in hydrogen and a new parametrization has been introduced for the nonhydrogen targets. The evidence that limiting fragmentation has been attained for these relatively light projectile nuclei at Bevalac energies is shown to be inconclusive, and further measurements at higher energies will be needed to address this question

Nuclear Interaction Cross Sections for UltraHeavy Nuclei

We summarize additions to our data base of charge-changing cross sections for relativistic ultraheavy nuclei interacting in targets ranging from H to Pb. We have improved parametric fits to those cross sections as functions of energy and of projectile, target, and fragment charge. At high energies, we have determined cross sections for Au projectiles at 10.6 GeV /nucleon in targets of H, CH_2, C, Al, Cu, Sn, and Pb. Compared with cross sections at 1 GeV /n, fragment production is substantially changed, especially for the H target. These changes have important implications for calculations of interstellar propagation of ultraheavy nuclei. At lower energies, we have added Kr and Ag to our list of projectiles. Analysis of these data has led to a better understanding of the systematics of these cross sections, hence more physically meaningful parameterizations for fragmentation at high energies and for charge pickup

Fragmentation of UH Nuclei

We have measured the total charge changing cross sections as a function of energy for projectile _(36)Kr nuclei in a wide range of targets ranging from polyethylene to lead. These cross sections are energy dependent and the dependence increases as the target mass increases

Response of Scintillators to UH Nuclei

In order to evaluate the performance of plastic scintillators for the detection of Ultra-Heavy cosmic ray nuclei, as envisaged in paper OG 10.1.14P, we have conducted experiments at the LBL Bevalac in which we exposed NE-114 and acrylic scintillators to beams of 47Ag ions and its interaction fragments. As a result we have calibrated these scintillators over the charge range 31 ≤ Z ≤ 47. Our results show that a combination of Cherenkov and scintillator detectors can resolve individual charges over this charge range. The resolution obtained in scintillator was 0.24 and 0.28 cu for NE-114 and acrylic scintillator respectively. In addition the light emission is shown to be linear to a good approximation with dE/dx over this charge range

Energy Dependence of the Fragmentation of UH-Nuclei

The fragmentation of 10.6 GeV/n Au in CH_2. C, Al, Cu, Sn, and Pb targets has been studied using an array of ion chambers, multi-wire proportional counters (MWPC), and Cherenkov counters. Total charge-changing cross sections were found to be monotonically increasing with target charge over cross sections measured and derived from lower energy data. Partial charge-changing cross sections yielding charge changes less than 1O were depressed from those measured at lower energy

Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners' (GPs') advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service's National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are reviewed, including their political acceptability. It is tentatively concluded that widespread dissemination of SBI, without the implementation of alcohol control measures, might have indirect influences on levels of consumption and harm but would be unlikely on its own to result in public health benefits. However, if and when alcohol control measures were introduced, SBI would still have an important role in the battle against alcohol-related harm

Use of microbiology tests in the era of increasing AMR rates- a multicentre hospital cohort study

Background: Effective use of microbiology test results may positively influence patient outcomes and limit the use of broad-spectrum antibiotics. However, studies indicate that their potential is not fully utilized. We investigated microbiology test ordering practices and the use of test results for antibiotic decision-making in hospitals. Methods: A multicentre cohort study was conducted during five months in 2014 in Medical departments across three hospitals in Western Norway. Patients treated with antibiotics for sepsis, urinary tract infections, skin and soft tissue infections, lower respiratory tract infections or acute exacerbations of chronic obstructive pulmonary disease were included in the analysis. Primary outcome measures were degree of microbiology test ordering, compliance with microbiology testing recommendations in the national antibiotic guideline and proportion of microbiology test results used to inform antibiotic treatment. Data was obtained from electronic- and paper medical records and charts and laboratory information systems. Results: Of the 1731 patient admissions during the study period, mean compliance with microbiology testing recommendations in the antibiotic guideline was 89%, ranging from 81% in patients with acute exacerbations of chronic obstructive pulmonary disease to 95% in patients with sepsis. Substantial additional testing was performed beyond the recommendations with 298/606 (49%) of patients with lower respiratory tract infections having urine cultures and 42/194 (22%) of patients with urinary tract infections having respiratory tests. Microbiology test results from one of the hospitals showed that 18% (120/672) of patient admissions had applicable test results, but only half of them were used for therapy guidance, i.e. in total, 9% (63/672) of patient admissions had test results informing prescription of antibiotic therapy. Conclusions: This study showed that despite a large number of microbiology test orders, only a limited number of tests informed antibiotic treatment. To ensure that microbiology tests are used optimally, there is a need to review the utility of existing microbiology tests, test ordering practices and use of test results through a more targeted and overarching approach