Clinical indicators for common paediatric conditions: processes, provenance and products of the CareTrack Kids study

BACKGROUND:In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS:Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS:From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION:A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.Louise K. Wiles, Tamara D. Hooper, Peter D. Hibbert, Charlotte Molloy, Les White ... Helena Williams ... et al

Produtividade da cana-de-açúcar após o cultivo de leguminosas

Estudou-se o efeito do cultivo prévio de leguminosas sobre a produtividade e lucratividade da cana-de-açúcar. Foram determinados a produtividade de biomassa, o acúmulo de nutrientes das leguminosas, a ocorrência natural de fungos micorrízicos arbusculares, bem como o efeito das leguminosas sobre a população de nematoides do gênero Pratylenchus à cana-de-açúcar. O experimento foi desenvolvido em Piracicaba (SP), Brasil, em solo classificado como Argissolo Vermelho-Amarelo distrófico, utilizando-se a cultivar de cana-de-açúcar (Saccharum spp.) IAC87-3396. As avaliações dos efeitos do cultivo prévio das leguminosas foram realizadas durante cinco cortes consecutivos. Os tratamentos consistiram do cultivo prévio das leguminosas: Amendoim (Arachis hypogaea L) - cultivares IAC-Tatu e IAC-Caiapó, crotalária júncea IAC 1 (Crotalaria juncea L) e mucuna preta [Mucuna aterrima (Piper & Tracy) Holland], e um tratamento-testemunha. Adotou-se o delineamento em blocos casualizados com cinco repetições. A leguminosa mais produtiva de biomassa seca (parte aérea+raízes) foi a crotalária júncea IAC 1 (10.264 kg ha-1), seguida da mucuna preta (4.391 kg ha-1) e dos amendoins, IAC-Caiapó (3.177 kg ha-1) e IAC-Tatu (1.965 kg ha-1). O amendoim IAC-Caiapó e a mucuna preta foram as espécies mais infectadas por fungos micorrízicos. O amendoim, independente da cultivar, foi a leguminosa que mais reduziu a infestação de Pratylenchus spp. na cana-de-açúcar. Após cinco cortes da cana-de-açúcar o melhor desempenho foi notado no tratamento com cultivo prévio de crotalária júncea IAC 1, o qual promoveu incrementos de 30% e 35% na produtividade de colmos e de açúcar respectivamente e o melhor desempenho econômico

Size Doesn't Matter: Towards a More Inclusive Philosophy of Biology

notes: As the primary author, O’Malley drafted the paper, and gathered and analysed data (scientific papers and talks). Conceptual analysis was conducted by both authors.publication-status: Publishedtypes: ArticlePhilosophers of biology, along with everyone else, generally perceive life to fall into two broad categories, the microbes and macrobes, and then pay most of their attention to the latter. ‘Macrobe’ is the word we propose for larger life forms, and we use it as part of an argument for microbial equality. We suggest that taking more notice of microbes – the dominant life form on the planet, both now and throughout evolutionary history – will transform some of the philosophy of biology’s standard ideas on ontology, evolution, taxonomy and biodiversity. We set out a number of recent developments in microbiology – including biofilm formation, chemotaxis, quorum sensing and gene transfer – that highlight microbial capacities for cooperation and communication and break down conventional thinking that microbes are solely or primarily single-celled organisms. These insights also bring new perspectives to the levels of selection debate, as well as to discussions of the evolution and nature of multicellularity, and to neo-Darwinian understandings of evolutionary mechanisms. We show how these revisions lead to further complications for microbial classification and the philosophies of systematics and biodiversity. Incorporating microbial insights into the philosophy of biology will challenge many of its assumptions, but also give greater scope and depth to its investigations

Intoxicação por Senecio spp. em bovinos no Rio Grande do Sul: condições ambientais favoráveis e medidas de controle

Este trabalho teve por objetivo revisar os principais aspectos da intoxicação por Senecio spp. no Rio Grande do Sul no que se refere à patologia, patogenia e epidemiologia dessa importante causa de morte em bovinos nesse Estado. Foram abordados, também, os principais fatores climáticos e ambientais que aparentemente favorecem a emergência e o estabelecimento da planta e a ocorrência da intoxicação, que tem aumentado a sua frequência nos últimos anos no Estado, e as possíveis formas de controle da planta incluindo o manejo correto do solo e a utilização de espécies domésticas menos susceptíveis nas áreas invadidas

Assessing the appropriateness of the management of otitis media in Australia: a population-based sample survey

AIM:Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. METHODS:We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. RESULTS:We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. CONCLUSIONS:Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME.Robyn Clay‐Williams, Jacqueline H Stephens, Helena Williams, Andrew Hallahan, Chris Dalton, Peter Hibbert ... et al. on behalf of the CareTrack Kids Investigative Tea