Evaluating the Guideline Enhancement Tool (GET): an innovative clinical training tool to enhance the use of hypertension guidelines in general practice

Background: This project aims to evaluate the effectiveness of an innovative educational intervention in enhancing clinical decision making related to the management of hypertension in general practice. The relatively low level of uptake of clinical practice guidelines by clinicians is widely recognised as a problem that impacts on clinical outcomes. This project addresses this problem with a focus on hypertension guidelines. Hypertension is the most frequently managed problem in general practice but evidence suggests that management of Hypertension in general practice is sub-optimal. Methods/design: This study will explore the effectiveness of an educational intervention named the ‘Guideline Enhancement Tool (GET)’. The intervention is designed to guide clinicians through a systematic process of considering key decision points related to the management of hypertension and provides a mechanism for clinicians to engage with the hypertension clinical guidelines. The intervention will be administered within the Australian General Practice Training program, via one of the regional training providers. Two cohorts of trainees will participate as the intervention and delayed intervention groups. This process is expected to improve clinicians’ engagement with the hypertension guidelines in particular, and enhance their clinical reasoning abilities in general. The effectiveness of the intervention in improving clinical reasoning will be evaluated using the ‘Script Concordance Test’. Discussion: The study design presented in this protocol aims to achieve two major outcomes. Firstly, the trial and evaluation of the educational intervention can lead to the development of a validated clinical education strategy that can be used in GP training to enhance the decision-making processes related to the management of hypertension. This has the potential to be adapted to other clinical conditions and training programs and can benefit clinicians in their clinical decision-making. Secondly, the study explores features that influence the effective use of clinical practice guidelines. The study thus addresses a significant problem in clinical education

The effects of changes in the order of verbal labels and numerical values on children's scores on attitude and rating scales

Research with adults has shown that variations in verbal labels and numerical scale values on rating scales can affect the responses given. However, few studies have been conducted with children. The study aimed to examine potential differences in children’s responses to Likert-type rating scales according to their anchor points and scale direction, and to see whether or not such differences were stable over time. 130 British children, aged 9 to 11, completed six sets of Likert-type rating scales, presented in four different ways varying the position of positive labels and numerical values. The results showed, both initially and 8-12 weeks later, that presenting a positive label or a high score on the left of a scale led to significantly higher mean scores than did the other variations. These findings indicate that different arrangements of rating scales can produce different results which has clear implications for the administration of scales with children

Mental health literacy: a cross-cultural approach to knowledge and beliefs about depression, schizophrenia and generalized anxiety disorder

Many families worldwide have at least one member with a behavioral or mental disorder, and yet the majority of the public fails to correctly recognize symptoms of mental illness. Previous research has found that Mental Health Literacy (MHL)—the knowledge and positive beliefs about mental disorders—tends to be higher in European and North American cultures, compared to Asian and African cultures. Nonetheless quantitative research examining the variables that explain this cultural difference remains limited. The purpose of our study was fourfold: (a) to validate measures of MHL cross-culturally, (b) to examine the MHL model quantitatively, (c) to investigate cultural differences in the MHL model, and (d) to examine collectivism as a predictor of MHL. We validated measures of MHL in European American and Indian samples. The results lend strong quantitative support to the MHL model. Recognition of symptoms of mental illness was a central variable: greater recognition predicted greater endorsement of social causes of mental illness and endorsement of professional help-seeking as well as lesser endorsement of lay help-seeking. The MHL model also showed an overwhelming cultural difference; namely, lay help-seeking beliefs played a central role in the Indian sample, and a negligible role in the European American sample. Further, collectivism was positively associated with causal beliefs of mental illness in the European American sample, and with lay help-seeking beliefs in the Indian sample. These findings demonstrate the importance of understanding cultural differences in beliefs about mental illness, particularly in relation to help-seeking beliefs

Struggling with strugglers: using data from selection tools for early identification of medical students at risk of failure.

BACKGROUND: Struggling medical students is an under-researched in medical education. It is known, however, that early identification is important for effective remediation. The aim of the study was to determine the predictive effect of medical school admission tools regarding whether a student will struggle academically. METHODS: Data comprise 700 students from the University of New South Wales undergraduate medical program. The main outcome of interest was whether these students struggled during this 6-year program; they were classified to be struggling they failed any end-of-phase examination but still graduated from the program. Discriminate Function Analysis (DFA) assessed whether their pre-admission academic achievement, Undergraduate Medicine Admission Test (UMAT) and interview scores had predictive effect regarding likelihood to struggle. RESULTS: A lower pre-admission academic achievement in the form of Australian Tertiary Admission Rank (ATAR) or Grade Point Average (GPA) were found to be the best positive predictors of whether a student was likely to struggle. Lower UMAT and poorer interview scores were found to have a comparatively much smaller predictive effect. CONCLUSION: Although medical admission tests are widely used, medical school rarely use these data for educational purposes. The results of this study suggest admission test data can predict who among the admitted students is likely to struggle in the program. Educationally, this information is invaluable. These results indicate that pre-admission academic achievement can be used to predict which students are likely to struggle in an Australian undergraduate medicine program. Further research into predicting other types of struggling students as well as remediation methods are necessary

Breadth of knowledge vs. grades: What best predicts achievement in the first year of health sciences programmes?

This study aimed to identify those features within secondary school curricula and assessment, particularly science subjects that best predict academic achievement in the first year of three different three-year undergraduate health professional programmes (nursing, pharmacy, and health sciences) at a large New Zealand university. In particular, this study compared the contribution of breadth of knowledge (number of credits acquired) versus grade level (grade point average) and explored the impact of demographic variables on achievement. The findings indicated that grades are the most important factor predicting student success in the first year of university. Although taking biology and physics at secondary school has some impact on university first year achievement, the effect is relatively minor

The Impact of the Employment Relations Act 2000 on Collective Bargaining

This study carried out by the Department of Labour in 2007/08 aims to assess whether there have been any significant changes in the coverage of collective bargaining that can be attributed to the Employment Relations Act 2000. The research draws on administrative data relating to union membership and collective bargaining coverage, as well as qualitative data from employers, employees, union representatives and other employment relations stakeholders. The research shows that collective bargaining has yet to regain pre Employment Relations Act levels. Collective bargaining remains concentrated in the public sector, with low density in the private sector. The study concludes that the effects of the Act on collective bargaining are chiefly observed in the recovery of collective bargaining in the public sector, and the continued decline (in general) in the private sector. The research offers no indications that these patterns will change

Student nurse selection and predictability of academic success : the Multiple Mini Interview project

BACKGROUND: With recent reports of public enquiries into failure to care, universities are under pressure to ensure that candidates selected for undergraduate nursing programmes demonstrate academic potential as well as characteristics and values such as compassion, empathy and integrity. The Multiple Mini Interview (MMI) was used in one university as a way of ensuring that candidates had the appropriate numeracy and literacy skills as well as a range of communication, empathy, decision-making and problem-solving skills as well as ethical insights and integrity, initiative and team-work. OBJECTIVES: To ascertain whether there is evidence of bias in MMIs (gender, age, nationality and location of secondary education) and to determine the extent to which the MMI is predictive of academic success in nursing. DESIGN: A longitudinal retrospective analysis of student demographics, MMI data and the assessment marks for years 1, 2 and 3. SETTINGS: One university in southwest London. PARTICIPANTS: One cohort of students who commenced their programme in September 2011, including students in all four fields of nursing (adult, child, mental health and learning disability). METHODS: Inferential statistics and a Bayesian Multilevel Model. RESULTS: MMI in conjunction with MMI numeracy test and MMI literacy test shows little or no bias in terms of ages, gender, nationality or location of secondary school education. Although MMI in conjunction with numeracy and literacy testing is predictive of academic success, it is only weakly predictive. CONCLUSIONS: The MMI used in conjunction with literacy and numeracy testing appears to be a successful technique for selecting candidates for nursing. However, other selection methods such as psychological profiling or testing of emotional intelligence may add to the extent to which selection methods are predictive of academic success on nursing

Appropriate management of traumatic dental injuries at the hospital emergency department provides a positive impact on patient outcomes

The objective of this case study is to highlight the importance of medical doctors’ management of acute dental trauma. Correct diagnosis and treatment techniques are essential for an optimal long-term prognosis of restored function and aesthetics for the patient. The aim of correct management of acute traumatic dental injuries (TDI) to permanent teeth is to protect patients from inaccurate diagnosis, poor treatment by clinicians and to stabilize the condition before referring to a dentist for permanent dental care. This case shows that appropriate management of acute dental injuries by the emergency doctor prevented the loss of teeth at an earlier age

Identifying barriers that affect medical doctors’ learning of dental trauma

BackgroundIt is important that medical doctors are familiar with the management of emergency dental trauma before referring a patient to a dentist. Correct diagnosis and treatment techniques are essential for a predictable and optimal long-term prognosis.AimsThe aim is to identify and categorize statements from the literature related to barriers (factors that hinder learning) on dental trauma for medical doctors.MethodsThe authors reviewed ten papers pertaining to medical doctors’ knowledge of dental trauma and identify some common barriers to learning.ResultsThe barriers identified were classified as internal (factors associated with the learner) or external (factors associated with the learning environment). Internal barriers negatively impact learners and may cause medical doctors to lose enthusiasm or interest in the subject. External barriers, on the other hand, often arise from within the university or teaching hospital and may affect medical students’ and doctors’ theoretical learning of dental trauma or hamper their clinical experience. ConclusionFrom a limited body of literature, this report has identified some common barriers that affect doctors’ learning of dental trauma. Consequently, to further investigate the relevance of these barriers and their impact on dental trauma learning, a systematic review in this area is indicated

Issues Around Researching OHS of Samoan Migrant Workers

Workers from Pacific nations constitute a substantial proportion of the labour force in NZ, particularly in Auckland, which has one of the largest concentrations of Pacific Island workers in the world. Samoans constitute the largest Pacific ethnic group in NZ, comprising 131,103 or 49% of the resident Pacific population (265,974) (Statistics NZ, 2010). However, Pacific Island workers in NZ are typically employed in low paid, precarious, hazardous work that often has little chance of advancement. There is also some evidence that Pacific Island workers are over­represented in NZ’s work­related injury and illness statistics (Allen & Clarke, 2006). While occupational health and safety (OHS) of Pacific Island migrant workers highlights a number of issues, studies often provide inadequate explanations of what exactly is occurring or fully capture the working experiences of Pacific Island migrant workers. This paper reports on the initial work undertaken as part of an international collaborative study located in Samoa and NZ, aimed at investigating the OHS experiences of Samoan migrant workers. In particular, the paper presents a multi­layered framework and a set of research principles that can be used to illuminate often inaccessible populations located in changing working and living environments. Finally, this study exemplifies the complex issues surrounding the migrant workers’ health and safety, workers’ compensation and rehabilitation