Development and evaluation of an innovative model of inter-professional education focused on asthma medication use.

BACKGROUND: Inter-professional learning has been promoted as the solution to many clinical management issues. One such issue is the correct use of asthma inhaler devices. Up to 80% of people with asthma use their inhaler device incorrectly. The implications of this are poor asthma control and quality of life. Correct inhaler technique can be taught, however these educational instructions need to be repeated if correct technique is to be maintained. It is important to maximise the opportunities to deliver this education in primary care. In light of this, it is important to explore how health care providers, in particular pharmacists and general medical practitioners, can work together in delivering inhaler technique education to patients, over time. Therefore, there is a need to develop and evaluate effective inter-professional education, which will address the need to educate patients in the correct use of their inhalers as well as equip health care professionals with skills to engage in collaborative relationships with each other. METHODS: This mixed methods study involves the development and evaluation of three modules of continuing education, Model 1, Model 2 and Model 3. A fourth group, Model 4, acting as a control.Model 1 consists of face-to-face continuing professional education on asthma inhaler technique, aimed at pharmacists, general medical practitioners and their practice nurses.Model 2 is an electronic online continuing education module based on Model 1 principles.Model 3 is also based on asthma inhaler technique education but employs a learning intervention targeting health care professional relationships and is based on sociocultural theory.This study took the form of a parallel group, repeated measure design. Following the completion of continuing professional education, health care professionals recruited people with asthma and followed them up for 6 months. During this period, inhaler device technique training was delivered and data on patient inhaler technique, clinical and humanistic outcomes were collected. Outcomes related to professional collaborative relationships were also measured. DISCUSSION: Challenges presented included the requirement of significant financial resources for development of study materials and limited availability of validated tools to measure health care professional collaboration over time.

Nurse practitioner prescribing practices: the most frequently prescribed medications.

AIMS AND OBJECTIVES: To explore which medications Australian nurse practitioners most frequently prescribe. BACKGROUND: Although nurse practitioners in Australia have prescriptive authority, little is known about which specific medications nurse practitioners are prescribing and how frequently they do so. DESIGN: Descriptive electronic survey. METHODS: A total of 209 nurse practitioners reported current prescribing practices. Medications reported were categorised according to the Australian Medicines Handbook major drug classifications and frequencies presented. RESULTS: Seventy-eight per cent of respondents reported prescribing medications as part of their Nurse Practitioner practice. In total, participants reported prescribing 234 separate medications from most Australian Medicines Handbook major drug classifications. Medications from the classification anti-infective drugs were most frequently prescribed followed by medications from analgesic, psychotropic, cardiovascular, musculoskeletal, genitourinary and gastrointestinal classifications. CONCLUSION: The majority of nurse practitioners in Australia prescribe medications in their clinical practice, although the proportion of nurse practitioners prescribing has not changed significantly in the past four years. The medications prescribed are comparable with those most frequently prescribed by all prescribers in Australia and highlight the diversity in scope of practice among nurse practitioners. RELEVANCE TO CLINICAL PRACTICE: Findings highlight the importance of Nurse Practitioner's a capacity to prescribe wide variety of medications, especially in practice areas such acute, primary and emergency care. The unique role nurse practitioners in relation to management of patients with infective processes and patients requiring pain relief is highlighted. Insight into current Nurse Practitioner prescribing trends informs future Nurse Practitioner curricular and future continuing education programmes. Findings give unique insight for future service planning, especially service providers considering introducing nurse practitioners to their service. The finding that nurse practitioners prescribing patterns are similar to other non-nurse practitioner prescribers in Australia highlights the potential for service providers to introduce new models of care that are Nurse Practitioner lead.

Sources of information used to support quality use of medicines: findings from a national survey of nurse practitioners in Australia.

PURPOSE: The purpose of this study was to investigate the sources, both print and electronic formats, which Australian nurse practitioners (NPs) currently use to obtain information regarding quality use of medicines (QUM). An additional aim was to document NPs' preferences for continuing education in relation to QUM. DATA SOURCES: A national electronic survey of Australian NPs was conducted in 2007 and again in 2010. CONCLUSIONS: Eighty percent of respondents accessed information on QUM from professional literature, which may include scholarly journal articles, reports, and independent publications. There was a decrease in the percentage of respondents who obtained information from drug industry representatives. NPs prefer to receive medicines information in an electronic form, rather than a paper-based version, and over the time period more NPs are utilizing electronic sources rather than paper. IMPLICATIONS FOR PRACTICE: These findings provide important insights into medical information products for the developers who may be able to use these results to ensure that their products meet the needs of NP clinicians. Additionally, the finding that NPs prefer to receive their continuing information related to medicines in electronic format, but also highly value conference proceedings, may help to inform future planning of NP education needs in relation to QUM.

Effects of aging on vibration detection thresholds at various body regions.

BACKGROUND: The ability to detect sinusoidal vibrations on the skin surface is dependent on the activation of two classes of receptors. The density of such receptors varies across the skin surface and is a factor in determining the sensory acuity of each skin area. However, the acuity of many sensory systems is known to deteriorate with advancing age. The aim of this study was to determine if vibrotactile sensibility of several skin surfaces deteriorated equally with advancing age. METHODS: Vibration detection thresholds for two frequencies of vibration (30 Hz and 200 Hz) were determined using a method of limits protocol, in two groups of healthy adults, one group aged 17 to 27 years and the other aged 55 to 90 years. Sinusoidal vibrations were generated by a computer and delivered to the skin surface via the probe (diameter = 2 mm) of a mechanical vibrator. Four skin sites (palmar surface of the tip of the middle finger, volar surface of the forearm, lateral aspect of the shoulder, cheek just caudal to the zygoma) were tested. RESULTS: The fingertip was the most sensitive site for vibrotactile detection at both frequencies in a substantial majority of subjects. The older group of subjects showed significantly higher detection thresholds for both frequencies at all sites, except the fingertip, when compared to young subjects. CONCLUSION: The study confirms the deterioration of vibrotactile acuity at several skin sites previously reported in the literature. However, there appears to be no significant reduction in vibrotactile detection at the fingertips in older subjects. This may reflect the high receptor density of this area, or the functional importance of vibrotactile sensibility of the fingertips or some combination of both of these factors.

Subthreshold transcranial magnetic stimulation during the long latency component of the cutaneomotor reflex.

Modulation of ongoing electromyographic (EMG) activity in the small hand muscles can be induced by electrical stimulation of the digital nerves or by stimulation of the skin of the fingers. Several groups have attempted to establish a role for the motor cortex in the generation of the facilitatory component of the cutaneomotor reflex. Our aim was to establish if the facilitatory component of the reflex could be diminished by a procedure known to inhibit the motor cortex, namely, subthreshold transcranial magnetic stimulation. During sustained small contractions of the first dorsal interosseus muscle transcranial magnetic stimuli (TMS), which were subthreshold for the generation of a motor evoked potential, were delivered via a figure-of-eight coil. Inhibition of ongoing EMG was observed in all subjects. In two separate series of trials, TMS was timed so that the resultant inhibition occurred coincident with either the short or long latency stretch reflex or with the initial or later part of the facilitatory component of the cutaneomotor reflex. The short latency stretch reflex is known to involve a largely monosynaptic loop via the spinal cord, whereas the long latency response involves a transcortical loop. The long latency response was reduced in size following subthreshold TMS, whereas the short latency response was unchanged. This provides evidence of the effectiveness of subthreshold TMS in inhibiting a transcortical reflex. When the TMS was timed so that the inhibition occurred coincident with the facilitatory component of the cutaneomotor response, neither the early nor later changes were inhibited. Thus, the pathway of the long-latency cutaneomotor reflex is not similar to the transcortical pathway of the stretch reflex. Either the response does not travel via the cortex or it involves different cortical neurones.

The history of contraction of the wrist flexors can change cortical excitability.

Voluntary contractions induce thixotropic changes in intrafusal muscle fibres and hence, by induction or removal of "slack", the background discharge and sensitivity of spindle endings to stretch is altered. This study assessed whether such changes also altered the "excitability" of the motor cortex. Eleven subjects performed a series of voluntary conditioning contractions of the wrist flexors designed to remove slack in the intrafusal fibres (contract and test at intermediate length, termed "contract-test") or to introduce slack (contract at long length and test at intermediate length, termed "contract-long"). Surface electromyographic recordings were made from one wrist flexor, flexor carpi radialis. Subjects relaxed after each contraction, and 10 s later a test stimulus was applied to elicit a tendon tap response, H-reflex, or motor-evoked potential (MEP) to transcranial magnetic stimulation in the flexor carpi radialis. Each of the three test stimuli was applied during 15 consecutive pairs of contractions ("contract-long" and "contract-test"). Three subjects repeated the protocol using transmastoid electrical stimulation as the test stimulus to evoke a cervicomedullary motor-evoked potential (CMEP). For the group of subjects, after conditioning contractions designed to induce slack there was a significant reduction in the amplitude of the tendon reflex, no significant change in the H-reflex, and a small but significant reduction in the amplitude of the MEP. In one subject the CMEP was significantly reduced, while it was unchanged in two others. In the absence of corresponding changes in the H-reflex (or CMEP), changes in the size of the response to motor cortical stimulation suggest that the level of motor cortical "excitability" changes according to naturally induced variations in the discharge of muscle spindle afferents.