Perinatal/neonatal palliative care: Effecting improved knowledge and multi-professional practice of midwifery and children's nursing students through an inter-professional education initiative.

This paper presents a study that examines the potential value of a new and innovative inter-professional education (IPE) experience for final year midwifery and children's nursing students focused on improving awareness of end-of-life care for infants in conjunction with the support of their families. The study uses an action research approach to examine midwifery and children's nursing student experiences of an IPE initiative in developing knowledge regarding perinatal/neonatal palliative care. The setting is a Higher Education Institute in the South of England that included final year midwifery students (n = 39) and children's nursing students (n = 34) taking part in the study. Qualitative and quantitative data indicated that the IPE intervention had proven worth in developing knowledge and confidence in the students as both student groupings felt they lacked knowledge and confidence about perinatal/neonatal palliative care before attending the study day. Students felt that learning with, from and about the other profession represented was important in generating their knowledge. Educators should explore innovative ways to enable the further development of the fledgling speciality of perinatal/neonatal palliative care through education on an interprofessional platform.

Australian midwives' experiences of implementing practice change.

OBJECTIVE: The introduction of the best available evidence into health care practice is a complicated and uncertain process. Attempts to translate even highly reliable evidence into care provision are known to flounder. The objective of this study was to investigate midwives' experiences of leading practice change. DESIGN: This study was conducted using Glaserian Grounded Theory methodology. SETTING: Australian midwifery practice contexts provided the setting for this study. PARTICIPANTS: Midwives who had led practice change initiatives. FINDINGS: Sixteen Australian midwife change leaders participated in this study. Each had sought to implement a workplace practice change. The core problem experienced by the participants was labelled 'So many barriers on so many levels'. KEY CONCLUSIONS: Although some participants were encouraged, supported and enabled to enact change to some degree, even when the change was initiated by the practice site, all participants experienced a number of obstacles at many levels in their implementation efforts. For most, this meant that their endeavours to move the best available evidence into practice took many years or did not progress at all. IMPLICATIONS FOR PRACTICE: The findings of this study will be of interest to midwives, midwifery leaders and midwifery educators. Understanding the factors in midwifery care environments that support or limit the uptake of best evidence into practice will help to inform and develop midwifery context-specific mechanisms to expedite sustained practice innovation.

Evaluating Integrative Cancer Clinics With the Claim Assessment Profile: An Example With the InspireHealth Clinic.

BACKGROUND: The evaluation of freestanding integrative cancer clinical programs is challenging and is rarely done. We have developed an approach called the Claim Assessment Profile (CAP) to identify whether evaluation of a practice is justified, feasible, and likely to provide useful information. OBJECTIVES: A CAP was performed in order to (1) clarify the healing claims at InspireHealth, an integrative oncology treatment program, by defining the most important impacts on its clients; (2) gather information about current research capacity at the clinic; and (3) create a program theory and path model for use in prospective research. STUDY DESIGN/METHODS: This case study design incorporates methods from a variety of rapid assessment approaches. Procedures included site visits to observe the program, structured qualitative interviews with 26 providers and staff, surveys to capture descriptive data about the program, and observational data on program implementation. RESULTS: The InspireHealth program is a well-established, multi-site, thriving integrative oncology clinical practice that focuses on patient support, motivation, and health behavior engagement. It delivers patient-centered care via a standardized treatment protocol. There arehigh levels of research interest from staff and resources by which to conduct research. CONCLUSIONS: This analysis provides the primary descriptive and claims clarification of an integrative oncology treatment program, an evaluation readiness report, a detailed logic model explicating program theory, and a clinical outcomes path model for conducting prospective research. Prospective evaluation of this program would be feasible and valuable, adding to our knowledge base of integrative cancer therapies.

Perfil socioeconômico profissional dos naturólogos do Brasil / Professional social and economic profile of Brazilian naturologists

Objetivo: A pesquisa objetivou descrever o perfil sócio econômico profissional dos naturólogos do Brasil. Materiais e método: Tratou-se de um estudo com abrangência nacional, classificado como pesquisa descritiva, de natureza quantitativa e de levantamento. Para a coleta de dados foi utilizado um questionário desenvolvido pelos autores. Os sujeitos da pesquisa foram 386 bacharéis em naturologia formados por instituições brasileiras até o ano de 2014 e a coleta de dados realizada entre fevereiro a maio de 2015. Resultados: Segundo os dados obtidos, observa-se que atualmente a Naturologia é uma profissão de predominância feminina (82,5%), cuja idade variou entre 21 e 64 anos, com média de 31 anos. A prevalência dos profissionais concentra-se no estado de São Paulo (45,6%), seguido por Santa Catarina (30,5%). Dentre os respondentes, a maioria (60,6%) atua com a Naturologia, predominando os que atuam no setor privado (78,9%), sendo as práticas mais utilizadas a aromaterapia (85,3%), a terapia floral (77,4%) e a massoterapia (76,1%). Considerações finais: A inserção de naturólogos dentro do Sistema Único de Saúde ainda é baixa, necessitando de maior estimulação para que a atuação deste profissional não corra o risco de se restringir a uma determinada classe social.(AU)

Objective: This work had as objective describing the social and economic profile of professional naturologists from Brasil. Materials and Method: It was a nation-wid study, classifiel as as descritive study, of quantitative and investigative natuure. For data acquiring was developed a questionnaire by the authors. Subjects were 386 professionals of Naturology graduated from brazilian colleges up to 2014 and was conducted between february and april of 2015. Results: According to data obtained, to this date Naturology is a profession majorly selected by women (82,5%), aging from 21 to 64 years, being 31 years the meddium age. Most professional are residents in São Paulo (41,6%), followed by Santa Catarina (30,5%). Amongst the subjects, the majority (60,6%) Works actually in the field of Naturology, mostly in the privat pratices (78,9%), beign aromatherapy (85,3%), floral therapy (77,4%) and masotherpy (76,1%) the most common pratices. Final Considerations: The insrtion of natutrologists in the public healthy system system is still low-profile, needing more stimuli so that the naturologists´ fiels of work does not become restriceted to a determinated social class.(AU)

Rúbricas para la evaluación de la práctica profesional, el internado y el examen de titulación para la carrera de cinesiología según competencias generales y específicas, perfil de egreso y proyecto educativo institucional de la Universidad de Antofagasta, Chile / Heading for evaluation of professional practice, internship and review of qualifications for race as Kinesiology general and specific skills, graduate profile institutional and educational project of the University of Antofagasta, Chile

Objetivo: Se describe el procedimiento utilizado para diseñar dos rúbricas, una para la evaluación de las actividades prácticas del último año de la carrera de cinesiología (práctica profesional y el internado) y otra para la evaluación del examen final de titulación. Sujetos y métodos: Metodológicamente, las rúbricas se diseñaron a partir de fundamentos bibliográficos, de la opinión de expertos en currículo, de cinesiólogos clínicos docentes guías de estudiantes en práctica profesional e internado, y de la revisión de los instrumentos de evaluación preexistentes en la unidad académica. Resultados: El resultado del estudio es la generación de dos instrumentos de evaluación que consideran el proyecto educativo institucional de la Universidad de Antofagasta, las competencias generales de la institución y específicas de la carrera, el perfil de egreso, el plan de estudios, los descriptores de práctica profesional e internado, y la reglamentación vigente, además de ajustarse en su forma y fondo a la información aportada por expertos consultantes. Conclusiones: Las rúbricas de evaluación propuestas en este estudio aportan a la evaluación de las etapas finales de la formación, en las que el estudiante está muy cerca de lograr su perfil de egreso, y chequean razonablemente los niveles de desempeño para asegurar que el egresado disponga de las competencias de la carrera y de la universidad que los formó

Aim: The study describes the procedure used to design two headings, one for evaluation of operational activities of the last year of the career of Kinesiology (professional practice and the boarding school) and another, for evaluation of the final degree exam. Subjects and methods: Methodologically the headings were designed from bibliographic fundamentals, the opinion of experts in curriculum, clinical physiotherapists teaching guides students in professional practice and internship and the review of evaluation tools pre existing in the academic unit. Results: The result of the study is the generation of two assessment instruments that consider the project educational institutional of the University of Antofagasta, General of the institution and competences specific race, the profile of graduation, syllabus, descriptors of professional practice and internship and regulations, in addition to conform in their form and substance to the information provided by expert consultants. Conclusions: The headings of evaluation proposed in this study contribute to the evaluation of the final stages of training, in which student is very close to your profile, and reasonably checked the levels of performance to ensure that graduates have the competencies career and the University that shaped them

Role of the pharmacist in parenteral nutrition therapy: challenges and opportunities to implement pharmaceutical care in Kuwait

Background: Pharmacists can provide beneficial pharmaceutical care services to patients receiving Parenteral Nutrition (PN) therapy by working within Nutrition Support Teams (NSTs). Objective: This study was designed to explore pharmacists’ role in PN therapy in hospitals of Kuwait, sources of PN-related information, opinions on NSTs, perceptions about the barriers to pharmaceutical care implementation and views on how to enhance their practices. Methods: Data were collected via face-to-face semi-structured interviews with the senior Total Parenteral Nutrition (TPN) pharmacists at all the hospitals which provide TPN preparation services (six governmental hospitals and one private hospital) in Kuwait. Descriptive statistics were used to describe pharmacists’ demographic details and practice site characteristics. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: The pharmacists mainly performed technical tasks such as TPN compounding with minimal role in providing direct patient care. They used multiple different sources of TPN-related information to guide their practice. They reported positive and negative experiences with physicians depending on their practice environment. None of the hospitals had a functional NST. However, pharmacists expressed preference to work within NSTs due to the potential benefits of enhanced communication and knowledge exchange among practitioners and to improve service. Pharmacists perceived several barriers to providing pharmaceutical care including lack of reliable sources of TPN-related information, lack of a standard operating procedure for TPN across hospitals, insufficient staff, time constraints and poor communication between TPN pharmacists. To overcome these barriers, they recommended fostering pharmacists’ education on TPN, establishing national standards for TPN practices, provision of pharmacy staff, development of NSTs, enhancing TPN pharmacists’ communication and conducting TPN-research research. Conclusion: TPN pharmacists in Kuwait are confined to performing TPN manufacturing processes. There are promising avenues for future development of their role in patient care. This can be achieved by overcoming the barriers to pharmaceutical care practice and providing pharmacists with educational opportunities to equip them with the clinical competencies needed to practise as nutrition support pharmacists with patient-centred roles (AU)

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Village midwives and their changing roles in Brunei Darussalam: A qualitative study.

BACKGROUND: There are lay midwives worldwide, interchangeably and universally called traditional birth attendants or traditional midwives by organisations such as the World Health Organization and the International Confederation of Midwives. AIM: This study aimed to explore the history of lay midwives (village midwives) in Brunei, describe the evolution from their previous to current roles and determine if they are still needed by women today. METHODS: This qualitative, descriptive study included in-depth, semi-structured interviews with eight women who had received care from village midwives. Data analysis was based on the principles underpinning thematic analysis and used a constant comparative method. FINDINGS: Village midwives have been popular in Brunei since the 1900s, with their major role being to assist women with childbirth. However, since the 1960s, their roles and practices have changed to focus on pre-conception, antenatal, postnatal and women's general healthcare. Traditional practices were influenced by religion, culture and the social context of and within Brunei. DISCUSSION: The major changes in village midwives' roles and practices resulted from the enforcement of the Brunei Midwives' Act in 1956. Village midwives' traditional practices became juxtaposed with modern complementary alternative medicine practices, and they began charging a fee for their services. CONCLUSION: Brunei village midwives are trusted by women, and their practices may still be widely accepted in Brunei. Further research is necessary to confirm their existence, determine the detailed scope and appropriateness of their practices and verify the feasibility of them working together with healthcare professionals.

Dentistry at the crossroads.

The dental practice pattern is shifting from small dental office to large corporate dental groups. This article analyzes the powers behind this change, and discusses the choices dental practitioners are facing and the reasons why many may choose to work in a corporate practice setting. Dental associations and specialty groups need to reaffirm their mission to provide quality oral health care. Dental treatment should not be viewed as a commodity used to measure corporate profitability.

The role of community pharmacists in screening and subsequent management of chronic respiratory diseases: a systematic review / Papel de los farmacéuticos comunitarios en rastreo y posterior manejo de enfermedades crónicas respiratorias: revisión sistemática

Objective: The purpose of this review was to evaluate the role of community pharmacists in provision of screening with/without subsequent management of undiagnosed chronic obstructive pulmonary disease (COPD) and uncontrolled asthma. Methods: An extensive literature search using four databases (ie. Medline, PubMed, International Pharmaceutical Abstracts (IPA) and Scopus) with search terms pharmacy, screening, asthma or COPD was conducted. Searches were limited to the years 2003-2013, those in English and those reporting research with humans. Data retrieval, analysis and result presentation employed a scoping review method. Results: Seventeen articles met the inclusion/exclusion criteria, of which fifteen studies were based on people with asthma and two were based on people with COPD. Only seven asthma studies and one COPD study involved screening followed by subsequent management. More than half of the people screened were found to be poorly controlled and up to 62% of people were identified at high risk for COPD by community pharmacists. The studies varied in the method and type of asthma control assessment/screening, the type of intervention provided and the outcomes measured. The limitations of the reviewed studies included varying definitions of asthma control, different study methodologies, and the lack of long-term follow-up. While many different methods were used for risk assessment and management services by the pharmacists, all the studies demonstrated that community pharmacists were capable of identifying people with poorly controlled asthma and undiagnosed COPD and providing them with suitable interventions. Conclusion: The literature review identified that community pharmacists can play an effective role in screening of people with poorly controlled asthma and undiagnosed COPD along with delivering management interventions. However, there is very little literature available on screening for these chronic respiratory conditions. Future research should focus on development of patient care delivery model incorporating a screening protocol followed by targeted management interventions delivered by the community pharmacist (AU)

Objetivo: El propósito de esta revisión fue evaluar el papel de los farmacéuticos comunitarios en la provisión de rastreos con/sin posterior manejo de enfermedad pulmonar obstructiva crónica (EPOC) no diagnosticada y asma no controlada. Métodos: Se realizó una extensiva búsqueda bibliográfica usando cuatro bases de datos (ie. Medline, PubMed, International Pharmaceutical Abstracts (IPA) and Scopus) con términos de búsqueda farmacia, rastreo, asma o EPOC. Las búsquedas se limitaron a los años 2003-2013, a las escritas en inglés, y a las que comunicaban investigación en seres humanos. La recuperación, y análisis de datos y la presentación de resultados se realizaron mediante un método de determinación del alcance. Resultados: 17 artículos cumplieron los criterios de inclusión/exclusión, de los cuales, 15 eran de personas con asma y 2 con EPOC. Sólo 7 de los estudios de asma y uno de los de EPOC envolvían rastreos seguidos del consiguiente manejo. Más de la mitad de las personas rastreadas estaban pobremente controladas y hasta un 62% de las personas fueron identificadas como en alto riesgo de EPOC por los farmacéuticos. Los estudios variaban en el método y tipo de evaluación/rastreo del control de asma, el tipo de intervención realizada y los resultados medidos. Las limitaciones de los estudios revisados incluyeron la diversidad de definiciones de control de asma, las diferentes metodologías de estudio, y la falta de seguimiento a largo plazo. Aunque se utilizaron muchos métodos diferentes de evaluación del riesgo y de servicios de manejo de la enfermedad por los farmacéuticos, todos los estudios demostraron que los farmacéuticos comunitarios eran capaces de identificar personas con asma pobremente controlada y EPOC no diagnosticada y de realizar con ellos las intervenciones apropiadas. Conclusión: La revisión de la literatura identifico que los farmacéuticos comunitarios pueden jugar un papel efectivo en el rastreo de personas con asma pobremente controlado y EPOC no diagnosticada así como realizarles las intervenciones de manejo. Sin embargo, hay muy poca literatura disponible sobre el rastreo de estas enfermedades respiratorias crónicas. La investigación futura debería centrarse en el desarrollo de modelos de atención a pacientes que incorporen un protocolo de rastreo seguido de intervenciones de manejo de la enfermedad proporcionadas por los farmacéuticos comunitarios (AU)

La filosofía de Patricia Benner y la práctica clínica / Review of Patricia Benner’s philosophy in clinical practice

Con el objetivo de explorar la aplicación de la filosofía de Patricia Benner en el ámbito clínico se realizó una búsqueda de la literatura científica inicialmente con vigencia mínima de 5 años, encontrándose durante este proceso escasa literatura, por lo cual surgió la necesidad de ampliar el período e incluir desde 1984 hasta el 2010. Se encontraron 90 artículos, de los cuales se seleccionaron 52. En el desarrollo del presente artículo se establecen las competencias que requiere el profesional de enfermería durante la práctica clínica, partiendo de los planteamientos de Patricia Benner quien modifica los niveles de adquisición de habilidades de los hermanos Dreyfus con el fin de aplicarlos a enfermeria en el área clínica; adicionalmente se relacionan con los patrones del conocimiento descritos por Barbara Carper y el perfil que debe tener la enfermera(o) que cuida pacientes que por su edad o condición clinica se encuentran en las areas de urgencias, unidad de cuidados intensivos y pediatria (AU)

In order to explore how to apply Patricia Benner’s philosophy on the clinical field, a research was done about the scientific literature, initially with a five year range. However, little material was found on that field and for this reason it was decided to increase the range to a period ranging from 1984 to 2010. 90 articles were found and 52 of them were selected. This article establishes the skills that a professional nurse needs during the clinical practice, based on Patricia Benner´s approach that modified the Dreyfus brothers’ skill acquisition levels in order to apply them to nursery in the clinical area; additionally, it is related to the knowledge patterns described by Barbara Carper and the profile that a nurse must have in order to take care of patients who, either due to their age or clinical condition, are located on the ICU or pediatrics (AU)

Evaluation of the supply of antifungal medication for the treatment of vaginal thrush in the community pharmacy setting: a randomized controlled trial / Evaluación del suministro de medicación antifúngica para el tratamiento de la candidiasis vaginal en la farmacia comunitaria: ensayo controlado aleatorizado

Background: The Pharmaceutical Society of Australia have developed “guidance” for the supply of several medicines available without prescription to the general public. Limited research has been published assessing the effect of these guidelines on the provision of medication within the practice of pharmacy. Objectives: To assess appropriate supply of nonprescription antifungal medications for the treatment of vaginal thrush in community pharmacies, with and without a guideline. A secondary aim was to describe the assessment and counseling provided to patients when requesting this medication. Methods: A randomized controlled trial was undertaken whereby two simulated patients conducted visits to 100 randomly selected community pharmacies in a metropolitan region. A product-based request for fluconazole (an oral antifungal that has a guideline was compared to a product-based request for clotrimazole (a topical antifungal without a guideline). The same patient details were used for both requests. Outcome measures of the visits were the appropriateness of supply and referral to a medical practitioner. Results: Overall 16% (n=16) of visits resulted in an appropriate outcome; 10% (n=5) of fluconozaole requests compared with 22% (n=11) of clotrimazole requests (chi-square=2.68, p=0.10). There was a difference in the type of assessment performed by pharmacy staff between visits for fluconazole and clotrimazole. A request for clotrimazole resulted in a significant increase in frequency in regards to assessment of the reason for the request (chisquare= 8.57, p=0.003), symptom location (chisquare= 8.27, p=0.004), and prior history (chisquare= 5.09, p=0.02). Conclusions: Overall practice was poor, with the majority of pharmacies inappropriately supplying antifungal medication. New strategies are required to improve current practice of community pharmacies for provision of non-prescription antifungals in the treatment of vaginal thrush (AU)

Antecedentes: La Sociedad Farmacéutica de Australia ha desarrollado una “guía” para el suministro de varios medicamentos sin prescripción al público general. Se ha publicado poca investigación evaluando el efecto de estas guías sobre la provisión de medicación en la práctica de la farmacia. Objetivos: Evaluar el suministro apropiado de antifúngicos sin receta para el tratamiento de candidiasis vaginal en farmacias comunitarias, con y sin guía. Un objetivo secundario fue describir la evaluación y el consejo proporcionado a los pacientes cuando solicitaban esta medicación. Métodos: Se realizó un ensayo controlado aleatorizado donde dos pacientes simulados condujeron visitas a 100 farmacias comunitarias aleatoriamente seleccionadas en una región metropolitana. Se comparó una solicitud de un producto con fluconazol (antifúngico oral que tiene guía) con una solicitud de un producto con clotrimazol (un antifúngico tópico sin guía). Los mismos datos de los pacientes fueron usados en ambas solicitudes. Las medidas de resultados en las visitas fueron la adecuación del suministro y la remisión al médico. Resultados: Un total de un 16% (n=16) de las visitas produjeron resultados apropiados; 10% (n=5) de fluconazol comparadas con el 22% (n=11) de clotrimazol (chi-square= 2,68, p=0,10). Hubo una diferencia significativa en el tipo de evaluación realizada por el personal de la farmacia entre las visitas del fluconazol y del clotrimazol. La solicitud de clotrimazol produjo un aumento significativo en la frecuencia de la evaluación de la causa de la solicitud (chi-square = 8,57, p=0,003), localización de los síntomas (chi-square= 8,27, p=0,004), e historia previa (chi-square = 5,09, p=0,02). Conclusiones: En general la práctica fue pobre, con la mayoría de las farmacias suministrando inadecuadamente la medicación antifúngica. Se requieren nuevas estrategias para mejorar la práctica actual de las farmacias comunitarias en el suministro de antifúngicos sin receta para la candidiasis vaginal (AU)

Efficient and effective models for integrating advanced practice professionals into oncology practice.

Advanced practice professionals (APP), primarily nurse practitioners and physician assistants, are increasingly being integrated into oncology practices. The reasons are numerous, and models of care options are numerous as well. Models of care have developed without much forethought and are often the result of the relative interests of the physician, the APP, and the mutual "comfort" of practice style. The increasing complexity of oncology care, the pressures of the health care crisis and health care reform mean that it is necessary that we examine models of collaborative care in terms of both quality of care and productivity.

Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity--the behavior change ball.

BACKGROUND: Childhood obesity is a 'wicked' public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers. DISCUSSION: We propose the 'Behavior Change Ball' as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the 'Behavior Change Wheel' by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system's resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity. SUMMARY: Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by incorporating multiple theoretical perspectives, specifying a set of organizational behaviors and linking the analysis of these behaviors to interventions and policies. We would encourage examination by others of our framework as a tool to explain and guide the development of integrated policies for the prevention of wicked public health problems.

The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework.

BACKGROUND: The case has been made for more and better theory-informed process evaluations within trials in an effort to facilitate insightful understandings of how interventions work. In this paper, we provide an explanation of implementation processes from one of the first national implementation research randomized controlled trials with embedded process evaluation conducted within acute care, and a proposed extension to the Promoting Action on Research Implementation in Health Services (PARIHS) framework. METHODS: The PARIHS framework was prospectively applied to guide decisions about intervention design, data collection, and analysis processes in a trial focussed on reducing peri-operative fasting times. In order to capture a holistic picture of implementation processes, the same data were collected across 19 participating hospitals irrespective of allocation to intervention. This paper reports on findings from data collected from a purposive sample of 151 staff and patients pre- and post-intervention. Data were analysed using content analysis within, and then across data sets. RESULTS: A robust and uncontested evidence base was a necessary, but not sufficient condition for practice change, in that individual staff and patient responses such as caution influenced decision making. The implementation context was challenging, in which individuals and teams were bounded by professional issues, communication challenges, power and a lack of clarity for the authority and responsibility for practice change. Progress was made in sites where processes were aligned with existing initiatives. Additionally, facilitators reported engaging in many intervention implementation activities, some of which result in practice changes, but not significant improvements to outcomes. CONCLUSIONS: This study provided an opportunity for reflection on the comprehensiveness of the PARIHS framework. Consistent with the underlying tenant of PARIHS, a multi-faceted and dynamic story of implementation was evident. However, the prominent role that individuals played as part of the interaction between evidence and context is not currently explicit within the framework. We propose that successful implementation of evidence into practice is a planned facilitated process involving an interplay between individuals, evidence, and context to promote evidence-informed practice. This proposal will enhance the potential of the PARIHS framework for explanation, and ensure theoretical development both informs and responds to the evidence base for implementation.

'Just waiting to be hauled over the coals': home birth midwifery in Ireland.

OBJECTIVE: to describe the context of Irish home birth midwives' practise experience. DESIGN: ethnography derived from participant observation, unstructured interview and documentary analysis. SETTING: women and midwives' homes and meeting places in Ireland. PARTICIPANTS: 21 self-employed community midwives. MEASUREMENTS AND FINDINGS: choice of place of birth is extremely limited in Ireland. Structural and professional supports for home birth and midwifery are lacking. Home birth midwives highly value midwifery professionalism but are professionally isolated. They promote women's birthing autonomy and choice of place of birth. However, they experience and anticipate negative, even punitive, responses from their own and other professions. This ethnography describes a particularly volatile period in Irish home birth midwifery practice. KEY CONCLUSIONS: Irish home birth midwives are professionally isolated which, given wider cultural antagonism to home birth, perfuses their practice with an element of defensiveness. Strong midwifery association is a key pillar of professionalism globally. In Ireland, the lack of a strong professional body undermines autonomous midwifery practice in all settings but particularly in the home. The midwifery philosophy of 'being with woman' appears to run contrary to professionalising discourses where the professional 'knows best'. Contemporary cultural expectations of professionalism such as clinical indemnification and risk averse practice protocols, bring challenges to autonomous midwifery practice. IMPLICATIONS FOR PRACTICE: place and context of birth effects not only the woman's birth experience but the midwife's professional autonomy. Without supports for autonomous midwifery, autonomous birthing is under threat. Place of birth effects birth experience and birth quality, not least because it is that context which also influences, for good or ill, midwifery autonomy.

Professional issues related to obstacles to midwifery practice in the Americas: a pilot survey.

BACKGROUND/OBJECTIVES: the WHO (2011) estimates that 350,000 newly trained midwives are needed internationally to meet Goal 5-- Improve Maternal Health--of the 8 Millennium Development Goals established by the United Nations in 2000. Recognizing the challenges in accomplishing this goal, it is also imperative to retain trained midwives in the profession. Little to date has been investigated regarding the factors that lead to experienced midwives leaving the profession prematurely, particularly in low resource countries. DESIGN: in an effort to initiate identification of barriers that limit midwives' ability to continue in practice, a pilot study was conducted with a convenience sample of 58 midwife attendees, representing 12 countries, at the International Confederation of Midwives - Americas Triennial Regional Meeting in 2010. A survey was distributed to midwife respondents to explore potential influences on work retention, including: encounters of adverse outcomes in practice; empowerment to make change in the work setting; and migration. FINDINGS: sixty per cent of respondents reported encountering a maternal or newborn death or injury, and 10% had considered leaving the profession. Over 50% of the midwives listed three potential results that could occur after experiencing an adverse outcome in practice. These included: (a) an investigation by a governmental agency; (b) complaints about the midwife via available media; and (c) involvement in a lawsuit. The consequence most frequently cited for not enacting evidence-based changes in the workplace was resistance from obstetrical colleagues. CONCLUSIONS: while there are limitations to gathering data from attendees at a professional meeting, this is the first known international survey of midwives regarding factors that may contribute to their leaving the profession at a time when there is an increasing global awareness of the need for a skilled birth attendant at every birth.

A naturologia no Brasil: avanços e desafios / The naturology in Brazil: developments and challenges

A naturologia é uma profissão recente no Brasil, a qual busca entendero ser-humano multidimensionalmente e respeitar a singularidade humana na busca de bem-estar, qualidade de vida e saúde através da relação de interagência e das Práticas Integrativas e Complementares.Este dossiê aborda um breve histórico das Práticas Integrativas e Complementares e Naturologia no Brasil, o processo de reconhecimentoda ocupação e regulamentação da profissão. O texto também explora os campos de atuação do naturólogo, órgãos de representação profissional, principais eventos científicos e publicações importantes da área. Por fim, são apresentados documentos importantes: Aprovaçãodo MEC dos cursos existentes, Carta de Intenção de abertura de curso superior de Naturologia por uma Universidade Federal, Editais de concursos públicos, Relatos de experiências de trabalhos de Naturólogosem instituições de renome nacional, Anais dos Congressos Brasileiros de Naturologia e Carta da Pedra Branca, a qual traça diretrizesfuturas para a Naturologia no Brasil.(AU)

Naturology is a new profession in Brazil, one which seeks to understand the human being in a multi-dimensional way, and respect human singularity in its search for well-being, quality of life and health through a relationship of interagency and Complementary and Integrative Practices. The present dossier addresses a brief history of Complementary and Integrative Practices and Naturology in Brazil, the process of recognizing the occupation and regulation of the profession. The paper also explores the fields in which the naturologist is active, the bodies of professional representation, the main scientific events and important publications in the fiels. Finally, important documents are presented: the approval by the Brazilian Ministry of Education (MEC) of existing courses, Statement of Purpose for opening undergraduate-level major in Naturology by a Federal University, notices for public tendering, Proceeding of Brazillian Naturology Conferences and the Charter of Pedra Branca, which sets future guidelines for Naturology in Brazil.(AU)

Practice analysis of chiropractic radiology: identifying items for part I of the clinical competency examination.

OBJECTIVE: The purpose of this study was to describe the current scope of practice of chiropractic radiologists by identifying frequent tasks conducted as well as those conditions most often seen and those that present the greatest risk of harm to patients. METHODS: A mixed-methods approach was used. An online survey was conducted with 91 diplomates listed with the American Chiropractic Board of Radiology. Participants rated the frequency of tasks they perform and conditions they see on a 5-point scale from "never" to "daily." They also rated the level of risk each condition presents to patients on a 5-point scale from "no risk" to "severe risk." Frequency and risk ratings were then presented in rank order to 22 subject matter experts at 3 focus groups. RESULTS: The most frequent task reported was writing radiology reports (mean [SD], 4.29 [1.58]). Ratings of the frequency of conditions seen in practice and the risk they present to patients were ranked from the highest to lowest for frequency and risk separately. The most frequent conditions seen were reportedly those with structural or joint derangement; the highest risk conditions seen are those that are systemic. Focus group members recommended that some conditions receive higher rankings and that certain conditions be recategorized for future practice analyses. CONCLUSIONS: This study helps to define the current scope of practice of chiropractic radiologists and identify frequent tasks and conditions. These results inform the development of a new test outline for Part I of the chiropractic radiology certification examination to ensure that examinees are tested on the most important conditions chiropractic radiologists see in practice.

Actuaciones profesionales realizadas en la farmacia comunitaria / Professional services carried out in the community pharmacy

Objetivo: Describir todas las actuaciones profesionales (AP) que se llevan a cabo como respuesta a las demandas realizadas por los usuarios en la farmacia comunitaria (FC). Material y métodos: Estudio observacional, descriptivo y transversal, realizado durante 6 meses en dos farmacias comunitarias de Denia (Alicante). La población de estudio fueron todas las demandas de servicio que realizaron los usuarios de ambas farmacias. La variable de estudio fue la AP, es decir, cada uno de los servicios demandados por el usuario en la FC: dispensación, indicación, automedicación, consultas y ventas, clasificándose cada uno en sus resoluciones e incidencias. Resultados: En el estudio se realizaron 30.617 AP, correspondiendo un 42% a la dispensación con receta, y se registró casi un 23% de incidencias. Las indicaciones farmacéuticas supusieron un 9% del total, resolviéndose en la mayoría de casos con la recomendación de un medicamento. Un 33% fueron demandas de automedicación, cursando con casi un 20% de incidencias. Un 7% fueron consultas y un 10% ventas de productos sanitarios. Conclusiones: Del total de AP realizadas, el 90% se consideran farmacéuticas. El 83% fueron dispensaciones de medicamentos, más de la mitad de éstas sin prescripción médica, lo que revela la importancia del asesoramiento farmacéutico en las dispensaciones sin receta. El hecho de que 9 de cada 10 incidencias que se producen en la dispensación con receta y en la automedica ción sean por la falta de información del paciente nos pone en alerta sobre la necesidad de implementar medidas que mejoren esta carencia(AU)

Objective: To describe all the professional actions (PA) carried out by the community pharmacy in response to the requests made by pharmacy users. Methods: Observational, cross-sectional, descriptive study in two pharmacies in Spain, over a 6 month-period. Population: all service requests made by pharmacy users. Study variable: Professional action, each of the services requested by pharmacy users: prescription-drug-dispensing, patient-counseling in minor ailments, self-medication, pharmacist-consultations, and sales-services. Classifying each of them in their decisions and incidents. Results: The study involved 30,617 PA, of which 42% were requests for prescription-drug-dispensing. Incidences were also recorded (23%). Nine percent of requests were for patient-counseling in minor ailments, and these were solved in 99% of cases with recommending of a drug, herbal or homeopathy product. Of the total PA, 33% were self-medication cases, with 20% of incidences. Seven percent were inquiries to the pharmacist and 10% of total requests were sales-services. In one out of four prescription-drug-dispensing event an incidence was detected, and in self-medication cases, in one out of every five. Conclusions: Of all the PA performed in the pharmacies under study, 90% were pharmaceutical activities. Most of these (83%) are directly associated with drug delivery (with/without prescription). The fact that more than a half of the total PA requested were without medical prescription should be further analyzed. The fact that nine out of ten incidents that occur in prescription-drug-dispensing and self-medication are the lack of patient information, it alerts us to implement measures to improve this shortcoming(AU)

[National organization of forensic medicine in France]. / Organisation nationale de la médecine légale en France.

Forensic medicine has long been characterized, in France, by diverse medical practices, which affected its recognition and development. A change was needed, Harmonization procedure includes the development of professional guidelines and allows forensic medicine to look at itself. However, the implementation of the recommendations is still far from complete. A national reform came into effect on 15 January 2011 and has defined a national reform of forensic medicine which includes funding by global budgets instead of fee-for-service. This reform allows easier organization and identification of forensic medicine units. One year later, tangible results are mixed. Forensic medicine is now more clearly identified but properly defined funding criteria are still lacking.