The provision of advice by pharmacy staff in eastern Indonesian community pharmacies

Background: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts. Results: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed

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Nurse managers' perspectives on nurses' performance in mentorship program

Objective: The aim of this study was to explore the nurse managers' perspectives on nurses' performance in a mentorship program. Method: A cross-sectional survey was conducted on 51 nurse managers in Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang, by using modified and self-developed questionnaire with the Cronbach's alpha value 0.994. The data were analyzed by using descriptive statistics such as central tendency, frequency and percentage. Results: The gender of respondents was predominantly female (100%). The mean age is 45.41 (SD ± 4.51). In terms of level of education, the majority of the respondents (76.5%) were having a diploma. The majority has been in practice as a staff nurse between 11 to 20 years, and most of them have been practicing as nurse managers for about five years and less. Meanwhile, results showed that the nurse managers had positive perceptions upon newly graduated nurses' performance in the mentorship program, concerning on their effective communication, professional development and creative thinking. Conclusions: It is vital to identify the effectiveness of the mentorship program among nurses; hence, it enhances job satisfaction among new nurses

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Practice Location Characteristics of Non-Traditional Dental Practices.

Current and future dental school graduates are increasingly likely to choose a non-traditional dental practice-a group practice managed by a dental service organization or a corporate practice with employed dentists-for their initial practice experience. In addition, the growth of non-traditional practices, which are located primarily in major urban areas, could accelerate the movement of dentists to those areas and contribute to geographic disparities in the distribution of dental services. To help the profession understand the implications of these developments, the aim of this study was to compare the location characteristics of non-traditional practices and traditional dental practices. After identifying non-traditional practices across the United States, the authors located those practices and traditional dental practices geographically by zip code. Non-traditional dental practices were found to represent about 3.1% of all dental practices, but they had a greater impact on the marketplace with almost twice the average number of staff and annual revenue. Virtually all non-traditional dental practices were located in zip codes that also had a traditional dental practice. Zip codes with non-traditional practices had significant differences from zip codes with only a traditional dental practice: the populations in areas with non-traditional practices had higher income levels and higher education and were slightly younger and proportionally more Hispanic; those practices also had a much higher likelihood of being located in a major metropolitan area. Dental educators and leaders need to understand the impact of these trends in the practice environment in order to both prepare graduates for practice and make decisions about planning for the workforce of the future.

Direct ultrasound localisation for pleural aspiration: translating evidence into action.

BACKGROUND: There is strong evidence that direct ultrasound localisation for pleural aspiration reduces complications, but this practice is not universal in Australia and New Zealand. AIMS: To describe the current utilisation and logistical barriers to the use of direct ultrasound localisation for pleural aspiration by respiratory physicians from Australia and New Zealand, and to determine the cost benefits of procuring equipment and training resources in chest ultrasound. METHODS: We surveyed all adult respiratory physician members of the Thoracic Society of Australia and New Zealand regarding their use of direct ultrasound localisation for pleural aspiration. We performed a cost-benefit analysis for acquiring bedside ultrasound equipment and estimated the capacity of available ultrasound training. RESULTS: One hundred and forty-six of 275 respiratory physicians responded (53% response). One-third (33.6%) of respondents do not undertake direct ultrasound localisation. Lack of training/expertise (44.6%) and lack of access to ultrasound equipment (41%) were the most frequently reported barriers to performing direct ultrasound localisation. An average delay of 2 or more days to obtain an ultrasound performed in radiology was reported in 42.7% of respondents. Decision-tree analysis demonstrated that clinician-performed direct ultrasound localisation for pleural aspiration is cost-beneficial, with recovery of initial capital expenditure within 6 months. Ultrasound training infrastructure is already available to up-skill all respiratory physicians within 2 years and is cost-neutral. CONCLUSION: Many respiratory physicians have not adopted direct ultrasound localisation for pleural aspiration because they lack equipment and expertise. However, purchase of ultrasound equipment is cost-beneficial, and there is already sufficient capacity to deliver accredited ultrasound training through existing services.

Pharmaceutical services and health promotion: how far have we gone and how are we faring? Scientific output in pharmaceutical studies

The objective of this study was to investigate the scientific output on health promotion within the pharmaceutical field and its relation with the development of pharmaceutical services within health systems. A comprehensive review of published scientific articles from the Medline and Lilacs databases was carried out. The review comprised articles published until December 2011, and used combinations of the terms 'health promotion' or 'health education' and 'pharmacy', 'pharmacist' or 'pharmaceutical'. The articles were selected according to inclusion and exclusion criteria. A total of 170 full texts and 87 indexed abstracts were analyzed, evidencing that most described actions of health promotion in community pharmacies and other services. Following the Ottawa Charter, most of the studies dealt with new guidance of the service and the supply of pharmaceutical information and services. It was concluded that there is a lack of theoretical background on health promotion in the pharmaceutical field to sustain the professional education and practice required by the health system and the population.

O objetivo do estudo foi investigar a produção científica sobre o desenvolvimento teórico e prático da promoção da saúde na farmácia e sua relação com o desenvolvimento da área e dos serviços farmacêuticos. A revisão integrativa de artigos científicos foi realizada a partir das bases de dados Medline e Lilacs. Ela compreendeu os artigos publicados até dezembro de 2011, através da combinação dos termos 'promoção da saúde ou educação em saúde' e 'farmácia, farmacêutico ou farmacêutica'. Critérios de inclusão e exclusão definiram a seleção dos textos. Ao todo, 170 artigos e 87 resumos foram analisados, sendo a maioria identificada como trabalhos teóricos que relatam atividades descritas como de promoção da saúde em farmácias comunitárias ou outros serviços. Confrontando com o referencial da Carta de Ottawa, a maioria dos estudos revelou ter como campo de investigação principal alguma proposição de reorientação dos serviços de saúde e oferta de informações e práticas farmacêuticas. Conclui-se que há uma carência de embasamento teórico sobre promoção da saúde na área farmacêutica para sustentar a formação e prática profissional, conforme exigido pelo sistema de saúde e pela população.

[Nursing practice settings and competence to incorporate evidence into decisions: analysis of the situation in the Balearic Islands (Spain)]. / Entorno de práctica de los profesionales de enfermería y competencia para la incorporación de la evidencia a las decisiones: situación en las Islas Baleares.

OBJECTIVES: To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses' characteristics and their occupational settings. METHODS: We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%. RESULTS: A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p<0.001). These differences remained significant when the questionnaires were compared according to professional category and experience. CONCLUSIONS: This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level.

Estudio de la Calidad de Vida Profesional en trabajadores de Atención Primaria del Área 7 de la Comunidad de Madrid / Quality of Professional Life (QoPL) among primary care workers in the Area 7 of Madrid Autonomous Region

Objetivo. Conocer la percepción de los trabajadores de Atención Primaria del Área 7 respecto a su calidad de vida profesional (CVP) y describir su evolución desde el año 2004. Material y métodos. Estudio descriptivo transversal. Se realiza en junio de 2008, en el Área 7 de Atención Primaria. Los participantes son todos los profesionales del Área (n=1003). Las mediciones principales son: Cuestionario CVP-35, anónimo y autoadministrado y variables sociodemográficas y profesionales que pudieran tener relación con la CVP. Se estudió la variación de los resultados respecto a los años 2004 y 2006. Resultados. La tasa de respuesta fue del 47%, siendo las medias: percepción global de demandas=6,09, percepción del apoyo directivo=5,10 y motivación intrínseca=7,56. Por estamentos, enfermería-fisioterapeutas y auxiliares son los más motivados, con mejor percepción de apoyo directivo y mejor CVP sentida. Los sujetos que desempeñan tareas directivas puntúan mejor los ítems relacionados con percepción de apoyo directivo y presentan mayor motivación intrínseca. Se observa cierta mejoría en los resultados de percepción de apoyo directivo, demandas y calidad de vida. Conclusiones. El análisis por ítems nos permite, partiendo de los peor valorados, establecer líneas de mejora y evaluar sus resultados. Así pues, observamos cierta mejoría de los resultados, en consonancia con las intervenciones desarrolladas que daban respuesta a demandas percibidas en años previos. Algunas de las intervenciones han sido recientemente implantadas, siendo necesario seguir evaluando su efectividad a través de la aplicación de este cuestionario(AU)

Objective. To describe the QoPL as perceived by Primary Care workers in the Primary Care Area 7 and to describe the progress since 2004. Material and methods. Cross – sectional study carried out in the Primary Care Area 7 in June 2008. Participants were all primary care workers (n=1003). Main measurements were: the CVP-35 questionnaire (anonymous and self-administered) and socio-demographic and professional variables that could be associated with QoPL. Results were compared to those obtained in previous years (2004–2006). Results. Positive answers: 47%. By dimension, average scores were: perception of demands: 6.09, managerial support: 5.10 and intrinsic motivation: 7.56. Nurses, physiotherapists, and nursing assistants had significantly higher scores in intrinsic motivation, managerial support and quality of life. The individuals who carried out management activities had higher scores in managerial support and intrinsic motivation items. Slight improvements were seen in perception of demands, managerial support and quality of life. Conclusions. Item analysis allows us to develop improvement plans and subsequently evaluate their results. In this sense, we observed slight improvements, according to planned strategies, based on perceived demands in previous years. Some of these strategies have been recently introduced, so future evaluations using the CVP-35 questionnaire are needed in order to analyse their effectiveness(AU)

What do psychotherapists really do in practice? An Internet study of over 2,000 practitioners.

Over 2,200 North American psychotherapists completed a Web-based survey concerning their clinical work, including theoretical orientation, client characteristics, and use of specific psychotherapy techniques. Psychotherapeutic integration was common, with the majority of respondents identifying with more than one theoretical orientation or as having an eclectic orientation. The modal patient was a White female adult suffering from a mood or anxiety disorder and interpersonal problems. Individual psychotherapy was the preferred treatment modality. The most frequently endorsed techniques were relationship-oriented such as conveying warmth, acceptance, understanding, and empathy. The least frequently endorsed techniques were biofeedback, neurofeedback, body and energy therapies, and hypnotherapy. Efforts to disseminate empirically based therapies require understanding and accommodating clinicians' tendencies to integrate techniques.

Dentists' knowledge and opinions about oral mucosal lesions.

This study aims to identify, compare and analyse the knowledge and opinions of dentists regarding oral mucosal lesions and evaluate the differences between the attitudes of dentists by practice settings. 300 dentists were enrolled in the study. Three groups were formed. The first group included general dental practitioners working in private dental offices; the second group were dentists practising in dental polyclinics; the third group was composed of dentists employed at universities in Istanbul, working in departments except for the department of oral surgery and medicine. A 17-item self constructed questionnaire investigating demographic attributes, dental practice characteristics, oral mucosal lesions (OML) knowledge and respondents' opinions was completed and all questions were asked by the same author. 85% of the dentists admitted difficulties in diagnosing OML. 62% failed to update their knowledge from the literature, 93% did not undertake biopsies or consult other practitioners. Dentists practising at universities attempted to treat fewer patients with OML (p=0.0001). The results of this questionnaire conclude that most dentists experience difficulties in diagnosing some OML.

The successful oral and maxillofacial surgery practice.

Oral and maxillofacial surgery has been and will continue to be one of the premiere health care specialties in the United States. Incomes of oral and maxillofacial surgeons are among the highest of any profession in the country. With efficient scheduling, organized business systems, efficient fee schedules, and appropriate use of consultants, oral and maxillofacial surgery can lead to a lifestyle that is relatively stress free, allows a direct route to financial independence, and provides a great public service.

Perfil sócio-demográfico e da situação de trabalho dos médicos atuantes no município de Tubarão, SC / Socio-demographic and work conditions profile of the physicians working in the municipality of Tubarão, SC

Introdução: O estudo do perfil da situação do trabalho dos médicos é relevante para a avaliação de como eonde os médicos estão trabalhando no contexto local. Objetivo: Descrever o perfil sócio-demográfico e de trabalho dos médicos que atuavam no município de Tubarão, SC no ano de 2006.Métodos: Foi realizado um estudo transversal envolvendo a totalidade dos médicos (n=207) que atuavam no município em 2006. Os dados foram coletados por intermédio de questionários auto-preenchíveis contendo questões sócio-demográficas, processo de formação, perfil da situação de trabalho e satisfação com o exercícioda profissão. O questionário foi pré-testado e um estudo piloto foi realizado para testar a metodologia proposta.Os dados foram analisados descritivamente. Resultados: A taxa de resposta foi de 33,4%. As especialidades médicas mais freqüentes foram a Pediatria, a Ginecologia / Obstetrícia e a Clínica Médica. 66,7% exercia a profissão no SUS e o trabalho em consultório privado foi relatado por 82,7%. Quase a metade dos médicos informou uma carga horária de trabalho entre 41 à 60 horas semanais e uma renda mensal entre 5.000 e 10.000 reais. Cerca de 25,0% dos entrevistados afirmaram que possuíam três inserções de trabalho; 63,8%julgou ser boa a infra-estrutura do seu principal local de trabalho e 94,3% relatou estar satisfeito com o exercícioda profissão. Conclusões: A maioria dos médicos submete-se a alta carga de trabalho, em várias inserções de trabalho. A infra-estrutura dos locais de trabalho foi considerada boa pela maioria dos profissionais, que se sentem satisfeitos com a profissão.

Background: The study the situation of the work conditions of physicians is relevant to the assessment of how and where they are working in the local context. However, there is a lack of information on the work conditionsof the medical category especially in the inner cities of Santa Catarina. Objective: To describe the socio-demographic andwork profile of physicians working in the municipality of Tubarão, SC in 2006.Methods: A cross-sectional study was conducted involving all physicians (n = 207) working in the municipalityof Tubarão, SC in 2006. Data were collected through auto-administered questionnaires containing socio-demographic questions, as well as regarding the process of training, profile of the work conditions and satisfactionwith the profession. The questionnaire was pre-tested and a pilot study was conducted to test the proposedmethodology. The data were descriptively analyzed Results: A total of 69 (33.4%) questionnaires were returned. The specialties most frequent were Pediatrics, Gynecology/Obstetrics and Medical Clinic. 66.7% of physicians related to be working at SUS and the private practice was reported by 82.7%. Almost half the physiciansreported 41 to 60 hours per week as workload and a monthly income between 5,000 and 10,000 reais. About25.0% of respondents said that had three insertions of work and 63.8% held to be good the infrastructure of their main workplace; 94.3% reported to be satisfied with the exercise of the Medicine. Conclusions: The majority of the physicians reported a high workload in different insertions of work. Theinfrastructure of workplaces was considered good by most professionals, who feel satisfied with the profession.

Agreement between Occupational Therapy Practice Framework classifications and occupational therapists' classifications.

The American Occupational Therapy Association (AOTA) developed the Occupational Therapy Practice Framework: Domain and Process (the Framework) to categorize and organize concepts in the field of occupational therapy in a manner that would be understandable to practitioners within the field as well as to external readers. The current study investigates the degree to which occupational therapists' classification of terminology agrees with the Framework's classification of terminology. Through mail survey format, 200 randomly selected AOTA occupational therapist members were asked to classify 30 randomly selected terms from the Framework into the 6 domain categories of the Framework. Based on the responses of 94 completed surveys, low levels of agreement were found between therapists' and the Framework's categorizations. Overall, practicing therapists did not categorize terms in a manner consistent with the categorization of the Framework. We recommend that AOTA refrain from developing systems of categorization, at least until a consensus develops in the field concerning terminology.

Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study.

BACKGROUND: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating with medical specialists in new collaborative care models. The following two questions are addressed in this study: What motivates GPs to initiate and sustain new models for collaborating with medical specialists? What kind of new collaboration models do GPs suggest? METHODS: A qualitative study design was used. Starting in 2003 and finishing in 2005, we conducted semi-structured interviews with a purposive sample of 21 Dutch GPs. The sampling criteria were age, gender, type of practice, and practice site. The interviews were recorded, fully transcribed, and analysed by two researchers working independently. The resulting motivational factors and preferences were grouped into categories. RESULTS: 'Developing personal relationships' and 'gaining mutual respect' appeared to dominate when the motivational factors were considered. Besides developing personal relationships with specialists, the GPs were also interested in familiarizing specialists with the competencies attached to the profession of family medicine. Additionally, they were eager to increase their medical knowledge to the benefit of their patients. The GPs stated a variety of preferences with respect to the design of new models of collaboration. CONCLUSION: Developing personal relationships with specialists appeared to be one of the dominant motives for increased collaboration. Once the relationships have been formed, an informal network with occasional professional contact seemed sufficient. Although GPs are interested in increasing their knowledge, once they have reached a certain level of expertise, they shift their focus to another specialty. The preferences for new collaboration models are diverse. A possible explanation for the differences in the preferences is that professionals are more knowledge driven than organisation driven as the acquiring of new knowledge is considered more important than the route by which this is achieved. A new collaboration model seems a way to acquire knowledge. Once this is achieved the importance of a model possibly diminishes, whereas the professional relationships last.

A profile of female academic surgeons: training, credentials, and academic success.

The objective of this study was to determine the profile (credentials, training, and type of practice) of female academic general surgeons and factors that influenced their career choice. A survey was sent to female academic surgeons identified through general surgery residency programs and American medical schools. The women had to be Board eligible/certified by the American Board of Surgery or equivalent Board and have an academic appointment in a Department of Surgery. Data were analyzed using the SPSS program. Two hundred seventy women (age range, 32-70 years) completed the survey (98.9% response rate). Fellowships were completed by 82.3 per cent (223/270), most commonly in surgical critical care. There were 134 (50.2%, 134/367) who had two or more Board certificates, most frequently (46%, 61/134) in surgical critical care. Full-time academic appointments were held by 86.7 per cent of women, most as assistant professors, clinical track; only 12.4 per cent were tenured professors. The majority of women described their practice as "general surgery" or "general surgery with emphasis on breast." The most frequent administrative title was "Director." Only three women stated that they were "chair" of the department. The top reason for choosing surgery was "gut feeling," whereas "intellectual challenge" was the reason they pursued academic surgery. When asked "Would you do it again?", 77 per cent responded in the affirmative. We conclude that female academic surgeons are well trained, with slightly more than half having two or more Board certificates; that most female academic surgeons are clinically active assistant or associate professors whose practice is "general surgery," often with an emphasis on breast disease; that true leadership positions remain elusive for women in academic general surgery; and that 77 per cent would choose the same career again.