David Gillham

Are complementary medicine practitioners implementing evidence based practice

BACKGROUND Over the past few decades the health professions have witnessed increasing pressure to shift from a culture of delivering care based on tradition and intuition, to a situation where decisions are guided and justified by the best available evidence. While there are concerns that many complementary and alternative medicine (CAM) practitioners may be cautious about embracing such an approach, no studies to date have effectively tested this assumption. OBJECTIVE To identify the skills, attitude, training and use of evidence-based practice (EBP) amongst CAM practitioners. DESIGN Descriptive survey, using the evidence-based practice attitude and utilisation survey (EBASE). SUBJECTS Randomly selected nationwide sample of system-based, non-medically qualified CAM practitioners practicing in a clinical capacity within Australia. MAIN OUTCOME MEASURES Practitioner skill, attitude, training and use of EBP. RESULTS Of the 351 questionnaires successfully dispatched, 126 were returned (36%). Most practitioners believed EBP was useful (92%) and necessary (73%) in CAM practice. While the majority of clinicians (>74%) reported participation in EBP activities, albeit infrequently, only a small to moderate proportion of decisions were based on evidence from clinical trials, with most practitioners relying on traditional knowledge, textbooks and clinical practice guidelines. Lack of available evidence, time, industry support and skills were perceived as barriers to EBP uptake. CONCLUSIONS While the small response rate limits the generalisability of these findings, the sample was considered representative of Australian CAM practitioners. What this study shows is that even though CAM practitioners may be supportive of EBP, education and training is needed to further improve clinician understanding and application of evidence-based practice.

Physiotherapy-provided operant conditioning in the management of low back pain disability: A systematic review†

BACKGROUND AND PURPOSE  Non-specific low back pain (LBP) is a leading cause of disability in developed countries. Behavioural interventions have been found efficacious in reducing disability in LBP. Operant conditioning is one type of behavioural intervention being employed by physiotherapists; however, the effectiveness of physiotherapist-provided operant conditioning (POC) in the management of LBP disability is unknown. This review aims to answer the question: is POC more effective than comparison interventions in reducing LBP disability?  METHOD  A systematic review of randomized controlled trials was conducted using a qualitative analysis of effect. Participants were adults ≥18 years with non-specific LBP. The intervention was defined as a time contingent, graduated increase in activity including goal setting and the education and reinforcement of positive pain behaviours with the aim of decreasing disability. The primary outcome measure was back pain specific disability. Secondary outcomes included generic functional status, pain intensity, sick leave, fear avoidance beliefs or behaviour and adverse effects.  RESULTS  Fifteen trials involving 3737 people were included. Eight studies reported a clinically significant difference. The POC intervention was not found to be inferior to any of the comparison interventions in reducing disability. Moderate evidence was found that POC is more effective than other behavioural interventions in reducing long term disability in chronic LBP. Moderate evidence showed POC may be more effective than other treatments in reducing post-treatment fear avoidance beliefs in a sub-acute population but less effective in reducing short term fear avoidance beliefs in a population with mixed LBP. Moderate evidence showed POC is more effective than a placebo intervention in reducing short term pain in sub-acute LBP.  CONCLUSION  POC may be considered efficacious in the treatment of LBP. Physiotherapists may also consider POC for its additional effect of reducing long term disability in chronic LBP.

The experience of young adult cancer patients described through online narratives.

Background: Young adults are often faced with challenges related to relationships, employment, housing, and emotional development. Experiencing cancer during this time complicates the developmental processes and creates a need for communicating concerns and discussing issues. Objective: The purpose of this study was to explore the experiences and gain a better understanding of young adults affected by cancer (YAACs) by examining their online narratives (also known as Web logs or blogs). Interventions/Methods: Inclusion and exclusion criteria were used to identify eligible Web sites. The Web site that most corresponded to the selection criteria was chosen for analysis (Planet Cancer, http://www.planetcancer.org/). The blog content generated in July 2011 was collected. The blogs were written by a total of 34 female and 12 male writers and included 136 (by female) and 28 (by male) blog entries. Researchers conducted a descriptive qualitative examination of blogs to explore YAACs’ experiences during/after cancer. Results At the end of the data analysis process, 10 main themes were identified: physical burdens, future prospects, isolation (physical and psychological), guilt, mortality, images of cancer, creating a positive attitude, healthcare, online social interaction, and cancer survivorship. Conclusions: The Internet provides young cancer patients with a space in which to express themselves and to share experiences with those who are of similar age and in similar situations. Implications for Practice: Blogs can be particularly helpful when patients are isolated or physically unable to interact with other people because of treatment requirements or physical deterioration. Future studies should investigate other types of Internet cancer communities and how they can benefit the development of Internet-based support networks for YAACs.

Evaluation of the Evidence-Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners

RATIONALE This paper describes the development of the Evidence-Based practice Attitude and utilization SurvEy (EBASE), which was designed to measure complementary and alternative medicine (CAM) practitioner attitude to and utilization of evidence-based practice (EBP). AIM The aim of this study was to evaluate the validity and reliability of the EBASE as a measure of CAM practitioner skill, attitude and use of EBP in order to adequately inform clinicians and researchers about this comprehensive survey tool. METHODS EBASE and the clinical effectiveness and EBP questionnaire (EBPQ) were distributed to nine experts in CAM education, research, questionnaire design and/or EBP. Responses to these questionnaires were used to evaluate the content validity, convergent validity, test-retest reliability and internal consistency of EBASE. RESULTS EBASE has found to have good internal consistency (Cronbachs alpha = 0.84) and acceptable test-retest reliability (ICC = 0.578-0.986). The instrument also demonstrated good content validity (CVI = 0.899), and adequately measured practitioner skill and utilization of EBP when compared to the EBPQ. CONCLUSION The current study supports the validity and reliability of EBASE as a measure of CAM practitioner skill, attitude, experience and training in, as well as barriers and facilitating factors of EBP.

Improving care transitions of older people: Challenges for today and tomorrow

Enabling optimal care transitions for older people remains a key challenge facing policy‐makers and service providers. This qualitative Australian study aimed to provide a comprehensive picture of the factors/issues surrounding care transitions from the perspective of older people and their carers. It documents how supports and services are searched for and gained during the care transition process and the effect of this process on older people and their families. These findings have implications for service provision and policy relating to both assisting older people to age in place wherever possible and facilitating optimal care transitions when they are required.

Competencies to enable learning-focused clinical supervision: a thematic analysis of the literature.

Clinical supervision is essential for development of health professional students and widely recognised as a significant factor influencing student learning. Although considered important, delivery is often founded on personal experience or a series of predetermined steps that offer standardised behavioural approaches. Such a view may limit the capacity to promote individualised student learning in complex clinical environments. The objective of this review was to develop a comprehensive understanding of what is considered ‘good’ clinical supervision, within health student education. The literature provides many perspectives, so collation and interpretation were needed to aid development and understanding for all clinicians required to perform clinical supervision within their daily practice.

A study of the development of critical thinking skills using an innovative web 2.0 tool.

BACKGROUND Healthcare educators face numerous challenges including technological change, information overload, and the need to maintain clinical expertise and research knowledge across multiple specialities. Students also need to develop their capacity for critical thinking, using and discriminating between diverse sources of knowledge in order to advance their own practice. OBJECTIVES To investigate student perceptions of the affordances of a novel web 2.0-based tool--the Web Resource Appraisal Process (WRAP), designed to support the development of critical thinking skills, and to identify how students understanding of critical thinking and their use of web 2.0 resources might inform the cross-disciplinary development of the WRAP. DESIGN A two phase, action research study of student perceptions of the WRAP and their ability to source and identify valid information sources. SETTINGS Implemented at the University of South Australia, development of the WRAP is an international project with the University of Westminster, UK. PARTICIPANTS Students from international locations participated in the project. METHODS A mixed methods approach was adopted involving a two phase action research study. In phase one, student perceptions of the WRAP were obtained using a modified course feedback questionnaire. This informed the development of a subsequent questionnaire used to survey student perceptions of their usage of online resources, the ease of access of such resources and their approaches to determining their validity. RESULTS Results suggest that students mainly use traditional resources when preparing work for assessment and they either do not understand the concept of, or do not exercise, critical thinking skills in such activities. However, the feedback from students using the WRAP, demonstrated that they found it instructive and useful. CONCLUSIONS To ensure that practice developments are based on authoritative evidence, students need to develop critical thinking skills which may be facilitated by tools such as the WRAP.

The quality of information on websites selling St. John's wort

BACKGROUND Health consumers are increasingly using the Internet to access information about health care, to self-diagnose, and to purchase medication. The use of the Internet to purchase herbal products is of particular interest because of the high level of consumer expenditure on herbal medicines, and the misperception by some consumers that herbal products are natural, and thus absent of any contraindications, drug interactions and adverse effects. It is possible that consumers may purchase herbal medicines via the Internet without consulting health professionals and therefore, use these medicines in an unsafe manner. OBJECTIVES To examine the quality of e-commerce websites that sell herbal products; specifically, websites where St. Johns wort (Hypericum perforatum) can be purchased. DESIGN Cross-sectional survey of 54 selected websites, including online pharmacies, online health food stores and manufacturers of herbal medicines. MAIN OUTCOME MEASURE A modified version of the DISCERN instrument was used to assess the quality of websites. RESULTS The majority of websites rated poorly with a concerning lack of information about the interaction between hypericum and warfarin, anti-depressants and oral contraceptives. Most sites also failed to provide sufficient information about the contraindications and adverse effects of hypericum treatment. CONCLUSIONS The results of this study strongly support the need for improved consumer education about herbal medicine, as well as the application of more stringent standards to websites that sell medications.

Scenariation: scenario generation for online teaching in nursing and health sciences

There are increased opportunities for online delivery innovation within the education sector because of rapid advances in Internet technology. This paper describes a unique and efficient approach to simulation called ‘scenariation’. The scenariation project aimed to establish efficient processes for the development of scenariation content and evaluate the use of a specific scenariation nurse education module. Students were presented with video simulating the workplace and then prompted to make clinical decisions such as selecting treatment options. The scenariation approach was implemented with a group of 380 1st-year nursing students and evaluated using multifaceted online evaluation. The results of this qualitative evaluation highlight not just the potential of scenariation but also some of the difficulties associated with online delivery to large and diverse student groups. Students valued the relevance to practice and interactive nature of scenariation, but some reported technical difficulties. The paper concludes by extending the discussion of scenariation to the areas of inter-professional learning and the integration of scenariation with face-to-face high fidelity simulation.

Web resource appraisal process (WRAP): A framework to establish critically appraised nursing knowledge—an active web based learning exercise

There have been dramatic advances in Internet technology in the past 10 years. However, for the Internet to reach its full potential for nursing practice and education, improvements in the quality and accessibility of health care information on the Internet are needed. This paper describes the development of a Web Resource Appraisal Process (WRAP). The WRAP consists of a template and series of online tutorials designed to facilitate the development of online resources for nursing. The WRAP can be described as a content focused authoring tool. The WRAP directs users through a range of high quality international health websites and databases in order to collect information related to specific practice areas. The WRAP then provides an ordered structure for the presentation of this information in an online format. The WRAP is a website with three main functions. Firstly, it is a teaching and learning resource promoting interactive learning using online resources. Secondly, the WRAP promotes the application of research evidence to practice by providing a standardised framework for the critical review of information resources. Thirdly, the WRAP provides a mechanism for the collaborative documentation of nursing knowledge. This paper concludes by discussing implications of the WRAP for the development, documentation and dissemination of knowledge across the health professions.