Learning with computerized guidelines in general practice?: A randomized controlled trial.

Clinical practice guidelines: who reads them? who needs them?

Guidelines for type 2 diabetes care in general practice are well known and accepted, but the implementation falls short. To implement these guidelines by introducing a diabetes support service (DSS) to support the care delivered by the GP. A controlled, non-randomised study with delayed intervention in the control group; 78 GPs (n=51 for the intervention and n=21 for the control group) in the south of the Netherlands and 613 of their type 2 diabetic patients participated. Data were collected on the frequency, content and results of the check-ups (fasting blood glucose, HbA1c, cholesterol, cholesterol/HDL ratio, triglycerides, creatinine, blood pressure, fundus photography, foot examination, body mass index and smoking status) for 3 years. The year before signing up with the DSS was taken for the pre-measurements and after 2 years of DSS the post-measurements took place. The effect of the DSS was analysed in a mixed model with repeated measurement covariance structure. At baseline the intervention and control group did not differ in control frequency and outcome (HbA1c). After the intervention the percentage of patients that attended four or more quarterly check-ups (with at least testing of fasting blood glucose or HbA1c) increased from 59 to 78%. In contrast, the frequency of check-ups in the control group remained constant. This effect was significant. The HbA1c remained the same in the intervention group while there was a significant deterioration in the HbA1c in the control group. Simple logistic support by the DSS proved to have the capacity to implement type 2 diabetes guidelines in general practice.

This paper provides a review of key issues affecting the uptake of clinical guidelines by general practitioners (GPs) in Australia and internationally. Attention is given to the barriers that affect guideline uptake, the quality of guidelines and the dissemination of guidelines to GPs in practice settings. A comprehensive cross-disciplinary literature review of peer-reviewed journals was conducted between January and April 2008. The literature review was undertaken by three independent researchers from diverse disciplinary backgrounds. The review focused on studies that explored the barriers and issues associated with the use of guidelines in general practice and suggestions for more effective use. Pathways for clinicians to evaluate and use guidelines are still not clear. The majority of contemporary literature promotes linear 'uptake' and 'accessibility' models for clinical guidelines that may not attend to more complex issues associated with GPs' ways of practising on a daily basis. There are also few clear guidelines for GPs on how to 'adapt' guidelines for local and individual patient circumstances. Peak organizations such as General Practice Queensland in Australia can have a significant role in helping GPs to evaluate and use clinical guidelines. The suggested approach emphasizes the need for such peak bodies to promote respect for practitioner experience, interpretation and patient insight.

Rates of tobacco treatment delivery in primary care are suboptimal. We report on the effectiveness of the TiTAN Crete intervention on rates of patient-reported 4As (ask, advise, assist, arrange) tobacco treatment and general practitioner's (GP) knowledge, attitudes, self-efficacy, and intentions. A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs ( n = 24) intervention and control group and a cross-sectional sample of their patients ( n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs ( n = 14) and a second cross-sectional sample of patients ( n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data. Among GPs exposed to the intervention, significant increases in knowledge, self-efficacy, and rates of 4As delivery were documented between the pre- and postassessment and compared with those of the control group. Specifically, the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for 4As delivery between the pre-and postassessment among GPs exposed to the TiTAN intervention were as follows: Ask AOR 3.66 (95% CI [2.61, 5.14]); Advise AOR 4.21 (95% CI [3.02, 5.87]); Assist AOR 13.10 (95% CI [8.83, 19.42]) and Arrange AOR 4.75 (95% CI [2.67, 8.45]). We found significant increases in rates at which GPs delivered evidence-based tobacco treatment following exposure to the TiTAN intervention. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice.

BackgroundAlmost one-third of children under 5 years old in Indonesia suffer from stunting. Stunting can be prevented optimally during pregnancy as the initial phase of the first 1000 days of life. This study aims to determine the effect of nutrition and reproductive health education of pregnant women in Bogor Regency, Indonesia.MethodsA quasi-experimental study was conducted among 194 pregnant women from August to November 2019. The pregnant women were randomly selected from four different villages in Bogor Regency. The intervention group (n = 97) received 2 h of nutrition and reproductive health education in small groups (four or five mothers per group) every 2 weeks for 3 consecutive months. This interactive education was given by facilitators using techniques such as lectures, role-playing, simulation, and games. The control group (n = 97) received regular health care services. A structured questionnaire was applied to collect data consisting of maternal characteristics, nutritional and reproductive health knowledge, attitudes, and practices in the intervention and control groups. Data were analysed using t-test and chi-square analysis.ResultsPregnant women in the intervention group indicated a significant increase in knowledge, attitudes, and practices regarding nutrition and reproductive health after receiving education. The pre-test and post-test mean scores in the intervention group were 55.1 and 83.1 for overall knowledge, 40.2 and 49.0 for attitudes, and 36.2 and 40.2 for practices, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for these three variables. There was a significant difference (P < 0.001) in the post-test mean between the intervention group and the control group, but the difference was not significant (P > 0.05) in the pre-test.ConclusionProviding nutrition and reproductive health education through small groups with interactive methods improves the knowledge, attitudes, and practices of pregnant women. This intervention has the potential to be replicated and developed for large-scale implementation by optimising collaboration between government, non-governmental organizations, and maternal and child health service providers.

BackgroundImplementation of new guidelines into clinical practice is often incomplete. Direct mail is a simple way of providing information to physicians and may improve implementation of new guidelines on basic life support (BLS). The aim of this study was to describe knowledge of the most recent European Resuscitation Council (ERC) Guidelines for BLS among general practitioners (GPs) and investigate whether direct mail improves theoretical knowledge of these guidelines.MethodsAll general practice clinics (n=351) in Central Denmark Region were randomised to receive either direct mail (intervention) or no direct mail (control). The direct mail consisted of the official ERC BLS/AED poster and a cover letter outlining changes in compression depth and frequency in the new guidelines. In general practice clinics randomised to intervention, every GP received a direct mail addressed personally to him/her. Two weeks later, a multiple-choice questionnaire on demographics and BLS guidelines were mailed to GPs in both groups.ResultsIn total, 830 GPs were included in this study (direct mail, n=408; control, n=422). The response rate was 58%. The majority (91%) of GPs receiving direct mail were familiar with BLS Guidelines 2010 compared to 72% in the control group (P<0.001). Direct mail improved knowledge of the new recommended chest compression depth (67% vs. 40%, P<0.001) and chest compression frequency (62% vs. 40%, P<0.001).ConclusionDirect mail improved knowledge of changes in BLS guidelines and thus facilitated the implementation of this knowledge into clinical practice. Resuscitation councils and medical societies may consider using direct mail as a simple strategy to facilitate implementation of changes in clinical guidelines.

To determine if patient-specific prescriber feedback for general medical practitioners (GPs), supported by educational material mailed to their patients, would increase home medicines review (HMR) rates. An observational study was conducted using the Repatriation Pharmaceutical Benefits Scheme (RPBS) Pharmacy Claims Database. The intervention group (n = 40 270) included all veterans aged >/=65 years, dispensed >/=5 unique medicines each month over a 4 month period. Comparison group veterans (n = 49,227) were those who did not have >/=5 or more unique medicines dispensed each month, but did have at least one prescription each month and >/=20 prescriptions over 4 months, of which five were unique medicines, Intervention GPs (n = 11,384) were subdivided into 2 groups: GPs with intervention veterans (n = 2097) and GPs with both intervention and comparison group veterans (n = 9287). The comparison group of GPs (n = 3630) were primary prescribers to the comparison veterans only. Rates of HMRs pre and post-intervention and the number of new GPs participating in HMR services were examined. There was a significant increase in HMR rates in intervention group, from 2.2 per 1000 in the pre-period to 4.6 per 1000 per month in the post-intervention period (Rate Ratio (RR) 2.06, 95% Confidence Interval (CI) (1.90, 2.22), p < 0.0001). HMR rates increased in the intervention group compared with the comparison group (p < 0.0001). HMR rates increased in the intervention group GPs compared with the comparison group (RR 1.79, 95% CI (1.58, 2.02), p < 0.0001). Patient-specific feedback provided to GPs, supported by educational material mailed directly to their patients increased HMR rates for targeted veterans and increased GP participation in the delivery of HMRs.

&lt;p&gt;Recent trends in the professional learning and development of teachers are moving more towards the activation of learning rather than content delivery. Teachers are expected to take more responsibility for their learning within collaborative environments. This has implications for the practice and learning of inservice teacher educators. Evidence-based inquiry into practice (EBIP) is one approach that is being adopted, which involves evaluation of practice against values, beliefs and assumptions. This study investigated the professional learning and development experiences and perceptions of a group of 10 inservice teacher educators, who participated in the Inservice Teacher Education Practice (INSTEP) project from 2005 to 2009. INSTEP was a New Zealand Ministry of Education project designed to investigate and develop professional learning approaches for inservice teacher educators. In particular, its focus was on the implementation of collaborative EBIP to improve practice. Collective case study and grounded theory methodologies were adopted. Semistructured interviews were conducted with participants in 2008 and 2010. The interviews were analysed using inductive content analysis. Theoretical sampling was applied to identify further participants and document sources such as artefacts, reports and publications, which were also used to inform the research. The findings indicate that, while all participants improved practice and gained knowledge through EBIP, some experienced transformations in their perceptions of themselves, their practice, and their role as inservice teacher educators. Rigorous and systematic EBIP was most effective, and only sustained, when it was supported within formal, informal and social organisational contexts. Such contexts incorporated collective responsibility for learning. This included negotiation and development of shared meanings, tools, mechanisms, and frameworks, which systematised and reified the process of EBIP. This also enabled individual professional learning goals to be located within an overall infrastructure incorporating a shared vision, and alignment with strategic priorities and resourcing. The study suggests that sustainability of change and improvement of practice within system-wide educational reform is more likely to be achieved by individuals working coherently within an educational system and organisations that value and adopt an inquiry approach and nurture collaborative environments. Such environments provide safety to expose vulnerabilities, and enable opportunities for learning that minimise the impact of power relations and contestable environments, while offering challenge, support and diversity of perspectives. The theoretical framework for EBIP derived from the research, and an integrative analysis of the literature, identifies three interconnected and interdependent components linked by a common vision of purpose, and a collective commitment to learning. The components are: individual learning and transformation; communities and connectedness; and systematisation and reification. The study includes recommendations for more research into the contexts and processes of collaborative models of professional learning, and into the changing role and professional learning requirements of inservice teacher educators. It also identifies a need to investigate valid means of judging effectiveness of practice for inservice teacher educators, since evidence of enhanced student learning is linked only by a chain of influence to inservice teacher educator practice.&lt;/p&gt;

A lot of students consumed snack that has imbalanced food quality and nutritional values. Preliminary study showed that 54,5% students at 001 Teratak elementary school had low level of knowledge on healthy snack choice. Nutrition education is needed with efficient and simple method such as guessing picture. The aim of this study was to analyze the effect of guessing picture media method on student’s knowledge on healthy snack choice in 001 Teratak Elementary School. This was quasy experimental study with a pre-test post-test control group design. 42 samples selected from 46 students in class 5 by purposive sampling technique with inclusion and exclusion criteria. Samples divided into intervention (n=21) and control group (n=21). The intervention group had guessing healthy snack choice picture while the control group had guessing ordinary pictures. Research variables were the level of knowledge in intervention and control group based on the value of the pre-test and post-test. The results showed that there was significant increase of knowledge that were given nutritional education of healthy snack choice using guessing picture media method (p

BackgroundThere is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute...

ObjectivesIran ranks among the top six countries globally with a significant incidence of Cutaneous Leishmaniasis (CL). Using planning models is one community-based intervention to promote preventive behaviors. The purpose of our study was to evaluate the effectiveness of the PRECEDE-PROCEED model (PPM) in modifying preventive behaviors related to CL in children through mother training in a community intervention.MethodsA randomized controlled trial based on the PPM model was conducted on 168 mothers (intervention (n = 84) and control group (n = 84) with 10 years old children in the rural areas of Iran. Mothers from 7 village areas were randomly allocated to the intervention (2 village) and control groups (5 village). The intervention group received a program comprising eight 90-minute training sessions and environmental interventions. In this study, we utilized the PPM as a framework to design the questionnaires on Leishmaniosis prevention behavior. Participants in both groups completed the questionnaires at baseline (before the intervention), immediately after the intervention, and at the 2-month follow-up. Analysis of the data was conducted utilizing SPSS20, with statistical significance set at p < 0.05.ResultsCompared to the control group, the intervention group showed significant increases in knowledge, enabling factors, reinforcing factors, attitude, and preventive behaviors related to Cutaneous Leishmaniasis over time from baseline to follow-up (P < 0.001). No significant differences (P > 0.05) were observed in the alterations of the PPM construct, knowledge, and preventive behaviors within the control group from pre-intervention to follow-up.ConclusionsCommunity (education and environmental) intervention based on PPM is feasible and acceptable to modify preventive behaviors of Cutaneous Leishmaniasis in children by increasing a mother’s knowledge and attitude as well as changing enabling and reinforcing factors.Trial registrationIRCT20160619028529N8.

Low knowledge of reproductive health among adolescents is characterized by an increase in premarital sexual behavior and limited access to information. The government, through the National Population and Family Planning Agency (BKKBN), developed the Generasi Berencana (GenRe) Program with the Youth Information and Counseling Center (PIK-R) based in schools as an effort to educate adolescents about reproductive health. Objective: This study aims to analyze the effectiveness of PIK-R education in improving adolescents' knowledge of reproductive health. The research design was quasi-experimental with a pre-post test with control group. A sample of 180 respondents was determined using purposive sampling and divided into intervention and control groups. The research instrument used a reproductive health knowledge questionnaire. Data analysis was performed using the Wilcoxon signed rank test and Mann-Whitney test. Results the study showed a significant increase in knowledge in the intervention group (p=0.000) after receiving PIK-R education compared to the control group (p=0.000). Education combined with board games and interactive counseling sessions proved to be effective in improving students' understanding and engagement in the learning process regarding reproductive health. Conclusion school-based PIK-R education has been proven effective in improving adolescents' reproductive health knowledge using an innovative approach.

Rheumatoid nodules: differential diagnosis and immunohistological findings.

Differences in prescribing behaviour among general practitioners (GPs). To formulate and validate clinical prescribing indicators based on general practice guidelines. Validatory study. Pharmacies and general practices in the Netherlands in 2003. A total of 379 pharmacies, 947 general practices and 3.8 million patients. A total of 51 potential indicators were formulated, based on medicinal recommendations from the evidence-based guidelines of the Dutch College of General Practitioners and the corresponding recommendations from the Commission Pharmaceutical Help of the Health Care Insurance Board. These indicators were submitted to an expert panel to assess content validity. The panel assessment was analysed using the RAND-UCLA appropriateness method (RAM). Then, for the remaining indicators, it was assessed to what extent these could be used to determine the prescribing behaviour of GPs and the level to which this behaviour varies among GPs. This was done using a prescribing analyses and cost (PACT) database that was compiled from prescription databases from 379 pharmacies, with all prescriptions from 1,434 GPs over an entire year to 3.8 million patients. The panel considered 34 of the 51 potential indicators to be valid with respect to providing an adequate reflection of the central recommendations in the guideline and in terms of relevance with respect to health gain and/or efficiency. Of these 34 indicators, 20 revealed considerable differences in the prescribing behaviour of GPs. On the basis of existing general practice guidelines, 20 prescribing indicators could be formulated that were assessed by an expert panel to be sufficiently valid and which could also discriminate the prescribing behaviour of GPs as reflected in the prescription databases of pharmacies.

Objective To systematically review the effectiveness of general practitioner contract service on blood glucose management and treatment compliance in diabetes patients in the community, and provide a basis and reference for general practitioner to manage diabetes patients. Methods We searched electronic databases including CNKI, VIP,CBM and WanFang Data for published articles from inception to Jan. 31 2018. Collected all literature on the study of general practitioner contract service and conventional community intervention in diabetic patients. According to the inclusion and exclusion criteria, two reviewers screened literature and extracted data of included studiesindependently. Then, meta-analysis was performed using Stata 12.0 software. Results Totally, 38 experiment studies were collected involving 8 809 diabetic patients, including 4 551 patients who received the contract service of general practitioner and 4 258 patients who received conventional community intervention. Compared with conventional community intervention group, the biochemical indexes in the contract service of general practitioner group were significantly lowerthan that of the control groups, except for high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol level. The level of HbA1c among intervention group was decreased with 1.07% compared with that of control group (SMD=-1.070, 95%CI=-1.309,-0.831). Diastolic blood pressure (DBP) was not significantly different between the intervention and control group (SMD=-0.171, 95%CI=-0.366, 0.025, P>0.05). The patient compliance indexes, such as taking drugs in a timely manner, dietary control, blood glucose monitoring and physical exercise, were significantly improvedamong intervention group:23.9% (RR=1.239,95%CI=1.147,1.338), 28.7% (RR=1.287, 95%CI=1.021,1.622), 39.4% (RR=1.394,95%CI=1.226,1.584) and 38.0% (RR=1.380, 95%CI=1.209,1.576) respectively. Conclusion The contract service of general practitioner has much more effectiveness and compliance than the traditional management of diabetes in communities. Key words: Diabetes mellitus; General practitioner; General practitioner contract service; Meta-analysis