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Guidelines to support health care professionals in early detection of, and responses to, suspected Child Abuse and Neglect (CAN) have become increasingly widely available. Yet little is known about professionals’ adherence to these guidelines or the determinants that affect their uptake. This study used a cross-sectional design to assess the adherence of Dutch Child Health Care (CHC) professionals to seven key activities described in a national guideline on preventing CAN. This study also examined the presence and strengths of determinants of guideline adherence. Online questionnaires were filled in between May and July 2013 by 164 CHC professionals. Adherence was defined as the extent to which professionals performed each of seven key activities when they suspected CAN. Thirty-three determinants were measured in relation to the guideline, the health professional, the organisational context and the socio-political context. Bivariate and multivariate regression analyses tested associations between determinants and guideline adherence. Most of the responding CHC professionals were aware of the guideline and its content (83.7%). Self-reported rates of full adherence varied between 19.5% and 42.7%. Stronger habit to use the guideline was the only determinant associated with higher adherence rates in the multivariate analysis. Understanding guideline adherence and associated determinants is essential for developing implementation strategies that can stimulate adherence. Although CHC professionals in this sample were aware of the guideline, they did not always adhere to its key recommended activities. To increase adherence, tailored interventions should primarily focus on enhancing habit strength. 相似文献
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This study examined the presence and strengths of determinants associated with consultation of an in-house expert on child abuse and neglect (CAN) by preventive child health care professionals who suspect CAN. This study also assessed the relationship between in-house CAN expert consultation and professionals’ performance of six recommended activities described in a national guideline on preventing CAN for preventive child health care professionals. A total of 154 professionals met the study’s inclusion criteria. They filled in a questionnaire that measured in-house consultation practices and twelve determinants associated with the professional, the in-house expert, and the organizational context. Bivariate and multivariate regression analyses were performed. Almost half of the participants (46.8%) reported to consult the in-house expert in (almost) all of their suspected CAN cases. Professionals who reported better recollection of consulting the in-house expert (i.e. not forgetting to consult the expert) (p = .001), who were more familiar with consultation (p = .002), who had more positive attitudes and beliefs about consultation (p = .011) and who reported being more susceptible to the behavior (p = .001) and expectations/opinions (p = .025) of colleagues regarding in-house expert consultation were more likely to consult the in-house expert. Furthermore, in-house expert consultation was positively associated with two of six key guideline activities: consulting the regional child protection service and monitoring whether support was provided to families. The implications of these results for improving professionals’ responses to CAN are discussed. 相似文献
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目的 总结26例肾移植的临床经验和教训。方法 回顾26例肾移植的临床资料,分析供受的状况,组织配型,移植手术,术后并发症及免疫抑制治疗方案对移植效果的影响。结果 70年代有80年代一年人/肾存活率均为33.3%/33.3%,90年代一年,三年人/肾存活率分别为90%/85%,80%/75%,超急性排斥反应发生率3.9%,急性及慢性排斥反应发生率均为11.5%,药物中毒发生率7.8%。结论 合理应用免疫抑制剂,提高外科手术,加强组织配型是提高肾移植受存活率的关键因素。 相似文献
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Margaret Attwood 《Action Learning: Research and Practice》2007,4(2):191-198
Can the development, both clinical and managerial, of practitioners involved in healthcare be enriched by connecting action learning principles and practice with research on ‘tempered radicals’? Might such connection also assist the efforts of patients and their advocates to create more holistic approaches to patient care? This paper explores these questions with reference to a UK Department of Health project to improve renal services. The prime focus is the experience of a set of set advisers who ‘held the ring’ on the project, supporting the work of the sets and attempting to make sense of the emerging learning. 相似文献
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教师是一个类似于医学、护理或临床心理学的临床实践专业。为达成培养高效教师的终极目标,美国"临床实践型教师教育"聚焦实践性教育学环节,对教育实习的目标与内容、实习基地学校和指导教师的资格认证均作出了明确规定。为确保教育实习的成效,"临床实践型教师教育"强调相关主体应建立起支持性合作伙伴关系,并尝试搭建全国性的信息网络平台,从而形成具有整体性、连贯性的教育实习体系,以培养高效教师,满足教育需求。 相似文献
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刘岩 《鞍山师范学院学报》2002,4(2):110-112
人的思维是在意识和无意识两种层面上进行的,学生的学习主要以有意识的活动为主,但同样离不开无意识活动的参与.本实验研究就是通过运用暗示教学技术,帮助大学生建立无意识心理倾向,开发其学习潜能,进而使其能够加速学习,提高学习效率. 相似文献
8.
针刀松解法治疗膝骨关节炎临床对照研究 总被引:3,自引:0,他引:3
目的:通过与电针治疗膝骨关节炎的疗效进行对比,观察针刀对膝骨关节炎患者各项指标的影响以及总体疗效如何。方法:采用随机、对照的方法,试验组24例,采用针刀治疗;对照组24例,采用电针治疗。对比两组临床疗效。结果:(1)经过3周的治疗,电针组和针刀组均取得了一定的近期效果,与治疗前相比各项指标均有显著改善,两组的有效率比较无显著差异。(2)疗效的趋向性与治疗方法有关,针刀组更加趋向于临床治愈(P=0.04)。(3)两组患者治疗前后自身指标分值比较:疼痛、关节僵硬、生理功能、压痛、肿胀、关节活动度均有下降,具有统计学意义;针刀组与电针组治疗后各指标分值比较,疼痛、关节僵硬、生理功能、压痛、肿胀均无统计学意义。针刀组患者治疗后关节活动度显著优于电针组。结论:通过上述研究认为针刀治疗膝骨关节炎近期疗效良好,值得进一步深入研究。 相似文献
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For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC = .700, 95% CI [.567–.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC = .591, 95% CI [.422–.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC = .720, 95% CI [.593–.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs. 相似文献
10.
In this article we propose that medical practice evolves as a result of progress along three different pathways: improvement in the ability to develop effective medical technologies, learning in medical practice, and advances in biomedical scientific understanding of disease. The relative importance of these three pathways varies from case to case, and often they interact strongly. More specifically, we argue here that in cases of therapeutic innovation where a new medical technology is involved the advance in medical practice is driven largely by the ability to develop and use effective medical artifacts and the interactive sequence among these interdependent pathways often starts with what is learned in practice and not in science. While we state this argument in general, we develop it in detail in a longitudinal and contextual case study of the emergence and evolution of a treatment for advanced heart failure based on an implantable device, the Left Ventricular Assist Device (LVAD). Our findings show that an essential aspect of the evolution of the LVAD therapy is collective and cumulative learning that requires experience that only can be gained through the actual use of LVADs. We discuss the theoretical and policy implications that follow from our understanding of how medical practice evolves for research on the evolution of medical practices and new medical technologies, and policies about the evaluation of rapidly moving medical practices and clinical research involved in their advancement. 相似文献