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Tsang, B., D. McDonald, I. McNamara, L. Kottam, A. Rangan und P. Baker. „National survey of occupational advice for lower limb arthroplasty patients“. Occupational Medicine 70, Nr. 2 (03.02.2020): 123–26. http://dx.doi.org/10.1093/occmed/kqaa006.
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Abstract Background Little is known what advice or support patients are given about return to work (RTW) after hip or knee replacement surgery. Aims This study aims to understand the delivery, timing and content of ‘RTW’ advice currently delivered by surgical teams offering hip and knee replacements across the UK. Methods National online survey exploring five specific areas relating to ‘RTW’ advice: (i) timings of interactions between hospital orthopaedic teams and patients prior to surgery, (ii) routine delivery of ‘RTW’ advice, (iii) methods used to deliver ‘RTW’ advice, (iv) confidence delivering advice and (v) need for an occupational ‘RTW’ advice intervention. Results A total of 152 participants including surgeons, physiotherapists, occupational therapists and nurses from 59 different public and private health providers responded. Only 20% (n = 30) of respondents reported that working patients were identified as a specific subgroup in need of additional support. Overall, 62% (n = 92) stated that they did not routinely offer ‘RTW’ advice. When given, ‘RTW’ advice was almost always verbal, generic advice using blanket timescales and based on the respondent’s anecdotal experience rather than the patients individualized needs. Overall, 116 (78%) felt an occupational advice intervention was needed. Conclusions This national survey demonstrated wide variation in the timing, content and delivery of information and advice for patients in work and intending to RTW after hip and knee replacement surgery. Current RTW advice provided to hip and knee replacement patients is inadequate.
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Pallin, Nickola D., Rebecca J. Beeken, Kathy Pritchard-Jones, Laura Charlesworth, Nick Woznitza und Abigail Fisher. „Therapeutic radiographers’ delivery of health behaviour change advice to those living with and beyond cancer: a qualitative study“. BMJ Open 10, Nr. 8 (August 2020): e039909. http://dx.doi.org/10.1136/bmjopen-2020-039909.
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ObjectivesTherapeutic radiographers (TRs) are well placed to deliver health behaviour change advice to those living with and beyond cancer (LWBC). However, there is limited research on the opinions of TRs around delivering such advice to those LWBC. This study aimed to explore TRs’ practices and facilitators in delivering advice on physical activity, healthy eating, alcohol intake, smoking and weight management.Setting and participantsFifteen UK-based TRs took part in a telephone interview using a semi‐structured interview guide. Data was analysed using the framework analysis method.ResultsEmergent themes highlighted that TRs are mainly aware of the benefits of healthy behaviours in managing radiotherapy treatment related side effects, with advice provision lowest for healthy eating and physical activity. Participants identified themselves as well placed to deliver advice on improving behaviours to those LWBC, however reported a lack of knowledge as a limiting factor to doing so. The TRs reported training and knowledge as key facilitators to the delivery of advice, with a preference for online training.ConclusionsThere is a need for education resources, clear referral pathways and in particular training for TRs on delivering physical activity and healthy eating advice to those LWBC.
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Silvestri, Nathaniel J., Jennifer Dahne, Amy E. Wahlquist, Benjamin Toll und Matthew J. Carpenter. „Does Medication Sampling Improve Compliance with Brief Advice? Results from a Pragmatic Randomized Clinical Trial“. Journal of Smoking Cessation 2021 (15.03.2021): 1–4. http://dx.doi.org/10.1155/2021/6638872.
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Introduction. The 5As model is a standard component of most guidelines for tobacco treatment. Unfortunately, provider adherence to this model is modest. Aims. Providing physicians with adjunctive tools to adhere to 5As guidelines may serve as a catalyst for brief advice delivery. Methods. This was a secondary data analysis of a cluster randomized clinical trial assessing the uptake and impact of free nicotine replacement therapy (NRT) sampling versus standard care in primary care. Patients reported receipt of separate elements of the 5As model, assessed one month following a baseline visit. Analyses compared patients who recalled receipt of brief advice among those who received NRT vs. standard care. Additional analyses examined demographic predictors of receiving brief advice. Results/Findings. Medication sampling did not improve compliance with ask, advise, or assess. Receipt of “assistance” was significantly higher among NRT recipients (70%) ( p ≤ 0.0001 ). The NRT sampling group was more likely to have received all components ( p = 0.004 ). As age increased, being asked ( p = 0.006 ), advised ( p = 0.05 ), and assessed ( p = 0.003 ) decreased. Non-Whites reported higher rates of assessment ( p = 0.02 ). Conclusions. Provision of NRT sampling increased provider compliance with some elements of the brief advice model, thus enhancing the impact of cessation advice within primary care. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02096029.
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Tanaka, Lidia. „Advice in Japanese radio phone-in counselling“. Pragmatics. Quarterly Publication of the International Pragmatics Association (IPrA) 25, Nr. 2 (01.06.2015): 251–85. http://dx.doi.org/10.1075/prag.25.2.06tan.
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Unlike the short and specific advice of service-encounters, advice in counselling settings is longer and more complex. In these interactions, it is known that advice is initially resisted in all languages. Scholars have tried to explain this phenomenon in terms of ‘face loss’ (Brown and Levinson 1987; Goldsmith 1992, 1994; Hinkel 1994; Murakami 1994); premature delivery (Heritage and Sefi 1992); the inappropriateness of the advisors (Jefferson and Lee 1992); or discrepancies in the interpretation of a problem (Murakami 1994). One of the difficulties in counselling or therapeutic settings is that the giving of advice in these interactions is a ‘process’ that is long and complex. In order to understand advice resistance, it is essential, first and foremost, to identify the characteristics of advice and how it is delivered. The present analysis of Japanese radio phone-in programs focuses on advice in order to identify its formal characteristics and also to try to understand the factors that determine its acceptance or resistance.
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O’Donovan, Clare B., Marianne C. Walsh, Clara Woolhead, Hannah Forster, Carlos Celis-Morales, Rosalind Fallaize, Anna L. Macready et al. „Metabotyping for the development of tailored dietary advice solutions in a European population: the Food4Me study“. British Journal of Nutrition 118, Nr. 8 (23.10.2017): 561–69. http://dx.doi.org/10.1017/s0007114517002069.
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AbstractTraditionally, personalised nutrition was delivered at an individual level. However, the concept of delivering tailored dietary advice at a group level through the identification of metabotypes or groups of metabolically similar individuals has emerged. Although this approach to personalised nutrition looks promising, further work is needed to examine this concept across a wider population group. Therefore, the objectives of this study are to: (1) identify metabotypes in a European population and (2) develop targeted dietary advice solutions for these metabotypes. Using data from the Food4Me study (n 1607), k-means cluster analysis revealed the presence of three metabolically distinct clusters based on twenty-seven metabolic markers including cholesterol, individual fatty acids and carotenoids. Cluster 2 was identified as a metabolically healthy metabotype as these individuals had the highest Omega-3 Index (6·56 (sd 1·29) %), carotenoids (2·15 (sd 0·71) µm) and lowest total saturated fat levels. On the basis of its fatty acid profile, cluster 1 was characterised as a metabolically unhealthy cluster. Targeted dietary advice solutions were developed per cluster using a decision tree approach. Testing of the approach was performed by comparison with the personalised dietary advice, delivered by nutritionists to Food4Me study participants (n 180). Excellent agreement was observed between the targeted and individualised approaches with an average match of 82 % at the level of delivery of the same dietary message. Future work should ascertain whether this proposed method could be utilised in a healthcare setting, for the rapid and efficient delivery of tailored dietary advice solutions.
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Koutoukidis, Dimitrios A., Sonia Lopes, Abigail Fisher, Kate Williams, Helen Croker und Rebecca J. Beeken. „Lifestyle advice to cancer survivors: a qualitative study on the perspectives of health professionals“. BMJ Open 8, Nr. 3 (März 2018): e020313. http://dx.doi.org/10.1136/bmjopen-2017-020313.
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ObjectivesAdoption of healthy lifestyle behaviours has shown promising effectiveness in reducing the high morbidity burden of cancer survivors. Health professionals (HPs) are well suited to provide lifestyle advice but few survivors report receiving guidance from them. This study aimed to explore HPs’ perspective of lifestyle advice (on healthy eating, physical activity, smoking, and alcohol) for cancer survivors.DesignIn-depth semistructured qualitative interviews were conducted by telephone or face to face. Data were analysed using qualitative content analysis.Setting and participantsTwenty-one UK HPs working in secondary care with breast, prostate or colorectal cancer survivors were interviewed.ResultsThe overarching theme was that HPs’ desire to provide lifestyle advice was not necessarily matched by knowledge and action. Three main themes were identified: (1) survivorship-centred barriers to provision, (2) HP-centred barriers to provision, and (3) optimal delivery of lifestyle advice. Results suggested that HPs’ perceptions of survivors’ current status of practising health behaviours, their perceived socioeconomic barriers and ability to practise health behaviours, and HPs’ fear for potential loss of connection with the patient influenced provision of lifestyle advice. Further factors included HPs’ knowledge of healthy lifestyle guidelines, feeling that they were not the ‘right person’ to provide advice, and lack of time and resources. HPs stressed that the optimal delivery of lifestyle advice should (1) be tailored to the individual and delivered throughout the cancer journey, (2) be focused on small and achievable changes framed as part of their treatment regimen and (3) be cost-effective for wide-scale implementation.ConclusionsIncorporation of the identified barriers when developing HP training programmes and lifestyle interventions could increase the probability of successful behavioural change, and thus improve outcomes for cancer survivors.
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Oberklaid, Frank. „Paediatric telephone advice: A major gap in quality service delivery“. Journal of Paediatrics and Child Health 38, Nr. 1 (Februar 2002): 6–7. http://dx.doi.org/10.1046/j.1440-1754.2002.00809.x.
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Bachman, Timothy A. „INFORMATION AND ADVICE: Innovations and Product Delivery for Financial Services“. Design Management Journal (Former Series) 3, Nr. 1 (10.06.2010): 103–10. http://dx.doi.org/10.1111/j.1948-7169.1992.tb00595.x.
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Krska, Janet, Ruth du Plessis und Hannah Chellaswamy. „Implementation of NHS Health Checks in general practice: variation in delivery between practices and practitioners“. Primary Health Care Research & Development 17, Nr. 04 (02.11.2015): 385–92. http://dx.doi.org/10.1017/s1463423615000493.
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AimTo evaluate NHS Health Check implementation in terms of frequency of data recording, advice provided, referrals to community-based lifestyle support services, statin prescribing and new diagnoses, and to assess variation in these aspects between practices and health professionals involved in delivery.BackgroundMost NHS Health Checks are delivered by general practices, but little detail is known about the extent of variation in how they are delivered in different practices and by different health professionals.MethodsThis was an observational study conducted in a purposively selected sample of 13 practices in Sefton, North West England. Practices used previously recorded information from their clinical management systems to identify patients with cardiovascular disease (CVD) risk ⩾20%, a potentially cost-effective approach. The evaluation was conducted during the first year of delivery in Sefton. Data were extracted from medical records of all patients identified, regardless of Health Check attendance.FindingsOf the 2892 patients identified by the 13 practices, 1070 had received an NHS Health Check at the time of the study. Of these, only 936 (87.5%) had a recorded CVD risk score, with risk ⩾20% confirmed in 92.0%. Estimated risk category was correct in 456/677 (67.4%) of patients with estimated and actual risk scores.Significant variation was found between practices and health professionals in parameters recorded, tests requested, advice given and referrals for lifestyle support. Only 45.3% of patients had body mass index, smoking, alcohol, exercise, blood pressure and cholesterol all recorded.Lifestyle advice and referral into lifestyle services were documented in 80.6% and 6.4% of attenders, respectively, again with significant variation between practices and professionals. Statin prescribing rose in attenders from 19.6% to 34.6%. A similar proportion of attenders and non-attenders received new diagnoses.ConclusionEffort is required to reduce variation in how practices deliver and follow-up NHS Health Checks, to ensure the consistency of the programme.
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Joshi, Prajakta Ganesh, und Ganesh Arun Joshi. „Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital“. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, Nr. 9 (28.08.2017): 4028. http://dx.doi.org/10.18203/2320-1770.ijrcog20174057.
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Background: Diabetes mellitus (DM) may be present in the patient before the conception or it may appear during pregnancy. Obstetric management shall ensure prevention of diabetic embryopathy and early detection and management of diabetic complications in pregnancy.Methods: A descriptive observational study was undertaken on participants from a Medical College Hospital. The pre-existing medical disorders, blood sugar, routine antenatal investigations, type of delivery, ultrasound findings, complications of delivery, foetal outcome etc. were recorded. The participants were advised diet, exercise and pharmacotherapy. The intranatal and postnatal events were recorded. The results were compared with related literature.Results: The study had total 89 participants. Five participants (5.6%) had abnormal blood sugar values. Out of these, 2 participants were having pregestational DM and 3 were having gestational DM. Although all the participants who had abnormal blood sugar levels required caesarean section, two could not be operated. One participant with gestational DM who did not follow management advice delivered a macerated still born baby after shoulder dystocia. Another participant having gestational DM, who complied strictly as per dietary advice and exercise, could be managed well without insulin and delivered a healthy baby. The requirement of insulin increased in pregnancy in patients with pregestational diabetes.Conclusions: It is essential to ensure compliance on all three pillars of management of diabetes viz. diet, exercise and insulin during pregnancy. Hence health education for diabetes with special emphasis on obstetric care in pregnancy with diabetes should be promoted.
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MacGeorge, Erina L., Kasey A. Foley, Emily P. C. Firgens, Rachel R. Vanderbilt, Amber K. Worthington und Nicole M. Hackman. „“Watchful Waiting” Advice for Pediatric Ear Infections“. Journal of Language and Social Psychology 39, Nr. 3 (12.05.2020): 414–24. http://dx.doi.org/10.1177/0261927x20912292.
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To reduce antibiotic use, clinical guidelines recommend treating many pediatric ear infections with watchful waiting (WW), which entails parents managing children’s symptoms while waiting to see if the infection will resolve without antibiotics. This study examines providers’ WW advice in recorded medical visits ( n = 28), focusing on five communication elements specified by guidelines and consistent with advice response theory. Results suggest directions for improving providers’ delivery of WW advice and are discussed with regard to theory.
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RAM, FAUJDAR, und ABHISHEK SINGH. „IS ANTENATAL CARE EFFECTIVE IN IMPROVING MATERNAL HEALTH IN RURAL UTTAR PRADESH? EVIDENCE FROM A DISTRICT LEVEL HOUSEHOLD SURVEY“. Journal of Biosocial Science 38, Nr. 4 (08.09.2005): 433–48. http://dx.doi.org/10.1017/s0021932005026453.
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Data from the District Level Household Survey (2002) conducted by the Reproductive and Child Health Project in India has been used to examine the impact of utilization of antenatal care services on improvement in maternal health in rural areas of Uttar Pradesh, India. Multilevel analysis shows that after controlling for other socioeconomic and demographic factors, utilization of antenatal care services may lead to the utilization of other maternal health related services such as institutional delivery, delivery assisted by trained professionals, seeking advice for pregnancy complications, and seeking advice for post-delivery complications. There is strong clustering of utilization of services within the primary sampling units (i.e. villages) and districts.
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Sur, S., K. W. Murphy und I. Z. Mackenzie. „Delivery after caesarean section: Consultant obstetricians' professional advice and personal preferences“. Journal of Obstetrics and Gynaecology 29, Nr. 3 (Januar 2009): 212–16. http://dx.doi.org/10.1080/01443610902735785.
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Henman, Paul. „Of algorithms, Apps and advice: digital social policy and service delivery“. Journal of Asian Public Policy 12, Nr. 1 (13.07.2018): 71–89. http://dx.doi.org/10.1080/17516234.2018.1495885.
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Moszynski, P. „World Food Programme seeks advice on improving safety of aid delivery“. BMJ 340, may24 2 (24.05.2010): c2750. http://dx.doi.org/10.1136/bmj.c2750.
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Franco, Rodrigo Zenun, Rosalind Fallaize, Faustina Hwang und Julie A. Lovegrove. „Strategies for online personalised nutrition advice employed in the development of the eNutri web app“. Proceedings of the Nutrition Society 78, Nr. 3 (18.12.2018): 407–17. http://dx.doi.org/10.1017/s0029665118002707.
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The internet has considerable potential to improve health-related food choice at low-cost. Online solutions in this field can be deployed quickly and at very low cost, especially if they are not dependent on bespoke devices or offline processes such as the provision and analysis of biological samples. One key challenge is the automated delivery of personalised dietary advice in a replicable, scalable and inexpensive way, using valid nutrition assessment methods and effective recommendations. We have developed a web-based personalised nutrition system (eNutri) which assesses dietary intake using a validated graphical FFQ and provides personalised food-based dietary advice automatically. Its effectiveness was evaluated during an online randomised controlled trial dietary intervention (EatWellUK study) in which personalised dietary advice was compared with general population recommendations (control) delivered online. The present paper presents a review of literature relevant to this work, and describes the strategies used during the development of the eNutri app. Its design and source code have been made publicly available under a permissive open source license, so that other researchers and organisations can benefit from this work. In a context where personalised diet advice has great potential for health promotion and disease prevention at-scale and yet is not currently being offered in the most popular mobile apps, the strategies and approaches described in the present paper can help to inform and advance the design and development of technologies for personalised nutrition.
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O’Hara, Rachel, Lindsey Bishop-Edwards, Emma Knowles und Alicia O’Cathain. „PP15 Non-technical skills in the delivery of ambulance service telephone advice“. Emergency Medicine Journal 36, Nr. 1 (Januar 2019): e6.2-e7. http://dx.doi.org/10.1136/emermed-2019-999.15.
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BackgroundAround 10% of calls to ambulance services in England are resolved over the phone (referred to as telephone advice or hear and treat). These calls are generally dealt with by clinicians following initial call-handler assessment. A systematic review concluded that telephone advice is a safe alternative for patients categorised as low priority but recommended the need to understand the skills required. Our research explores the non-technical skills (cognitive, social and personal) required.MethodsNon-participant observation of telephone advice in three ambulance services involved 40 hours of observation per service, (total n=27 clinicians and 20 call-handlers) and semi-structured interviews with clinicians (n=7), call-handlers (n=7) and managers (n=3). A framework approach and NVIVO qualitative data analysis software were used to analyse the data.FindingsSituation awareness was a necessary skill in gathering information by telephone. Strategies included visualisation, attending to tone of voice and listening to Background noise. Decision making skill was needed to select an appropriate course of action. For clinicians this involved reference to prior experience and risk judgement that the available information supported a safe decision. Call-handlers were more reliant on computerised triage systems. Communication skill required rephrasing technical questions, providing reassurance and assertiveness in managing expectations. Call-handlers had less discretion to rephrase computerised scripts. Personal resources were required to manage role demands that included dealing with high call volumes, task conflict and difficult conversations with callers expecting an ambulance response.ConclusionsThe findings have implications for the recruitment, training and ongoing development of call-handlers and clinicians involved in the delivery of telephone advice. There is scope for further research to provide a more detailed understanding of non-technical skills in the delivery of telephone advice to ensure the consistent delivery of appropriate and safe care that is acceptable to patients.
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Mitchell, Lana J., Lesley MacDonald-Wicks und Sandra Capra. „Nutrition advice in general practice: the role of general practitioners and practice nurses“. Australian Journal of Primary Health 17, Nr. 2 (2011): 202. http://dx.doi.org/10.1071/py10101.
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General practice is an ideal setting to be providing nutrition advice; however, it is important that the role of general practitioners (GPs) and practice nurses in providing nutrition advice is acknowledged and defined. This article aims to discuss the role of GPs and practice nurses in the delivery of nutrition advice. Ten general practitioners and 12 practice nurses from a NSW urban Division of General Practice participated in questionnaires and a Lifescripts© implementation study, as well as their consenting patients receiving Lifescripts© (n = 13). An online survey was conducted with 90 Australian private practice dietitians. Semi-structured telephone interviews were conducted with 52 Australian private practice dietitians. The provision of basic nutrition advice is acknowledged to be part of the role of GPs and practice nurses, as they are the first point of contact for patients, allowing them to raise nutrition awareness. However, it is important that this advice is evidence based and able to be delivered in a time-efficient manner. Increased nutrition education and the availability of appropriate resources and nutrition-related best practice guidelines will assist in this process.
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O'Hara, Rachel, Lindsey Bishop-Edwards, Emma Knowles und Alicia O'Cathain. „Variation in the delivery of telephone advice by emergency medical services: a qualitative study in three services“. BMJ Quality & Safety 28, Nr. 7 (12.01.2019): 556–63. http://dx.doi.org/10.1136/bmjqs-2018-008330.
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BackgroundAn emergency ambulance is not always the appropriate response for emergency medical service patients. Telephone advice aims to resolve low acuity calls over the phone, without sending an ambulance. In England, variation in rates of telephone advice and patient recontact between services raises concerns about inequities in care. To understand this variation, this study aimed to explore operational factors influencing the provision of telephone advice.MethodsThis is a multimethod qualitative study in three emergency medical services in England with different rates of telephone advice and recontact. Non-participant observation (120 hours) involved 20 call handlers and 27 clinicians (eg, paramedics). Interviews were conducted with call handlers, clinicians and clinician managers (n=20).ResultsServices varied in their views of the role of telephone advice, selection of their workforce, tasks clinicians were expected and permitted to do, and access to non-ambulance responses. Telephone advice was viewed either as an acceptable approach to managing demand or a way of managing risk. The workforce could be selected for their expertise or their inability to work ‘on-the-road’. Some services permitted proactive identification of calls for a lower priority response and provided access to a wider range of response options. The findings aligned with telephone advice rates for each service, particularly explaining why one service had lower rates.ConclusionSome of the variation observed can be explained by operational differences between services and some of it by access to alternative response options in the wider urgent and emergency care system. The findings indicate scope for greater consistency in the delivery of telephone advice to ensure the widest range of options to meet the needs of different populations, regardless of geographical location.
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Wang, Tina J., und Jeffrey A. Russell. „A Tenuous Pas de Deux: Examining University Dancers’ Access to and Satisfaction with Healthcare Delivery“. Medical Problems of Performing Artists 33, Nr. 2 (01.06.2018): 111–17. http://dx.doi.org/10.21091/mppa.2018.2018.
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BACKGROUND: Dance is a rigorous art form and athletic activity accompanied by a high injury rate. The purpose of this study was to gather injury and healthcare availability information from university dancers to better understand dancers’ access to professional medical attention and their satisfaction with the medical advice they receive. METHODS: An author-designed online questionnaire about dance-related injury (DRI), access to healthcare, and satisfaction with healthcare was distributed to dancers at 102 American post-secondary institutions in 2 states that offer programs in dance; 211 dancers completed the survey. RESULTS: 75% of dancers reported seeking healthcare advice from dance teachers. A majority (55%) who visited healthcare professionals for a DRI disclosed negative experiences; the top reasons stemmed from the professionals’ not understanding dancers (70%), providing unhelpful advice (43%), or not spending enough time in the healthcare consultation (33%). Of dancers who reported positive experiences, they most commonly discovered the provider by word-of-mouth (89%) or through the provider’s affiliation with their institution (41%). CONCLUSION: Dancers tend to access healthcare when it is available to them but find the lack of relevant and applicable advice from healthcare practitioners the biggest contributors to their negative experience with the healthcare system. When confronted with DRIs, dancers tend to seek advice from their dance instructors. To ensure proper evaluation, instructors should refer dancers to licensed healthcare providers, and dance medicine practitioners should make themselves known to dancers through both formal and informal networks.
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Rosseel, J. P., J. E. Jacobs, S. R. Hilberink, D. Segaar, R. Akkermans, I. M. Maassen, A. J. M. Plasschaert und R. P. T. M. Grol. „Patient-reported feedback promotes delivery of smoking cessation advice by dental professionals“. International Journal of Health Promotion and Education 50, Nr. 3 (Mai 2012): 101–10. http://dx.doi.org/10.1080/14635240.2012.661958.
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McCarty, Maribet C., Deborah J. Hennrikus, Harry A. Lando und John T. Vessey. „Nurses' Attitudes Concerning the Delivery of Brief Cessation Advice to Hospitalized Smokers“. Preventive Medicine 33, Nr. 6 (Dezember 2001): 674–81. http://dx.doi.org/10.1006/pmed.2001.0944.
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Okawa, Sumiyo, Hla Hla Win, Keiko Nanishi, Akira Shibanuma, Phyu Phyu Aye, Thu Nandar Saw und Masamine Jimba. „Advice on healthy pregnancy, delivery, motherhood and information on non-communicable diseases in the maternal care programme in Myanmar: a cross-sectional study“. BMJ Open 9, Nr. 3 (März 2019): e025186. http://dx.doi.org/10.1136/bmjopen-2018-025186.
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ObjectivePregnancy and delivery periods offer an opportunity for counselling women to improve behavioural risk and prevent complications, including non-communicable diseases (NCDs). However, little evidence is available on counselling offered during antenatal and postnatal care (PNC) in Myanmar. This study aimed to assess the contents of advice and information received by women during antenatal and postnatal counselling and to identify factors associated with receiving those advice and information.DesignCross-sectional study.SettingA predominantly rural township in the Ayeyawady region and a predominantly urban township in the Yangon region.Participants1500 women who had given birth in the last 6 weeks to 12 months prior to the survey.Outcome measuresReceiving advice on 18 items during antenatal counselling, 10 items during postnatal counselling and information on five major NCDs during antenatal care (ANC).ResultsNearly 52% of women received advice on 18 items during antenatal counselling, and 60% received advice on 10 items during postnatal counselling. About 28% received information on five NCDs during ANC. Women who were living in the Yangon site, who had primary school education or lower and who experienced complications were less likely to receive advice on all items during both antenatal and postnatal counselling. Women who received PNC outside of a healthcare facility and were primiparas were also less likely to receive advice on all items during postnatal counselling. Women living in the Yangon site and those who utilised a private care facility were less likely to receive information on NCDs.ConclusionsOnly 60% of women received advice on healthy pregnancy, delivery and motherhood, whereas 30% received information on NCDs. Although non-modifiable maternal factors were associated with these results, counselling practice can be improved and information on NCDs can be offered as the first step of integrated NCDs care in maternal care programme in Myanmar.
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Kuźma-Markowska, Sylwia, und Agata Ignaciuk. „Family Planning Advice in State-Socialist Poland, 1950s–80s: Local and Transnational Exchanges“. Medical History 64, Nr. 2 (17.03.2020): 240–66. http://dx.doi.org/10.1017/mdh.2020.5.
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This paper scrutinises the relations between different models of family planning advice and their evolution in Poland between the mid-1950s and the late 1980s, focusing on their similarities and dissimilarities, conflicts and concordances. From 1956 onwards, the delivery of family planning advice became a priority for both the Polish Catholic Church and the party-state, especially its health authorities, which supported the foundation of the Society of Conscious Motherhood and aspired to mainstream birth control advice through the network of public well-woman clinics. As a consequence, two systems of family planning counselling emerged: the professional, secular family planning movement and Catholic pre-marital and marital counselling. We argue that reciprocal influence and emulation existed between state-sponsored and Catholic family planning in state-socialist Poland, and that both models used transnational organisations and debates relating to contraception for their construction and legitimisation. By evaluating the extent to which the strategies and practices for the delivery of birth control advice utilised by transnational birth control movements were employed in a ‘second world’ context such as Poland, we reveal unexpected supranational links that complicate and problematise historiographical and popular understandings of the Iron Curtain and Cold War Europe.
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Burr, ML, J. Trembeth, KB Jones, J. Geen, LA Lynch und ZES Roberts. „The effects of dietary advice and vouchers on the intake of fruit and fruit juice by pregnant women in a deprived area: a controlled trial“. Public Health Nutrition 10, Nr. 6 (Juni 2007): 559–65. http://dx.doi.org/10.1017/s1368980007249730.
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AbstractObjectiveTo examine the effectiveness of two methods of increasing fruit and fruit juice intake in pregnancy: midwives' advice and vouchers exchangeable for juice.DesignPregnant women were randomly allocated to three groups: a control group, who received usual care; an advice group, given advice and leaflets promoting fruit and fruit juice consumption; and a voucher group, given vouchers exchangeable for fruit juice from a milk delivery firm. Dietary questionnaires were administered at ~16, 20 and 32 weeks of pregnancy. Serum β-carotene was measured at 16 and 32 weeks.SettingAn antenatal clinic in a deprived area.SubjectsPregnant women aged 17 years and over.ResultsThe study comprised 190 women. Frequency of fruit consumption declined during pregnancy in all groups, but that of fruit juice increased substantially in the voucher group. Serum β-carotene concentration increased in the voucher group, from 106.2 to 141.8 μmol l− 1in women with measurements on both occasions (P = 0.003), decreased from 120.0 to 99.8 μmol l− 1in the control group (P = 0.005), and was unchanged in the advice group.ConclusionsPregnant women drink more fruit juice if they receive vouchers exchangeable for juice supplied by the milk delivery service. Midwives' advice to eat more fruit has no great effect. Providing vouchers for fruit juice is a simple method of increasing its intake in a deprived population and may be useful for other sections of the community.
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Schaafsma, I., F. Hoogenboom, M. Visschedijk, J. Prins und G. Dijkstra. „P339 Pregnant women with perianal Crohn’s Disease: suggestions for the improvement of the current guideline on delivery method“. Journal of Crohn's and Colitis 15, Supplement_1 (01.05.2021): S364. http://dx.doi.org/10.1093/ecco-jcc/jjab076.463.
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Abstract Background Pregnant women with active perianal Crohn’s disease (CD), have an indication for a caesarean section according to the current ECCO guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and to worsening of faecal continence. However, there is no strong evidence to support this. This study aims to examine the effects of delivery method on perianal disease progression and faecal incontinence in women with perianal CD Methods In this retrospective cohort study, 209 women were selected from a large IBD database within a tertiary hospital in the Netherlands. All women are aged >18 years, have perianal CD, and have at least one child. In addition, 102 women of this cohort completed a questionnaire. Faecal continence was scored using the Vaizey-score. Descriptive analysis using SPSS and linear regression analysis were performed. The outcome was corrected for the years after delivery (median 15, range 0-55). p-values <0,05 were considered statistically significant. Results The caesarean section rate within this cohort was 27,8%, which is high when compared the general Dutch population (14%). Within the group of women who delivered at least one child vaginally (n=84), 25,5% reported an alteration of faecal continence, compared to 18,8% of the women who never had a vaginal delivery (n=18). No significant relation between mode of delivery and faecal continence was found (B 0,97 [-1,19-3,14] p 0,375). The average Vaizey-score within this cohort in women who delivered solely through caesarean section had a median Vaizey-score of 5 (range 0-12). Women who had at least one vaginal delivery had an median Vaizey-score of 7 (range 0-20). In a large study amongst the general Dutch population (n=1259) a median Vaizey-score of 11 (range 0-17) was reported. Conclusion Faecal incontinence after vaginal delivery in CD women with perianal fistula is not significantly increased. Therefore the current guideline to advice a caesarean section should be adjusted and other factors such as the location of the fistula should be taken into account. To draw solid conclusions, better registration of fistula location and objective documentation of fistula activity (using PDAI-score) and stool consistency is needed.
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Paxton, Ben, Katie Mills und Juliet A. Usher-Smith. „Fidelity of the delivery of NHS Health Checks in general practice: an observational study“. BJGP Open 4, Nr. 4 (23.09.2020): bjgpopen20X101077. http://dx.doi.org/10.3399/bjgpopen20x101077.
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BackgroundThe NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. Failure to deliver the consultation appropriately could undermine its efficacy. To date, to the authors’ knowledge, there are no published data on the fidelity of delivery of NHS Health Checks.AimTo assess the fidelity of delivery of NHS Health Checks in general practice.Design & settingFidelity assessment of video and audio recordings of NHS Health Check consultations conducted in four GP practices across the East of England.MethodA secondary analysis of 38 NHS Health Check consultations, which were video or audio recorded as part of a pilot study of introducing discussions of cancer risk into NHS Health Checks. Using a checklist based on the NHS Health Check Best Practice Guidance, fidelity of delivery was assessed as the proportion of key elements completed during the consultations.ResultsThe mean number of elements of the NHS Health Check completed across all consultations was 14.5/18 (80.6%), with a range of 10 to 17 (55.6% to 94.4%). The mean fidelity for risk assessment, risk communication, and risk management sections was 8.7/10 (87.0%), 4.1/5 (82.0%), and 1.7/3 (56.7%), respectively. Clinically appropriate lifestyle advice was given in 34/38 consultations. Elements with the lowest fidelity were ethnicity assessment (n = 12/38; 31.6%), family history of cardiovascular disease (CVD) assessment (n = 25/38; 65.8%), AUDIT-C communication (n = 13/38; 34.2%), and dementia risk management (n = 6/38; 15.8%).ConclusionAlthough fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed.
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Crisp, A. H. „Advice to Government on London health services“. Psychiatric Bulletin 16, Nr. 9 (September 1992): 582–83. http://dx.doi.org/10.1192/pb.16.9.582.
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In October 1991 the then Secretary of State for Health, William Waldegrave, appointed Sir Bernard Tomlinson to act as adviser on health services in London. Early on it was agreed that Sir Bernard would also take account of the role of these services in teaching and research. Previous reports have focused on one or other aspect, e.g. the Todd Report (1966) and Flowers Working Party Report (1979) primarily considered teaching and research while the report of the London Health Planning Consortium (1979) mainly addressed provision of services. While the former two reports have been followed by extensive change in the organisation of medical academic activities in London, there has been much less change in health care delivery. For instance, primary care and community care are still seriously deficient in parts of London while high technology hospital based medical practice, sometimes providing a nationwide service, has survived and sometimes continued to develop in an entrepreneurial way. The problem is riven by academic and professional concerns of nationwide relevance and importance.
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Baker, Paul, Lucksy Kottam, Carol Coole, Avril Drummond, Catriona McDaid und Amar Rangan. „Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study“. BMJ Open 10, Nr. 7 (Juli 2020): e036191. http://dx.doi.org/10.1136/bmjopen-2019-036191.
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ObjectiveTo obtain consensus on the content and delivery of an occupational advice intervention for patients undergoing primary hip and knee replacement surgery. The primary targets for the intervention were (1) patients, carers and employers through the provision of individualised support and information about returning to work and (2) hospital orthopaedic teams through the development of a framework and materials to enable this support and information to be delivered.DesignModified Delphi study as part of a wider intervention development study (The Occupational advice for Patients undergoing Arthroplasty of the Lower limb (OPAL) study: Health Technology Assessment Reference 15/28/02) (ISRCTN27426982).SettingFive stakeholder groups (patients, employers, orthopaedic surgeons, general practitioners, allied health professionals and nurses) recruited from across the UK.ParticipantsSixty-six participants.MethodsStatements for the Delphi process were developed relating to the content, format, delivery, timing and measurement of an occupational advice intervention. The statements were based on evidence gathered through the OPAL study that was processed using an intervention mapping framework. Intervention content was examined in round 1 and intervention format, delivery, timing and measurement were examined in round 2. In round 3, the developed intervention was presented to the stakeholder groups for comment.ConsensusFor rounds 1 and 2, consensus was defined as 70% agreement or disagreement on a 4-point scale. Statements reaching consensus were ranked according to the distribution of responses to create a hierarchy of agreement. Round 3 comments were used to revise the final version of the developed occupational advice intervention.ResultsConsensus was reached for 36 of 64 round 1 content statements (all agreement). In round 2, 13 questions were carried forward and an additional 81 statements were presented. Of these, 49 reached consensus (44 agreement/5 disagreement). Eleven respondents provided an appraisal of the intervention in round 3.ConclusionsThe Delphi process informed the development of an occupational advice intervention as part of a wider intervention development study. Stakeholder agreement was achieved for a large number of intervention elements encompassing the content, format, delivery and timing of the intervention. The effectiveness and cost-effectiveness of the developed intervention will require evaluation in a randomised controlled trial.Trial registration numberInternational Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982
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Goldberg, David N., Arthur M. Hoffman, Maria F. Farinha, David C. Marder, Linda Tinson-Mitchem, D. e. e. Burton und Elmer G. Smith. „Physician Delivery of Smoking-Cessation Advice Based on the Stages-of-Change Model“. American Journal of Preventive Medicine 10, Nr. 5 (September 1994): 267–74. http://dx.doi.org/10.1016/s0749-3797(18)30578-6.
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Grobman, William A., Karen Kavanaugh, Teresa Moro, Raye-Ann DeRegnier und Teresa Savage. „Providing Advice to Parents for Women at Acutely High Risk of Periviable Delivery“. Obstetrics & Gynecology 115, Nr. 5 (Mai 2010): 904–9. http://dx.doi.org/10.1097/aog.0b013e3181da93a7.
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BARRETT, Helen L., Karin LUST, Leonie K. CALLAWAY, Narella FAGERMO und Carol PORTMANN. „Termination of pregnancy for maternal medical indications: Failings in delivery of contraceptive advice?“ Australian and New Zealand Journal of Obstetrics and Gynaecology 51, Nr. 6 (20.10.2011): 532–35. http://dx.doi.org/10.1111/j.1479-828x.2011.01371.x.
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Ockene, Judith K., David W. Hosmer, Joanne W. Williams, Robert J. Goldberg, Ira S. Ockene, Timothy Biliouris und James E. Dalen. „The relationship of patient characteristics to physician delivery of advice to stop smoking“. Journal of General Internal Medicine 2, Nr. 5 (September 1987): 337–40. http://dx.doi.org/10.1007/bf02596170.
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Downey, Peter, Jon Thomas und Mark Stone. „From initial advice statement to export – a 10 year retrospective of Queensland's liquefied natural gas industry“. APPEA Journal 59, Nr. 1 (2019): 58. http://dx.doi.org/10.1071/aj18070.
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A decade on from the submission of project initial advice statements to Queensland Government agencies in 2008, this paper provides a retrospective on the development journey of three integrated coal seam gas (CSG) to liquefied natural gas (LNG) mega-projects currently delivering domestic and international markets. The process from development concept to operating asset is considered from several perspectives including: project rationale, description and delivery, as well as regulatory approvals. Project delivery is further considered in terms of the upstream, midstream and downstream components. The delivery of world first CSG to LNG is discussed in the context of project execution during significant volatility in the global oil, gas and LNG markets. All three projects have successfully completed commissioning and start-up. Although all six trains have been performance tested at name-plate production capacity, current LNG production is below this level. This paper examines their evolution from the initial concepts through to delivery, including current gas reserves and those required to sustain gas supply over expected project life. The paper also considers how these projects and any future expansion of the Queensland LNG industry will be impacted upon by an evolving global LNG market.
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Ndetan, Harrison, Marion Willard Evans, Kaming Lo, David Walters, Michael Ramcharan, Patricia Brandon, Cathy Evans und Ronald Rupert. „Health Promotion Practices in Two Chiropractic Teaching Clinics: Does a Review of Patient Files Reflect Advice on Health Promotion?“ Journal of Chiropractic Education 24, Nr. 2 (01.10.2010): 159–64. http://dx.doi.org/10.7899/1042-5055-24.2.159.
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Purpose: To retrospectively review patient files in two teaching clinics in the United States and to assess the documented attempts to deliver health promotion messages when a chart indicated a need for health promotion or a red-flag condition that could be helped with positive behavioral changes. Methods: Approximately 100 patient files were randomly selected from each of two separate chiropractic teaching clinics, for patients seen after January 2007. Files were assessed for pertinent family history of diseases, personal medical history, and red-flag conditions of patients that would warrant intervention with health promotion. Results: Health promotion advice on at least one occasion was noted in 108 (53.7%) patient charts. Only 7 of 98 overweight or obese patients and none of those with family history of obesity were advised on weight management. Among 23 hypertensive patients, only 5 were advised and 17 of the 97 patients with risk of cardiovascular disease were advised. Conclusion: Chiropractic teaching clinics should assess what they are doing to help Americans reach their health goals. There is an opportunity to shape future practitioners so they include primary prevention as a part of what they do if the profession cares to move in that direction. Future research should look at mechanisms of delivery for health promotion, including better tracking of patients who need it and how staff doctors are trained to deliver oversight to interns in the area of primary prevention.
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Merrilees, D., und A. Duncan. „Review of attitudes and awareness in the agricultural industry to diffuse pollution issues“. Water Science and Technology 51, Nr. 3-4 (01.02.2005): 373–81. http://dx.doi.org/10.2166/wst.2005.0612.
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The Scottish Executive considers ‘Diffuse Pollution from Agricultural Enterprises’ as a priority issue over the next 5-10 years and recognises the need to improve knowledge transfer, advice and training amongst farmers, crofters, contractors and advisers. The Scottish Environment Protection Agency commissioned SAC to survey advisory staff on diffuse pollution issues, mitigation measures and delivery of environmental advice to the farming industry. This showed that the impact of agricultural diffuse pollution on the environment is considered a serious problem as is the future impact of legislation on farm business. There is an urgent requirement to raise advisers' awareness of environmental legislation and of mitigation measures. Advisers consider that farmers have limited awareness of diffuse pollution problems but those that do would consider the impact on the environment to be serious. There is a lack of knowledge on the effectiveness of pollution mitigation measures. Better technical information, supported by research, is required. This information is best conveyed to advisers via the internet, technical notes and directly by environmental specialists and delivered on to farmers by farm visits. Lack of funds prevents most farmers adopting best management practices and more than 80% of advisers consider that environmental advice should be free.
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Coughlin, Tim, Alan R. Norrish, Brigitte E. Scammell, Paul A. Matthews, Jessica Nightingale und Ben J. Ollivere. „Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures: a randomized controlled trial of effectiveness“. Bone & Joint Journal 103-B, Nr. 6 (01.06.2021): 1033–39. http://dx.doi.org/10.1302/0301-620x.103b.bjj-2020-2026.r1.
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Aims Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. Methods Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. Results A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). Conclusion Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy. Cite this article: Bone Joint J 2021;103-B(6):1033–1039.
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O'Donovan, Clare B., Marianne C. Walsh, Michael J. Gibney, Eileen R. Gibney und Lorraine Brennan. „Can metabotyping help deliver the promise of personalised nutrition?“ Proceedings of the Nutrition Society 75, Nr. 1 (11.08.2015): 106–14. http://dx.doi.org/10.1017/s0029665115002347.
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Over a decade since the completion of the human genome sequence, the promise of personalised nutrition available to all has yet to become a reality. While the definition was originally very gene-focused, in recent years, a model of personalised nutrition has emerged with the incorporation of dietary, phenotypic and genotypic information at various levels. Developing on from the idea of personalised nutrition, the concept of targeted nutrition has evolved which refers to the delivery of tailored dietary advice at a group level rather than at an individual level. Central to this concept is metabotyping or metabolic phenotyping, which is the ability to group similar individuals together based on their metabolic or phenotypic profiles. Applications of the metabotyping concept extend from the nutrition to the medical literature. While there are many examples of the metabotype approach, there is a dearth in the literature with regard to the development of tailored interventions for groups of individuals. This review will first explore the effectiveness of personalised nutrition in motivating behaviour change and secondly, examine potential novel ways for the delivery of personalised advice at a population level through a metabotyping approach. Based on recent findings from our work, we will demonstrate a novel strategy for the delivery of tailored dietary advice at a group level using this concept. In general, there is a strong emerging evidence to support the effectiveness of personalised nutrition; future work should ascertain if targeted nutrition can motivate behaviour change in a similar manner.
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Pollock, C. A., L. S. Ibels, F. Y. Zhu, M. Warnant, R. J. Caterson, D. A. Waugh und J. F. Mahony. „Protein intake in renal disease.“ Journal of the American Society of Nephrology 8, Nr. 5 (Mai 1997): 777–83. http://dx.doi.org/10.1681/asn.v85777.
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The dietary protein intake (DPI) of 766 patients (aged 7 to 88 yr) was determined from 24-h urinary urea and protein excretion by urea kinetic modelling. Five hundred sixty-five patients had a normal serum creatinine concentration, and of these 565, 385 patients had no dietary modification advised and 180 were advised to follow a low-protein diet. The remaining 201 patients had an increased serum creatinine concentration; 148 of these 201 patients had been advised to restrict their DPI. Patients with a normal serum creatinine concentration who had no dietary restriction had a significantly higher DPI than those advised to restrict their protein intake (1.08 +/- 0.01 versus 0.96 +/- 0.02 g/kg per day (mean +/- SEM), P < 0.01). Similarly, patients with abnormal renal function who were advised to follow a low-protein diet had a reduced DPI (0.93 +/- 0.01 versus 0.87 +/- 0.02 g/kg per day; P < 0.05). A lower DPI correlated with level of renal dysfunction, independent of dietary advice (P < 0.0001). In the overall population, DPI correlated with body mass index (BMI; P < 0.0001) and serum albumin (P < 0.0001), and inverse correlations were evident between age (P < 0.0001), blood glucose level (P < 0.01), serum cholesterol level (P < 0.0001), and triglyceride levels (P < 0.0001) independently of renal function. Fifty-two patients were assessed within the 3 months before the commencement of dialysis, and 47 were reassessed within 3 months after the commencement of dialysis. Despite advice regarding an increase in dietary protein after the commencement of dialysis, this increase failed to occur within the 3 months of commencement of dialytic therapy (0.79 +/- 0.04 versus 0.82 +/- 0.03 g/kg per day); P = 0.64). However, 6 to 9 months after the commencement of dialysis, a significant increase in protein intake was evident (1.04 +/- 0.04 g/kg per day; P < 0.005 versus both prior measurements). Hence a low DPI in renal impairment occurs independently of dietary advice, but compliance with such advice is evident because patients advised to consume a low-protein diet had significantly lower protein intake than did patients receiving no dietary advice. Adaptation to a high-protein diet after instigation of dialysis is unsuccessful in the short term, irrespective of whether or not advice is given regarding a low-protein diet before dialysis is initiated. However, 6 to 9 months after the commencement of dialysis, a significant increase in protein intake occurs, which in the hemodialysis population correlates with dialysis delivery.
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Konin, Jeff G., und Craig R. Denegar. „Professional Presentations for an International Audience“. Athletic Training Education Journal 14, Nr. 4 (01.10.2019): 323–28. http://dx.doi.org/10.4085/1404323.
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Context The opportunity to deliver a professional presentation to an international audience is a privilege. As with all other presentations, preparation and planning are essential components for a successful outcome. The difference between a diverse international audience and a homogeneous audience of the same background as the speaker requires consideration of additional factors associated with relevant delivery of the content matter. Recognition and integration of cultural differences, language barriers, and delivery expectations are critical to the creation and conveyance of one's presentation. Objective This article will share advice for preparing for and delivering presentations to an international audience. Data Source Factors to consider when preparing a platform-style presentation include knowing the cultural background of audience members, the speed and tone of one's delivery, the appearance of slides, the use of hand gestures, and the integration of appropriate terminology. The process of speaking through an interpreter and additional methods that have been proven to be effective in the delivery of an international presentation will also be identified. Conclusion One can never have enough experience, as each presentation to a diverse international audience may be vastly different.
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Barnes, Katie Blissard, und Richard Westmoreland. „Assessing the delivery of smoking cessation interventions in adult inpatients“. BJPsych Open 7, S1 (Juni 2021): S311. http://dx.doi.org/10.1192/bjo.2021.822.
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AimsTo assess level of compliance with national and local guidance with regards to the recording of service users smoking status and offering of interventions.BackgroundAcross the general population, prevalence of smoking is decreasing but in those with severe mental illness, the prevalence hasn't significantly changed. LYPFT are working towards becoming a smoke-free trust. The Trust Guidance expects that Trusts should ask 100% of service users if they smoke (which should be recorded on their physical health CQUIN) and of those that do, should be offered nicotine replacement therapy and cessation advice. Public Health England is working towards all hospital trusts across the UK being Smoke-free.MethodAll service users on each of the 4 adult inpatient wards at the Becklin Centre, Leeds, were included in the audit. A total of 78 service users were included in the audit.We reviewed the digital records for every service user, specifically looking at the physical health CQUIN. We recorded if smoking status had been documented and what interventions (if any) had been recorded as given. Possible interventions included offering brief advice and offering Nicotine replacement therapy. We then reviewed medication charts to see if any nicotine replacement therapy had been prescribed.ResultThe audit found that approximately half of all service users in our audit smoked cigarettes and that the vast majority of these had their smoking status documented in their digital medical records.Three quarters of those that smoked were offered brief cessation advice and half of them were offered Nicotine Replacement Therapy. Only a third of service users that smoked had NRT prescribed on their medication chart. This represented 65% of those recorded as being offered NRT.ConclusionThere are numerous possible reasons for the above outcomes. These include a lack of knowledge and confidence in delivering smoking cessation interventions, conversations having taken place but not recorded and confusion regarding the appropriate staff member to deliver the intervention. In addition, whilst only medical professionals typically prescribe NRT, the physical health CQUIN is recorded by nurses. Therefore, this may reflect a lack of communication between staff groups.Our trust will become smoke free in the near future. To facilitate this, we hope to reduce the discrepancy between the number of service users who smoke and the number prescribed NRT.
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Vincken, Walter, Mark L. Levy, Jane Scullion, Omar S. Usmani, P. N. Richard Dekhuijzen und Chris J. Corrigan. „Spacer devices for inhaled therapy: why use them, and how?“ ERJ Open Research 4, Nr. 2 (April 2018): 00065–2018. http://dx.doi.org/10.1183/23120541.00065-2018.
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We present an extensive review of the literature to date pertaining to the rationale for using a spacer/valved holding chamber (VHC) to deliver inhaled therapy from a pressurised, metered-dose inhaler, a discussion of how the properties of individual devices may vary according to their physical characteristics and materials of manufacture, the potential risks and benefits of ancillaries such as valves, and the evidence that they contribute tangibly to the delivery of therapy.We also reiterate practical recommendations for the correct usage and maintenance of spacers/VHCs, which we trust offer practical help and advice to patients and healthcare professionals alike.
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Avery, Pearl, Lisa Younge, Lesley Dibley und Jonathan Segal. „Inflammatory bowel disease advice lines during the COVID-19 pandemic: a retrospective service evaluation“. Gastrointestinal Nursing 19, Nr. 3 (02.04.2021): 38–49. http://dx.doi.org/10.12968/gasn.2021.19.3.38.
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Background: The COVID-19 pandemic significantly impacted on healthcare delivery worldwide, affecting many services, including those for inflammatory bowel disease (IBD). Aims: To evaluate the impact of COVID-19 on worldwide IBD telephone advice-line services. Methods: A mixed-methods 25-item online survey was distributed to IBD specialist nurses globally using IBD professional networks, email and social media. Data were analysed using descriptive statistics (quantitative data) and content and thematic analysis (qualitative data). Findings: Across 21 countries, 182 IBD specialists participated. With adjustments, all advice lines remained functional. Call content changed, and call volume increased exponentially. Strategies were recommended to maintain services. IBD specialist nurses faced considerable challenges, including overwhelming workload, disrupted referral pathways, fragmented IBD clinical team support, isolation and greatly lowered morale. Conclusions: To cope with similar future crises, advice-line training, resilience coaching and ringfencing of the IBD clinical team are essential. Development of global guidelines for maintaining advice-line functionality in any scenario is recommended.
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Kawashima, Michie. „Giving instruction on self-care during midwifery consultations in Japan“. Journal of Asian Pacific Communication 20, Nr. 2 (15.07.2010): 207–25. http://dx.doi.org/10.1075/japc.20.2.03kaw.
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This study focuses on instructional talk during prenatal visits in Japan. In order to prepare an upcoming delivery, a midwife often engages in instructional talk about the patient’s self-care at home. Yet, giving instruction is an interactionally challenging task, even in the medical setting. For example, a recipient may not accept advice easily, since this may reveal a recipient’s lack of knowledge and incompetence. By using conversation analysis, I find some interactional steps through which a midwife establishes interactional relevance of instruction. These steps include (1) assuring readiness of a recipient, (2) unpacking instruction and (3) contextualizing the instruction to a recipient’s everyday life. In each step, a patient’s claim for her competency and concern is used as a resource for developing the instructions. For example, a midwife gives advice to a patient about self-care in order to address the patient concerns. Instead of simply teaching what is generally considered necessary to self-care for delivery, a midwife designs her advice according to what an individual patient has expressed as a concern and what can be anticipated for her situation given her social category. This allows a more individualized presentation manner, which may encourage a patient’s active participation in her self-care.
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Eid, Mustafa I. M., Ibrahim M. Al-Jabri und M. Sadiq Sohail. „Selection of Cloud Delivery and Deployment Models“. International Journal of Decision Support System Technology 10, Nr. 4 (Oktober 2018): 17–32. http://dx.doi.org/10.4018/ijdsst.2018100102.
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Research interests on cloud computing adoption and its effectiveness in terms of cost and time has been increasing. However, one of the challenging decisions facing management in adopting cloud services is taking on the right combinations of cloud service delivery and deployment models. A comprehensive review of literature revealed a lack of research addressing this selection decision problem. To fill this research gap, this article proposes an expert system approach for managers to decide on the right combination of service delivery and deployment model selection. The article first proposes a rule-based expert system prototype, which provides advice based on a set of factors that represent the organizational conditions and requirements pertaining to cloud computing adoption. Next, the authors evaluate the system prototype. Lastly, the article concludes with a discussion of the results, its practical implications, limitations, and further research directions.
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Thieme, Andrea, und Petra Kalischewski. „Myasthenia Gravis: Family Planning, Pregnancy and Delivery“. Neurology International Open 02, Nr. 01 (Januar 2018): E46—E50. http://dx.doi.org/10.1055/s-0043-122651.
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AbstractMyasthenia gravis affects women younger than 40 about three times more frequently than men. Therefore, questions about family planning, pregnancy and delivery are common for these patients and their treating physicians. The outcome for mother and child depends a good deal on knowledge of the influence of pregnancy on myasthenia, therapy options, the relationship between the disease and delivery and the newborn. This paper provides an overview of these situations to support women with myasthenia gravis and their physicians in their decision-making regarding desire for children, the course of pregnancy and delivery and neonatal considerations. With thorough advice, good preparation and support of partners and families, the desire for a child can come true for patients with myasthenia gravis. Taking special precautions and with interdisciplinary treatment, the risks for mother and child can be minimized.
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Christopher, Kipps, Delves Sarah, Burke Georgina, Halfpenny Christopher, Kitley Joanna, Frankel Jonathan, Slaght Sean und Gibb William. „THUR 018 Advice and guidance: not so quick and easy“. Journal of Neurology, Neurosurgery & Psychiatry 89, Nr. 10 (13.09.2018): A3.4—A3. http://dx.doi.org/10.1136/jnnp-2018-abn.12.
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BackgroundWaiting times for outpatient consultations are consistently under pressure, and delivery of the mandatory 18 week target from referral to completed review remains challenging. An Advice and Guidance scheme offers an opportunity to access neurological advice while reducing face-to-face consultation needs. We designed this project to develop the requirements, methods, audit and costing of sustainable neurological advice.MethodsA DGH Neurology service worked with a local CCG comprising 18 GP practices. All 176 referrals and advice requests received during a 6 month pilot were considered for A and G instead of a clinic appointment.ResultsAdvice was offered in 37% of cases overall (48 patients), but a net increase of 12% in face-to-face consultations was observed, as 28 (16%) of advice requests required clinic review. Headache and alteration of consciousness were common, and cases with an established diagnosis the most tractable for the ‘Advice Only’ option. GP referral quality was judged good, neurology satisfaction was reasonable, and a cost of at least £68 per episode was indicated.DiscussionThis pilot showed an increase in the number of face-to-face clinic reviews required. We suggest that other reported schemes may have not included advice requests that resulted in referrals in their metrics.
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Goodman, Elisabeth, und Lucy Loh. „Organizational change“. Business Information Review 28, Nr. 4 (Dezember 2011): 242–50. http://dx.doi.org/10.1177/0266382111427087.
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Change is again in the spotlight. Much of the current debate about organizational change is focusing on large scale changes, e.g. public sector reshaping or the role of the third sector, for example, and many private sector organizations are working hard on internal efficiencies. All of these bring huge challenges. But what about the people and the teams within these organizations, who must continue to deliver today as well as achieve changes to their own roles and services for delivery tomorrow? This article describes some of the current drivers of change, and the challenges for teams. It highlights a number of models and approaches which describe the cycle of change and the elements of team effectiveness, and gives practical advice on how to use those to develop and support teams in a time of change. Our advice is grounded in good practice gained through real life experience, with practical tips and suggestions. These will help readers to build and rebuild teams so that they remain effective and the people in them motivated and aligned to the organization’s goals.
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Rashid, Haroon, Nick Dobbin und Smarak Mishra. „104 Management of sports-related concussion in UK emergency departments: a multi-centre study“. Emergency Medicine Journal 37, Nr. 12 (23.11.2020): 822.2–822. http://dx.doi.org/10.1136/emj-2020-rcemabstracts.2.
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Aims/Objectives/BackgroundIt is necessary for those working in emergency departments to have adequate knowledge and delivery of current sport-related concussion (SRC) management protocols including identifying patients with concussion, managing their symptoms, giving appropriate advice with regards to return to play and referring those at risk of further injuries to an appropriate service.This study aimed to establish the current practice, knowledge base and views towards SRC management of emergency department clinicians who have trained or are currently training in emergency medicine in the North West of England.Methods/DesignThis study was a multi centre, cross sectional study of 111 emergency department clinicians (EDCs) working across 15 centres in the North West of England A 21 item online survey was issued. The key questions focused on the advice given to patients on discharge, the importance of cognitive and physical rest, and knowledge of GRTP.Results/ConclusionsApproximately, 37% of the population responded to the invitation, with 111 responses included in this study. Only 27% of total respondents were aware of the Consensus Statements of Concussion in Sport guidelines, whilst 45% were unaware of any SRC guidelines. 57% of respondents had heard of a graded return to play (GRTP) protocol. Physical rest following an SRC was advised by 95% of respondents with 61% advising concomitant cognitive rest and 42% of respondents providing specific written advice. 90% of clinicians had not received any SRC training.There is a lack of knowledge amongst EDCs in the North West of England in managing and providing discharge advice according to recommendations for patients with SRC. This is likely a consequence of the limited training that these clinicians have received in managing SRC and suggests further work needs to be undertaken to educate EDCs on current SRC management guidance to ensure appropriate care and discharge advice is given to patients.
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Willis, Richard, J. Neill Marshall und Ranald Richardson. „The Impact of ‘Branchless Banking’ on Building Society Branch Networks“. Environment and Planning A: Economy and Space 33, Nr. 8 (August 2001): 1371–84. http://dx.doi.org/10.1068/a33171.
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The authors examine the impact of the remote delivery of financial services on the branch network of British building societies. The current phase of branch-network rationalisation in the financial sector in Europe and North America is argued in the academic literature to be the inevitable consequence of the growth of electronic and telemediated forms of delivery of financial services. In the British building society sector, despite some evidence of branch closure as the use of the Internet and telephone call centres in the delivery of financial services has grown, the picture that emerges is of a dynamic branch network that is responding to changing customer demands and new technological possibilities. Face-to-face advice and discussions between customers and trained ‘experts’ remain an important part of the mortgage transaction. In the savings market, where products have become more commodified, telephone call centres and, more recently, the Internet have become more prominent, but institutions still rely heavily on the branch network to deliver services. The authors suggest that, although there have been changes in the relative importance of different distribution channels as sources of business in the financial sector, it is wrong to view these changes in terms of a simple branch-versus-direct dichotomy. A more complex picture is presented, with most institutions adopting a multichannel approach to the delivery of financial services, and electronic forms of delivery of financial services being developed as an additional delivery channel alongside the branch.