SUMMARY: Published guidelines for distance learning library services provide a framework for distance education librarians to use in planning services for off-campus students. Other literature in the arena of distance education librarianship provides concrete examples of how reference services have been offered in real settings. This paper attempts to synthesize these two types of literature in order to offer models of reference service for distance learners.

What is Known and Objective: The development of rapid diagnostics has revolutionized antimicrobial stewardship with efforts targeting earlier de-escalation or discontinuation of antibiotics. The respiratory viral panel (RVP) is one tool quickly able to detect common viral and bacterial pathogens using polymerase chain reaction technology. Utility may be further enhanced in conjunction with procalcitonin (PCT). However, the optimal use of the RVP to the clinical pharmacist in the treatment of community-acquired respiratory infections remains unclear. Methods: The purpose of this guide is to review the available literature regarding the impact of the RVP with and without procalcitonin on antimicrobial stewardship efforts and to provide guidance on how to use each of these tools. Results and Discussion: In total, 13 studies were included, 5 of which utilized PCT in conjunction with RVP and 8 of which did not use PCT. The majority of studies were retrospective in nature, and the most common outcomes evaluated were antibiotic days of therapy (DOT) and time to antibiotic discontinuation. What is New and Conclusion: After review, RVP alone has limited value to antimicrobial stewardship; however, when used in conjunction with procalcitonin, RVP has the potential to reduce antibiotic use and duration.

Title: Vietnamese nursing students’ knowledge and attitudes to hospital-acquired infections and hygiene guidelines. Background: Increased hospital-acquired infections are a global concern. Compliance to hygiene guidelines is essential to prevent infections in health care. Knowledge and attitudes are important factors that affect implementations of precautions in health care. Aim: The aim of this study was to describe the knowledge and attitudes of Vietnamese nursing students’ in year 2, 3 and 4 regarding hospital-acquired infections and hygiene guidelines. Method: An empirical cross-sectional study were 2 questionnaires with set responses was answered by 235 nursing students at a Vietnamese university. Result: The result showed that the students’ knowledge was overall at a moderate level. The 3rd year students reported best amount of knowledge, 2nd year the next best and 4th year students reported the lowest. Students’ attitudes regarding hand hygiene were mostly positive. Questions students reported negative attitudes into were regarded priorities due to lack of time and resources, the effort of remember hand hygiene actions and comfort in reminding other health care workers. Students in 4th year were the ones with the least positive attitudes while year 2 and 3 were more equal. Conclusion: The scores on the hand hygiene (HH) knowledge test improved from year 2 to year 3 but decreased in year 4. The amount of positive attitudes in the subject was equal in year 2 and 3 but less positive in year 4. This indicates that infection control training needs to be ongoing during all the education. We also think it should be highlighted to clinical supervisors and other HCWs that they have a responsibility to emphasize the importance of hand hygiene when teaching future nurses.

>Magister Scientiae - MSc / MAGISTER SCIENTlAE IN THE FACULTY OF NATURAL SCIENCES OF THE UNIVERSITY OF THE WESTERN CAPE. This thesis focuses on Environmental Impact Assessments (EIA's) as prepared in the Western Cape Province. The thesis attempts to summarise the legal requirements for EIA's and then to analyse two recent assessmentsin the light of the concern raised by Alex Weaver, at the South African chapter of the International Association for Impact Assessment National Conference in 1999, that EIA's~l§_cLI>listoricaily _gisadvantag~and do not give sufficient attention to social impacts. The thesis also attempts to analyse the EIA's and to critically assess whether they comply with the intention of the legal requirements. The applicable legislation and regulations are analysed to determine whether there are sufficient guidelines for practitioners to assessthe socio-economic impacts of development in an equitable manner to the assessmentof the biophysical impacts. It was found that the legislation and the regulations do not provide clear guidance for the consideration of the socia-economic aspects of the environment or impacts in the preparation of EIA's. The EIA's regarding the Relocation Of The Informal Settlement At Stanford and for the Koringberg-Platvlei-MiddelburgWater Supply Pipeline required to provide potable water to rural communities are analysed, as both have socio-economicgoals. In the Stanford case, an informal settlement located on the town's water source has to be relocated to the town, where there is a shortage of land available for development and site-specific impacts on a major employer, with the threat of a potential loss in employment opportunities. In the Koringberg-Platvlei-Middelburg case, the rural community has insufficient potable water and a supply scheme is proposed in a potentially sensitive environment. In order to analyse the two assessments,the ideal EIA and recent trends are first established from literature. Criteria for the assessment of the EIA's are determined and then used to ascertain whether the concern raised by Weaver is correct. In the analysis of the subject EIA's it was found that both address the social issues of concern, albeit without clear guidance from the applicable legislation and regulations. Following on the critical assessmentof the recent EIA's, the thesis provides proposals and stepby-step guidelines for the drafting of EIA's for use by students and inexperienced practitioners in the field of environmental management. Weaver's concern is found to be correct and recommendations are made to adjust the relevant regulations, to give clear guidance for the consideration of seclo-economic concerns in the preparation of EIA's.

Background Expert guidelines recommend low-risk women to consume a daily multivitamin supplement containing 400 µg of folic acid (FA) to prevent the occurrence of neural tube defects. This study assessed the knowledge, attitude and practice of physicians regarding FA recommendations, status and health outcomes during pregnancy since physicians play an essential role in promoting appropriate FA intake. Methods A cross-sectional survey of a sample of physicians practicing in the National Capital Region was self-administered in 2018-2019. Results Approximately 70% of physicians were not familiar with the most recent guidelines and 55% of them most often recommend a 1000 µg-FA supplement. A high level of willingness to recommend a supplement containing 400 µg-FA was reported by almost all physicians. Conclusion While most physicians would not feel comfortable recommending a supplement that is not in line with the most recent evidence-based guidelines, educational programs targeted to physicians are needed to improve their knowledge, attitude and practice.

Stroke is a devastating disease. Stroke care has advanced greatly in the past 20 years with innovations in radiologic imaging, development of tissue plasminogen activator (tPA), organized systems of care, telestroke, and best practice guidelines via Get with the Guidelines Stroke (GWTGS). However, stroke remains the 5th leading cause of death in the United States. To provide current and quality care for stroke patients, nurses need ongoing stroke education. Additionally, stroke centers must provide a sustainable stoke education program to their nurses to keep their knowledge current. Guided by Rosswurm and Larrabee's model, this quality improvement project addressed whether an educational program based on evidence in GWTGS could increase nursing knowledge of stroke. A convenience sample of 50 medical-surgical nurses from a stroke telemetry unit participated in this program. Nursing knowledge was assessed by using a student-developed tool based on the GWTGS best practice evidence to evaluate for increased knowledge regarding stroke and stroke management. Using simple descriptive statistics, the percent difference from pretest to posttest was calculated. The results revealed a 16.79% increase in nurses' knowledge. The practicum organization therefore adopted the program. Implications for nursing practice and social change include organizations adopting the educational program as a sustainable learning opportunity for nurses in regards to stroke care.

Background Antineoplastic drugs constitute an important cornerstone in treating malignant cancer diseases. The nurses administering these drugs risk developing short- and long-term side effects from exposure if not properly protected by personal protective equipment. The National Institute for Occupational Safety & Health produces guidelines and recommendations for healthcare personnel handling antineoplastic drugs in order to minimise exposure. Aim The aim of this study was to observe and describe registered nurses’ compliance to National Institute for Occupational Safety & Health guidelines and recommendations concerning the use of personal protective equipment during drug administration at a public hospital in Guangzhou, China. Method Data was collected at three different departments using structured direct observations, totalling 211 administrations encompassing day and evening shifts. Results Total compliance to National Institute for Occupational Safety & Health guidelines and recommendations was 0 percent as a result of non-existent gown use. The overall compliance for the use of double gloves was 76,3 percent. The Department of Medical Oncology had the highest department-specific compliance rate for double gloves at 80,7 percent, whereas the evening shift at Chemotherapy Outpatient Department boasted the highest shift-specific compliance rate for the same item at 83,3 percent. Conclusion Interventions are needed concerning the use of personal protective equipment, in particular the use of gowns. Obtained hospital-specific guidelines did not include the procedure of drug administration, warranting the implementation of hospital-specific standard operating procedure guidelines encompassing this aspect.

No description available.

Health care guidelines provide a means of assessing the best available research evidence on a given health care topic and offering recommendations about use of specific interventions and management of patient care. Guidelines allow clinicians, patients, health administrators and policy-makers to be efficiently informed and stay up to date on alternative care options. The development of guidelines is a complex and multidisciplinary process, with a defining feature of involving a panel of experts in steps such as selecting health care questions, assessing the research evidence, making judgements about health benefits and harms, and, ultimately, formulating recommendations. Guideline methodology has advanced over the past decades, including establishment of specific steps and standards to ensure trustworthiness of guidelines. However, there remain critical research questions on how to best accomplish and reach these standards, including how to best engage panels in the steps. This thesis presents a body of research on the development and evaluation of new methods for decision-making and considering health outcomes in guidelines, prioritizing health care questions for guidelines, and evaluating the guideline development process. It includes three studies: 1) a methodological study on developing health outcome descriptors to define health outcomes considered in decision-making by guideline panels; 2) a methodological study and randomized controlled trial to evaluate specific criteria for panels to consider when prioritizing health care questions for guidelines and to judge the importance of health outcomes; and 3) an instrument development and validation study to create a tool for panel members to evaluate the appropriateness of the guideline development process they participate in. In these studies, we established a method and steps for creating health outcome descriptors with panels, aimed at achieving consistency in how health outcomes are considered throughout the guideline development process, from prioritization to formulating a recommendation on the basis of those outcomes. The structured approach and criteria evaluated for prioritization of healthcare questions informed panel deliberations and decisions about choosing questions for their guideline topics, and the proposed methods for outcome prioritization facilitated panels in informing what the critical and important outcomes were for decision-making. Finally, the instrument we developed facilitated members of guideline panels to provide their assessment of the guideline development process and identify strengths and weaknesses and areas for improvement. Our findings will allow organizations responsible for guideline development to apply the new methods with their panels and to evaluate their guideline processes to inform quality-improvement efforts. / Thesis / Doctor of Philosophy (PhD) / Health care guidelines, also referred to as clinical practice or public health guidelines, involve summarizing the available research evidence on a given health care topic and issuing recommendations about the best care. Guidelines allow clinicians, patients, health administrators and policy-makers to be efficiently informed and stay up to date on alternative care options, such as the best current treatments and strategies to diagnose various diseases and health conditions. Developing a guideline is a complex and multidisciplinary process that includes involving a panel of experts, typically consisting of clinicians, patients, public health professionals and other providers or consumers of health care. The panel is involved in selecting the health care questions to address (e.g. specific treatments or diagnostic strategies to evaluate), reviewing a summary of the evidence from research studies, and making judgements about benefits and harms of alternate options or strategies. The panel then formulates recommendations that give guidance on what the best options are to use for the health condition in question. The steps and approaches to develop a guideline that is considered trustworthy have been established over the past decades, including universally accepted standards. However, there remain critical research questions on how to best reach these standards, including how to best engage guideline panels in the steps. The research work presented in this thesis focuses on proposing and evaluating new methods and approaches for guidelines panels to make decisions about health outcomes, priority health care questions for guidelines, and to evaluate the guideline development process. It includes three studies: 1) a study on creating health outcome descriptors with panels to provide a commonly accepted definition of a health outcome; 2) a study to evaluate specific criteria that panels can use to prioritize health care questions, and an approach to judge the importance of health outcomes; and 3) a study to develop a survey instrument for guideline panel members to evaluate the guideline development process they participate in. In these studies, we established an approach for creating the health outcome descriptors with panels, which helped in keeping consistency with how panels understood and considered different health outcomes throughout the guideline development process. The criteria evaluated for prioritizing healthcare questions informed panel discussions and selection of questions for their guideline topics. The proposed approach for judging the importance of health outcomes helped panels to select what the critical outcomes were for making decisions about the benefits and harms of alternate options or strategies. Finally, the survey tool we created allowed members of guideline panels to provide feedback on strengths and weaknesses and areas for improvement in the process after they participated in developing a guideline. Our findings will allow organizations responsible for guideline development to apply the new methods with their panels and to evaluate their guideline processes to inform quality-improvement efforts.

What is Known and Objective: The development of rapid diagnostics has revolutionized antimicrobial stewardship with efforts targeting earlier de-escalation or discontinuation of antibiotics. The respiratory viral panel (RVP) is one tool quickly able to detect common viral and bacterial pathogens using polymerase chain reaction technology. Utility may be further enhanced in conjunction with procalcitonin (PCT). However, the optimal use of the RVP to the clinical pharmacist in the treatment of community-acquired respiratory infections remains unclear. Methods: The purpose of this guide is to review the available literature regarding the impact of the RVP with and without procalcitonin on antimicrobial stewardship efforts and to provide guidance on how to use each of these tools. Results and Discussion: In total, 13 studies were included, 5 of which utilized PCT in conjunction with RVP and 8 of which did not use PCT. The majority of studies were retrospective in nature, and the most common outcomes evaluated were antibiotic days of therapy (DOT) and time to antibiotic discontinuation. What is New and Conclusion: After review, RVP alone has limited value to antimicrobial stewardship; however, when used in conjunction with procalcitonin, RVP has the potential to reduce antibiotic use and duration.