Anatomical education is becoming modernized, not only in its teaching and learning, but also in its assessment formats. Traditional "steeplechase" examinations are being replaced with online gross anatomy examinations. The aims of this study were to: (1) determine if online anatomy practical examinations are equivalent to traditional anatomy practical examinations; and (2) to examine if students' perceptions of the online or laboratory testing environments influenced their performance on the examinations. In phase one, 10 third-year students were interviewed to generate perception items to which five anatomy lecturers assigned content validity. In phase two, students' gross anatomical knowledge was assessed by examinations in two modes and their perceptions were examined using the devised survey instrument. Forty-five second-year chiropractic students voluntarily participated in Phase Two. The two randomly allocated groups completed the examinations in a sequential cross-over manner. Student performance on the gross anatomy examination was not different between traditional "steeplechase" (mean ± standard deviation (SD): 69 ± 11%) and online (68 ± 15%) modes. The majority of students (87%) agreed that they felt comfortable using computers for gross anatomy examinations. However, fewer students found it easy to orientate images of cadaver specimens online. The majority of students (85%) agreed that they felt comfortable working with cadavers but there was less agreement on the effect of moving around the laboratory during practical examinations. This data will allow anatomists to confidently implement online assessments without fear of jeopardizing academic rigor or student performance.

BackgroundFacilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care.MethodsElectronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs.ResultsThe synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy.ConclusionsThis meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.

The present study explores people's experience of living with antipsychotic medication side-effects. Qualitative data were gathered through semistructured interviews with 10 mental health consumers in a community care setting in Australia. The interview transcriptions were content analysed, and enhanced by combining manifest and latent content. Important contextual cues were identified through replaying the audio-recordings. Several main themes emerged from the analysis, including the impact of side-effects, attitudes to the use of medication and side-effects, and coping strategies to manage medication side-effects. Each participant reported between six and seven side-effects on average, which were often pronounced and had a major disruptive impact on their lives. Of these effects, the most commonly mentioned was sedation, which the participants described as leaving them in a 'zombie'-like state. Most participants expressed an attitude of acceptance about the side-effects. The participants' most common strategy to manage side-effects was to change the dosage of the medication. Other common side-effect management strategies involved using other medications to control side-effects, and diverse self-help techniques, the most common of which was relaxation/distraction techniques.

BackgroundResearch into chiropractors’ use of evidence in clinical practice appears limited to a single small qualitative study. The paucity of research in this area suggests that it is timely to undertake a more extensive study to build a more detailed understanding of the factors that influence chiropractors’ adoption of evidence-based practice (EBP) principles. This study aimed to identify Australian chiropractors’ attitudes and beliefs towards EBP in clinical practice, and also examine their use of research literature and clinical practice guidelines.MethodsWe used an online questionnaire about attitudes, beliefs and behaviours towards the use of EBP in clinical practice that had been developed to survey physiotherapists and modified it to ensure that it was relevant to chiropractic practice. We endeavoured to survey all registered Australian chiropractors (n = 4378) via email invitation distributed by Australian chiropractic professional organisations and the Chiropractic Board of Australia. Logistic regression analyses were conducted to examine univariate associations between responses to items measuring attitudes and beliefs with items measuring: age; years since registration; attention to literature; and use of clinical practice guidelines.ResultsQuestionnaires were returned by 584 respondents (response rate approximately 13%). The respondents’ perceptions of EBP were generally positive: most agreed that the application of EBP is necessary (77.9%), literature and research findings are useful (80.2%), EBP helps them make decisions about patient care (66.5%), and expressed an interest in learning or improving EBP skills (74.9%). Almost half of the respondents (45.1%) read between two to five articles a month. Close to half of the respondents (44.7%) used literature in the process of clinical decision making two to five times each month. About half of the respondents (52.4%) agreed that they used clinical practice guidelines, and around half (54.4%) agreed that they were able to incorporate patient preferences with clinical practice guidelines. The most common factor associated with increased research uptake was the perception that EBP helps make decisions about patient care.ConclusionsMost Australian chiropractors hold positive attitudes towards EBP, thought EBP was useful, and were interested in improving EBP skills. However, despite the favourable inclination towards EBP, many Australian chiropractors did not use clinical practice guidelines. Our findings should be interpreted cautiously due to the low response rate.

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Objective: To systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details. Methods:A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL and The Cochrane Library up to January 12, 2012 by an experienced reference librarian. Study selection was performed by 2 independent reviewers using predefined criteria.We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis. A serious adverse event was defined as an untoward occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. We included studies published in English, German, Dutch and Swedish.Results: 2046 studies were screened and 41 studies reporting on 77 cases were included. Important case details were frequently unreported. Adverse events consisted of cauda equina syndrome (29 cases, 38% of total), lumbar disc herniation (23 cases, 30%), fracture (7 cases, 9%), hematoma or hemorrhagic cyst (6 cases, 8%), or other serious adverse events (12 cases, 16%) such as neurological or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing and esophageal rupture. Conclusions:This systematic review describes the case details of serious adverse events reported to occur following SMT of the lumbopelvic region. The anecdotal nature of these reports does not allow for causal inferences between SMT and the events identified in this review. Recommendations regarding future case reporting and research aimed at furthering the understanding of SMT's safety profile are discussed.

Implementing and sustaining evidence-based practice change in clinical practice is challenging. Ongoing evaluation is necessary for identifying the long-term implications of practice improvement interventions and issues that influence the adoption of evidence-based practice. Strategies to address barriers, and to increase awareness and engagement of the pain resource nurse role with wider collaboration require further investigation.

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