Revisiting Classroom Practices in East Asian Countries: Examination of Within-Country Variations and Effects of Classroom Instruction

ERIC Educational Resources Information Center

Kim, Yoonjeon

2018-01-01

Background/Context: East Asian schools receive much attention for the comparatively high achievement of their students. To account for this success, scholars and commentators advance broad claims about the rote character of instruction or the complexity of classroom practice, typically generalizing to an entire nation. Yet little is known about…

The Impact of Game Sense Pedagogy on Australian Rugby Coaches' Practice: A Question of Pedagogy

ERIC Educational Resources Information Center

Light, Richard Lawrence; Robert, John Evans

2010-01-01

Background: Recent developments in games and sport teaching such as that of Teaching Games for Understanding, Play Practice and Game Sense suggest that they can make a significant contribution toward the development of tactical understanding, ability to read the game, decision-making and a general "sense of the game", yet empirical…

The dilemma of osteopathic physicians and the rationalization of medical practice.

PubMed

Eckberg, D L

1987-01-01

Years ago, Peter New observed that osteopathic medical students faced a dilemma concerning their identity. On the one hand, they wished to be considered complete medical practitioners. On the other hand, they wished to be seen as different from MDs. There is evidence that osteopathic physicians continue to face that dilemma. I hypothesize that in part this stems from a conflict between classical 'lifestyle commitments' of the osteopathic community (e.g. toward general practice, osteopathic manipulative therapy, holism) and the rationalized model of medicine practiced by MDs (characterized by specialization and scientific elitism). Results of a survey of a local population of osteopathic physicians generally confirm this. Specific findings are that (1) classical elements of osteopathic commitment are not tied to commitment to the profession in general, (2) there appears to be a waning of commitment to general practice, (3) an increasing number of osteopathic physicians used the DO degree as a 'back door' into medicine and are less likely to identify with classical osteopathic norms, and (4) DOs from socially conservative backgrounds are more likely than others to maintain commitment to the classical elements of osteopathic practice.

Between subway and spaceship: practical ethics at the outset of the twenty-first century.

PubMed

Benjamin, M

2001-01-01

Moral deliberation involves a constant interplay among specific judgments, general moral values and principles, and background beliefs about the world. We may also construct broad moral theories to explain how our judgments and general commitments hang together, but there is little hope of settling on any one comprehensive moral theory.

Management and Prevalence of Long-Term Conditions in Primary Health Care for Adults with Intellectual Disabilities Compared with the General Population: A Population-Based Cohort Study

ERIC Educational Resources Information Center

Cooper, Sally-Ann; Hughes-McCormack, Laura; Greenlaw, Nicola; McConnachie, Alex; Allan, Linda; Baltzer, Marion; McArthur, Laura; Henderson, Angela; Melville, Craig; McSkimming, Paula; Morrison, Jill

2018-01-01

Background: In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Method: Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term…

Understanding general practice: a conceptual framework developed from case studies in the UK NHS

PubMed Central

Checkland, Kath

2007-01-01

Background General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. Aim To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. Design of study In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Setting Five general practices in England, selected using purposeful sampling. Method Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Conclusion Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality. PMID:17244426

Following the funding trail: Financing, nurses and teamwork in Australian general practice

PubMed Central

2011-01-01

Background Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate. Methods This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies. Results Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice. Conclusions Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice. PMID:21329506

Undergraduate teaching in UK general practice: a geographical snapshot

PubMed Central

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-01-01

Background Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. Aim To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. Design and setting National survey of all medical schools in the UK. Method All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK’s health departments. Results All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum–maximum) of 142 (17–385) practices per school. The median (minimum–maximum) distance between a school and a teaching practice was 28 km (0–1421 km), 41 (0:00–23:26) minutes’ travel by car and 1 hour 12 (0:00–17:29) minutes’ travel by public transport. All teaching practices were accessible by public transport in one school and 90–99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. Conclusion The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. PMID:24868071

Analysis of 1263 deaths in four general practices.

PubMed Central

Holden, J; O'Donnell, S; Brindley, J; Miles, L

1998-01-01

BACKGROUND: The death of a patient is a significant event that occurs often enough in general practice for it to have the potential to tell us much about the care we provide. There are few large series in the literature and we still know little about the collaborative use of this outcome measure. AIM: To determine the pattern of deaths and potentially preventable factors in our practices. METHOD: We completed a standard data collection form after each death in four general practices over a 40-month period. The results were discussed at quarterly meetings. RESULTS: A total of 1263 deaths occurred among our registered patients during the period of the audit. Preventable factors contributing to deaths were considered to be attributable to: patients (40%): mainly cigarette smoking, poor compliance, and alcohol problems; general practice teams (5%): mainly delayed referral, diagnosis and treatment, and failure to prescribe aspirin to patients with vascular disease; hospitals (6%): mainly delayed diagnosis and perceived treatment problems; the environment (3%): mainly falls, principally resulting in fractured neck of femur. CONCLUSION: A simple audit of deaths along the lines that we describe gives important information about the care provided by general practice teams and those in hospital practice. It has both educational value and is a source of ideas for service improvement and further study, particularly when carried out over several years. PMID:9800400

Council tax valuation band of patient residence and clinical contacts in a general practice

PubMed Central

Beale, Norman; Taylor, Gordon; Straker-Cook, Dawn; Peart, Carole; Gwynne, Mark

2005-01-01

Background There is a dearth of data relating UK general practice workload to personal and social markers of individual patients. Aim To test whether there is a significant association between general practice patient contact rates and the council tax valuation band of their residential address. Design of study Cross-sectional analyses using data recorded, over 1 year, for over 3300 general practice patients. Setting One medium-sized group practice in an industrialised English market town. Method Face-to-face contacts between the patients and the doctors and nurses in the practice were compared by patient age, sex, registration period, distance from surgery, Underprivileged Area 8 (UPA8) score, and council tax valuation band. Results Patient sex, age, recent registration, distance from surgery, and council tax valuation band were each significantly associated with face-to-face contact rate in univariate analyses. UPA8 score was not significantly associated with contact rates. On multivariate testing, sex, age, recent registration, and council tax valuation band remained significantly associated with contact rates. The last is a new finding. Conclusion Council tax valuation bands predict contact rate in general practice; the lower the band, the higher the contact rate. Council tax valuation band could be a useful marker of workload that is linked to socioeconomic status. This is a pilot study and multipractice research is advocated. PMID:15667763

Effectiveness of empathy in general practice: a systematic review

PubMed Central

Derksen, Frans; Bensing, Jozien; Lagro-Janssen, Antoine

2012-01-01

Background Empathy as a characteristic of patient–physician communication in both general practice and clinical care is considered to be the backbone of the patient–physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice. This literature review explores the effectiveness of empathy in general practice. Effects that are discussed are: patient satisfaction and adherence, feelings of anxiety and stress, patient enablement, diagnostics related to information exchange, and clinical outcomes. Aim To review the existing literature concerning all studies published in the last 15 years on the effectiveness of physician empathy in general practice. Design and setting Systematic literature search. Method Searches of PubMed, EMBASE, and PsychINFO databases were undertaken, with citation searches of key studies and papers. Original studies published in English between July 1995 and July 2011, containing empirical data about patient experience of GPs’ empathy, were included. Qualitative assessment was applied using Giacomini and Cook’s criteria. Results After screening the literature using specified selection criteria, 964 original studies were selected; of these, seven were included in this review after applying quality assessment. There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients’ anxiety and distress and delivers significantly better clinical outcomes. Conclusion Although only a small number of studies could be used in this search, the general outcome seems to be that empathy in the patient–physician communication in general practice is of unquestionable importance. PMID:23336477

Management in general practice: the challenge of the new General Medical Services contract

PubMed Central

Checkland, Kath

2004-01-01

Background: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. Aim: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. Design of study: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Setting: Three general practices in England, chosen using purposeful sampling. Method: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. Conclusion: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role. PMID:15469672

Improving access for patients – a practice manager questionnaire

PubMed Central

Meade, James G; Brown, James S

2006-01-01

Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB) in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256) had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006), urban practices (p < 0.001) and those with above average patient list sizes (p < 0.001). Receptionists had not received training in patient appointment management in a quarter of practices. Practices with smaller list sizes were more likely than larger ones to utilise nurses in seeing extra patients (p = 0.007) or to undertake triage procedures (p = 0.062). Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study. PMID:16784530

Does general surgery residency prepare surgeons for community practice in British Columbia?

PubMed Central

Hwang, Hamish

2009-01-01

Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663

GPs’ job satisfaction: doctors who chose general practice early or late

PubMed Central

Lambert, Trevor; Smith, Fay; Goldacre, Michael

2013-01-01

Background In the UK many practising GPs did not choose general practice as their first choice of career when they originally graduated as doctors. Aim To compare job satisfaction of GPs who chose general practice early or later in their career. Design and setting Questionnaires were sent to all UK-trained doctors who graduated in selected years between 1993 and 2000. Method Questionnaires were sent to the doctors 1, 3, 7 and 10 years after graduation. Results Of all 3082 responders working in general practice in years 7 and 10, 38% had first specified general practice as their preferred career when responding 1 year after graduation, 19% by year 3, 21% by year 5, and 22% after year 5. Job satisfaction was high and, generally, there was little difference between the first three groups (although, when different, the most positive responses were from the earliest choosers); but there were slightly lower levels of job satisfaction in the ‘more than 5 years’ group. For example, in response to the statement ‘I find enjoyment in my current post’, the percentages agreeing in the four groups, respectively, were 91.5%, 91.1%, 91.0% and 88.2%. In response to ‘I am doing interesting and challenging work’ the respective percentages were 90.2%, 88.0%, 86.6% and 82.6%. Conclusions Job satisfaction levels were generally high among the late choosers as well as the early choosers. On this evidence, most doctors who turn to general practice, after preferring another specialty in their early career, are likely to have a satisfying career. PMID:24267855

Review of Private Sector Personnel Screening Practices

DTIC Science & Technology

2000-10-01

private sector investigative sources or methods would be useful to the DoD for conducting national security background investigations. The federal government by and large examines more sources and conducts more thorough investigations than industry. In general, private employers (1) have less access to information about applicants...outsource many elements of background checks. It is recommended that the DoD periodically evaluate private sector screening programs and data sources in order to monitor

Approach to Patient with a Generalized Rash

PubMed Central

Leung, Lawrence; Soeyonggo, Tony

2013-01-01

Background: Generalized rash is amongst the most common conditions presented to practicing General Practitioners and common differentials include contact dermatitis, atopic eczema, sun-induced damage, drug eruption and general manifestations of systemic diseases or infections. Materials and Methods: We illustrate with differential diagnoses our clinical case of a generalized rash in a 55-year-old man with pathognomonic signs of a diagnosis, which has received increasing global concern. Conclusion: Despite the array of available laboratory tests, a detailed history and physical examination is still of paramount importance to arrive at the most likely diagnosis for any patient with a generalized skin rash. PMID:26664833

Getting the right balance? A mixed logit analysis of the relationship between UK training doctors’ characteristics and their specialties using the 2013 National Training Survey

PubMed Central

Chalkley, Martin

2017-01-01

Objective To analyse how training doctors’ demographic and socioeconomic characteristics vary according to the specialty that they are training for. Design Descriptive statistics and mixed logistic regression analysis of cross-sectional survey data to quantify evidence of systematic relationships between doctors’ characteristics and their specialty. Setting Doctors in training in the United Kingdom in 2013. Participants 27 530 doctors in training but not in their foundation year who responded to the National Training Survey 2013. Main outcome measures Mixed logit regression estimates and the corresponding odds ratios (calculated separately for all doctors in training and a subsample comprising those educated in the UK), relating gender, age, ethnicity, place of studies, socioeconomic background and parental education to the probability of training for a particular specialty. Results Being female and being white British increase the chances of being in general practice with respect to any other specialty, while coming from a better-off socioeconomic background and having parents with tertiary education have the opposite effect. Mixed results are found for age and place of studies. For example, the difference between men and women is greatest for surgical specialties for which a man is 12.121 times more likely to be training to a surgical specialty (relative to general practice) than a woman (p-value<0.01). Doctors who attended an independent school which is proxy for doctor’s socioeconomic background are 1.789 and 1.413 times more likely to be training for surgical or medical specialties (relative to general practice) than those who attended a state school (p-value<0.01). Conclusions There are systematic and substantial differences between specialties in respect of training doctors’ gender, ethnicity, age and socioeconomic background. The persistent underrepresentation in some specialties of women, minority ethnic groups and of those coming from disadvantaged backgrounds will impact on the representativeness of the profession into the future. Further research is needed to understand how the processes of selection and the self-selection of applicants into specialties gives rise to these observed differences. PMID:28801397

Significant event auditing.

PubMed

Pringle, M

2000-12-01

Significant event auditing has been described for 5 years and it is slowly gaining credibility as an effective method of quality assurance in British general practice. This paper describes what it is, what its background is, how it is done and whether it is effective. While it needs a positive team culture - and therefore may not suit every practice - where it is used it appears to be a useful adjunct to a clinical audit programme.

Web-based credential monitoring instantly flags health professionals with fraudulent licenses or criminal backgrounds.

PubMed

Haddad, Matthew

2009-01-01

An alarming number of practicing medical professionals and healthcare staffers across the nation may have criminal backgrounds, jeopardizing the health of hundreds of millions of patients and compromising the integrity of healthcare in this country. An investigation conducted by The Los Angeles Times found that an extraordinary number of nurses in California with criminal backgrounds had been allowed to continue working in healthcare facilities for years--their crimes virtually swept under the rug. This article suggests that continuous monitoring of healthcare credentials can mitigate the potential harm posed by credentialing fraud, recommending 24/7 monitoring in real-time as opposed to once every year or two as is the current practice. This would include verification of provider licenses, Drug Enforcement Administration certification, Office of Inspector General status, and criminal offenses. Automatic and continuous monitoring of licenses and other databases for changes and lapses, and reports on issues that are uncovered, help to prevent harmful acts on the part of healthcare providers with questionable backgrounds.

Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases

PubMed Central

Jordan, Kelvin; Clarke, Alexandra M; Symmons, Deborah PM; Fleming, Douglas; Porcheret, Mark; Kadam, Umesh T; Croft, Peter

2007-01-01

Background Primary care consultation data are an important source of information on morbidity prevalence. It is not known how reliable such figures are. Aim To compare annual consultation prevalence estimates for musculoskeletal conditions derived from four general practice consultation databases. Design of study Retrospective study of general practice consultation records. Setting Three national general practice consultation databases: i) Fourth Morbidity Statistics from General Practice (MSGP4, 1991/92), ii) Royal College of General Practitioners Weekly Returns Service (RCGP WRS, 2001), and iii) General Practice Research Database (GPRD, 1991 and 2001); and one regional database (Consultations in Primary Care Archive, 2001). Method Age-sex standardised persons consulting annual prevalence rates for musculoskeletal conditions overall, rheumatoid arthritis, osteoarthritis and arthralgia were derived for patients aged 15 years and over. Results GPRD prevalence of any musculoskeletal condition, rheumatoid arthritis and osteoarthritis was lower than that of the other databases. This is likely to be due to GPs not needing to record every consultation made for a chronic condition. MSGP4 gave the highest prevalence for osteoarthritis but low prevalence of arthralgia which reflects encouragement for GPs to use diagnostic rather than symptom codes. Conclusion Considerable variation exists in consultation prevalence estimates for musculoskeletal conditions. Researchers and health service planners should be aware that estimates of disease occurrence based on consultation will be influenced by choice of database. This is likely to be true for other chronic diseases and where alternative symptom labels exist for a disease. RCGP WRS may give the most reliable prevalence figures for musculoskeletal and other chronic diseases. PMID:17244418

A qualitative evaluation of New Zealand consumers perceptions of general practice nurses

PubMed Central

2013-01-01

Background An important consideration in health service delivery is ensuring that services meet consumer needs and that consumers are satisfied with service delivery. Patient satisfaction can impact on compliance with suggested treatments and therefore impact on health outcomes. Comparatively few studies have explored consumer satisfaction with nurses in general practice. Methods A sub-group of 18 consumers from a larger quantitative evaluation of consumer satisfaction with New Zealand general practice nurses participated in semi-structured telephone interviews. Interview data was analysed using thematic analysis. Results Four major themes emerged from the data. These themes highlighted that, despite confusion experienced by some consumers regarding the practice nurse role, consumers were happy with the level of care provided by them. Consumers felt valued by Practice Nurses and considered them competent and highly knowledgeable. Findings also convey that consumers appreciate the accessibility and financial benefits of utilising the services of practice nurses. Conclusions Consumers are highly satisfied with practice nurse service delivery and value their relationships with these health professionals. Consumers revealed that greater clarity around the practice nurse role and their scope of practice may enhance their utilisation. Spreading the message of practice nurses being the right person to deliver care, within their scope of practice, at the right time may have the potential to provide more timely care within the primary care setting. PMID:23433311

The contribution of demographic and morbidity factors to self-reported visit frequency of patients: a cross-sectional study of general practice patients in Australia

PubMed Central

Knox, Stephanie A; Britt, Helena

2004-01-01

Background Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP) in Australia. Methods A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. Results Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p < .001). After adjustment, patients from remote/very remote locations made 2.3 fewer visits per year than patients from locations where services were highly accessible (p < .001). After adjustment for patient demographics, patients with diagnosed anxiety made on average 2.7 more visits per year (p = 0.003), those with diagnosed depression 2.2 more visits than average (p < .0001), and those with back problems 2.4 more visits (p = 0.009) than patients without the respective disorders. Conclusions Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems. PMID:15318948

Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons

PubMed Central

Donker, Gé A; Slotman, Frank G; Spreeuwenberg, Peter; Francke, Anneke L

2013-01-01

Background Little is known about the quantity and reasons for use of palliative sedation in general practice. Aim To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice. Design and setting Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Method Data collected in the years from 2005 until 2011 in the Dutch Sentinel General Practice Network were analysed. Trends and reasons for use of palliative sedation were analysed using multilevel analyses to control for clustering of observations within general practices. Results From 2005–2011, 183 cases were reported from 56 general practices. The incidence of palliative sedation fluctuated between 33.7 per 100 000 patients in 2006 and 15.2 in 2011. No rise or decline during the period was observed. Palliative sedation was applied in 5.7% of all deaths and most frequently used in younger patients with cancer. The mean number of refractory symptoms was 2.6 (SD 1.2); pain (69.4%), dyspnoea (53.0%), and fear (39.3%). Patient involvement in decision making before the start of palliative sedation (87.4%) was less frequently present in patients suffering from cardiovascular or chronic obstructive pulmonary disease and in older patients compared to patients with cancer (P<0.05). Pending euthanasia requests were present in 20.8% of cases; the choice for palliative sedation in these cases was clearly motivated. Conclusion Palliative sedation is performed in a small proportion of dying patients in Dutch general practice, without a rise or decline observed from 2005 to 2011. Patients with non-cancer diseases are less frequently involved in decision making than patients with cancer, possibly related to sudden deterioration. PMID:24152481

Separate But Equal? A Levels and GNVQs. Further Education Series.

ERIC Educational Resources Information Center

Edwards, Tony; Fitz-Gibbon, Carol Taylor; Hardman, Frank; Haywood, Roy; Meagher, Nick

This book contrasts British programs for vocationally and academically minded students and looks at differences and similarities in practice in General National Vocational Qualifications (GNVQs) and Advanced level (A level) courses. "Contrasts in Learning?" (Tony Edwards) provides background. "Educating Leaders and Training…

A flexible framework for process-based hydraulic and water quality modeling of stormwater green infrastructure performance

EPA Science Inventory

Background Models that allow for design considerations of green infrastructure (GI) practices to control stormwater runoff and associated contaminants have received considerable attention in recent years. While popular, generally, the GI models are relatively simplistic. However,...

Reliability of Speech Diadochokinetic Test Measurement

ERIC Educational Resources Information Center

Gadesmann, Miriam; Miller, Nick

2008-01-01

Background: Measures of articulatory diadochokinesis (DDK) are widely used in the assessment of motor speech disorders and they play a role in detecting abnormality, monitoring speech performance changes and classifying syndromes. Although in clinical practice DDK is generally measured perceptually, without support from instrumental methods that…

Data Content and Exchange in General Practice: a Review

PubMed Central

Kalankesh, Leila R; Farahbakhsh, Mostafa; Rahimi, Niloofar

2014-01-01

Background: efficient communication of data is inevitable requirement for general practice. Any issue in data content and its exchange among GP and other related entities hinders continuity of patient care. Methods: literature search for this review was conducted on three electronic databases including Medline, Scopus and Science Direct. Results: through reviewing papers, we extracted information on the GP data content, use cases of GP information exchange, its participants, tools and methods, incentives and barriers. Conclusion: considering importance of data content and exchange for GP systems, it seems that more research is needed to be conducted toward providing a comprehensive framework for data content and exchange in GP systems. PMID:25648317

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

PubMed Central

2014-01-01

Background Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. Methods In the nascence of the expansion of the role of nurses in Australian general practice (2003–2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009–2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. Results Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses’ role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses’ role in general practice was slightly decreased over time. Conclusions This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce. PMID:24666420

Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices

PubMed Central

Butler, Chris C; Dunstan, Frank; Heginbothom, Margaret; Mason, Brendan; Roberts, Zoë; Hillier, Sharon; Howe, Robin; Palmer, Stephen; Howard, Anthony

2007-01-01

Background GPs are urged to prescribe antibiotics less frequently, despite lack of evidence linking reduced antibiotic prescribing with reductions in resistance at a local level. Aim To investigate associations between changes in antibiotic dispensing and changes in antibiotic resistance at general-practice level. Design of study Seven-year study of dispensed antibiotics and antibiotic resistance in coliform isolates from urine samples routinely submitted from general practice. Setting General practices in Wales. Method Multilevel modelling of trends in resistance to ampicillin and trimethoprim, and changes in practice total antibiotic dispensing and amoxicillin and trimethoprim dispensing. Results The primary analysis included data on 164 225 coliform isolates from urine samples submitted from 240 general practices over the 7-year study period. These practices served a population of 1.7 million patients. The quartile of practices that had the greatest decrease in total antibiotic dispensing demonstrated a 5.2% reduction in ampicillin resistance over the 7-year period with changes of 0.4%, 2.4%, and −0.3% in the other three quartiles. There was a statistically significant overall decrease in ampicillin resistance of 1.03% (95% confidence interval [CI] = 0.37 to 1.67%) per decrease of 50 amoxicillin items dispensed per 1000 patients per annum. There were also significant reductions in trimethoprim resistance in the two quartiles of practices that reduced total antibiotic dispensing most compared with those that reduced it least, with an overall decrease in trimethoprim resistance of 1.08% (95% CI = 0.065 to 2.10%) per decrease of 20 trimethoprim items dispensed per 1000 patients per annum. Main findings were confirmed by secondary analyses of 256 370 isolates from 527 practices that contributed data at some point during the study period. Conclusion Reducing antibiotic dispensing at general-practice level is associated with reduced local antibiotic resistance. These findings should further encourage clinicians and patients to use antibiotics conservatively. PMID:17925135

State Strategic Planning for Technology. Issuegram 38.

ERIC Educational Resources Information Center

McCune, Shirley

This brief publication provides general background on issues related to using microcomputers for instruction and suggests ways in which computer technologies can be included in state education improvement plans. Specific computer assisted instruction (CAI) uses mentioned are individual drill and practice and developing higher order skills. Three…

Implementing evidence-based medicine in general practice: a focus group based study

PubMed Central

Hannes, Karin; Leys, Marcus; Vermeire, Etienne; Aertgeerts, Bert; Buntinx, Frank; Depoorter, Anne-Marie

2005-01-01

Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed. PMID:16153300

"Saying no is no easy matter" A qualitative study of competing concerns in rationing decisions in general practice

PubMed Central

Carlsen, Benedicte; Norheim, Ole Frithjof

2005-01-01

Background The general practitioner in Norway is expected to ensure equity and effectiveness through fair rationing. At the same time, due to recent reforms of the Norwegian health care sector, both the role of economic incentives and patient autonomy have been strengthened. Studies indicate that modern general practitioners, both in Norway and in other countries are uncomfortable with the gatekeeper role, but there is little knowledge about how general practitioners experience rationing in practice. Methods Through focus group interviews with Norwegian general practitioners, we explore physicians' attitudes toward factors of influence on medical decision making and how rationing dilemmas are experienced in everyday practice. Results Four major concerns appeared in the group discussions: The obligation to ration health care, professional autonomy, patient autonomy, and competition. A central finding was that the physicians find rationing difficult because saying no in face to face relations often is felt uncomfortable and in conflict with other important objectives for the general practitioner. Conclusion It is important to understand the association between using economic incentives in the management of health care, increasing patient autonomy, and the willingness among physicians to contribute to efficient, fair and legitimate resource allocation. PMID:16281967

Experiences with online consultation systems in primary care: case study of one early adopter site

PubMed Central

Casey, Michael; Shaw, Sara; Swinglehurst, Deborah

2017-01-01

Background There is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care. Aim To explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices. Design and setting Mixed methods case study in an inner-city general practice. Method The study was conducted through interviews with IT developers, clinicians, and administrative staff, and scrutiny of documents, websites, and demonstrator versions of Tele-Doc, followed by thematic analysis and discourse analysis. Results Three interrelated themes were identified: online consultation systems as innovation, managing the ‘messiness’ of general practice consultations, and redistribution of the work of general practice. These themes raise timely questions about what it means to consult in contemporary general practice. Uptake of Tele-Doc by patients was low. Much of the work of the consultation was redistributed to patients and administrators, sometimes causing misunderstandings. The ‘messiness’ of consultations was hard to eliminate. In-house training focused on the technical application rather than associated transformations to practice work that were not anticipated. GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice. Conclusion Tele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs’ workload. Tele-Doc’s potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences. PMID:28993306

Developing a preliminary ‘never event’ list for general practice using consensus-building methods

PubMed Central

de Wet, Carl; O’Donnell, Catherine; Bowie, Paul

2014-01-01

Background The ‘never event’ concept has been implemented in many acute hospital settings to help prevent serious patient safety incidents. Benefits include increasing awareness of highly important patient safety risks among the healthcare workforce, promoting proactive implementation of preventive measures, and facilitating incident reporting. Aim To develop a preliminary list of never events for general practice. Design and setting Application of a range of consensus-building methods in Scottish and UK general practices. Method A total of 345 general practice team members suggested potential never events. Next, ‘informed’ staff (n =15) developed criteria for defining never events and applied the criteria to create a list of candidate never events. Finally, UK primary care patient safety ‘experts’ (n = 17) reviewed, refined, and validated a preliminary list via a modified Delphi group and by completing a content validity index exercise. Results There were 721 written suggestions received as potential never events. Thematic categorisation reduced this to 38. Five criteria specific to general practice were developed and applied to produce 11 candidate never events. The expert group endorsed a preliminary list of 10 items with a content validity index (CVI) score of >80%. Conclusion A preliminary list of never events was developed for general practice through practitioner experience and consensus-building methods. This is an important first step to determine the potential value of the never event concept in this setting. It is now intended to undertake further testing of this preliminary list to assess its acceptability, feasibility, and potential usefulness as a safety improvement intervention. PMID:24567655

Sharing resources to create a district drug formulary: a countywide controlled trial.

PubMed Central

Hill-Smith, I

1996-01-01

BACKGROUND: Creating a drug formulary takes considerable time, but merely adopting one lacks local perspective and ownership. Sharing resources between several practices treads a middle path between these extremes, but is it effective? AIM: The aim of the study was to audit the influence of a district primary care drug formulary on prescribing by general practitioners. METHOD: A controlled trial was carried out to compare prescribing by 50 general practitioners from 11 urban and semirural practices in south Bedfordshire that participated in creating a district drug formulary with prescribing by all other general practitioners in the county. RESULTS: The proportion of prescription items that were for drugs listed in the formulary rose significantly in three therapeutics groups: cardiovascular (by 7-12% above control practice values); musculoskeletal (by 1-11% above control practice values); and obstetrics and gynaecology (by 6-9% above control practice values). The number of items prescribed per prescribing unit fell significantly in three therapeutic groups: musculoskeletal (by 1-7% below control practice values); nervous (by 7-12% below control practice values); and nutrition and blood (by 15-21% below control practice values). The estimated saving resulting from the creation of the formulary was 150,000 pounds (3000 pounds per doctor) per year. CONCLUSIONS: Sharing resources between practices to create a district-wide primary care drug formulary can lead to changes in prescribing and reduce costs sustained over 3 years. PMID:8762741

Experiences of using email for general practice consultations: a qualitative study

PubMed Central

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-01-01

Background Reports suggest approximately 21–23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. Aim To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. Design and setting A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. Method A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. Results In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the ‘rules of engagement’ in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Conclusion Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients. PMID:24267859

Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

PubMed

Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

2011-04-01

Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

Epidemiology of Patient Harms in New Zealand: Protocol of a General Practice Records Review Study

PubMed Central

Leitch, Sharon; Wallis, Katharine A; Eggleton, Kyle S; Cunningham, Wayne K; Williamson, Martyn I; Lillis, Steven; McMenamin, Andrew W; Tilyard, Murray W; Reith, David M; Samaranayaka, Ari; Hall, Jason E

2017-01-01

Background Knowing where and why harm occurs in general practice will assist patients, doctors, and others in making informed decisions about the risks and benefits of treatment options. Research to date has been unable to verify the safety of primary health care and epidemiological research about patient harms in general practice is now a top priority for advancing health systems safety. Objective We aim to study the incidence, distribution, severity, and preventability of the harms patients experience due to their health care, from the whole-of-health-system lens afforded by electronic general practice patient records. Methods “Harm” is defined as disease, injury, disability, suffering, and death, arising from the health system. The study design is a stratified, 2-level cluster, retrospective records review study. Both general practices and patients will be randomly selected so that the study’s results will apply nationally, after weighting. Stratification by practice size and rurality will allow comparisons between 6 study groups (large, medium-sized, small; urban and rural practices). Records of equal numbers of patients from each study group will be included in the study because there may be systematic differences in patient harms in different types of practices. Eight general practitioner investigators will review 3 years of electronic general practice health records (consultation notes, prescriptions, investigations, referrals, and summaries of hospital care) from 9000 patients registered in 60 general practices. Double-blinded reviews will check the concordance of reviewers’ assessments. Study data will comprise demographic data of all 9000 patients and reviewers’ assessments of whether patients experienced harm arising from health care. Where patient harm is identified, their types, preventability, severity, and outcomes will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 18.0. Results We have recruited practices and collected electronic records from 9078 patients. Reviews of these records are under way. The study is expected to be completed in August 2017. Conclusions The design of this complex study is presented with discussion on data collection methods, sampling weights, power analysis, and statistical approach. This study will show the epidemiology of patient harms recorded in general practice records for all of New Zealand and will show whether this epidemiology differs by rural location and clinic size. PMID:28119276

Evaluation of a rule base for decision making in general practice.

PubMed Central

Essex, B; Healy, M

1994-01-01

BACKGROUND. Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM. A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD. The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS. Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION. The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice. PMID:8204334

Michigan High School Student Drug Attitudes and Behavior Questionnaire.

ERIC Educational Resources Information Center

Bogg, Richard A.; And Others

This questionnaire assesses drug use practices and attitudes toward drugs in high school students. The instrument has 59 items (multiple choice or completion), some with several parts. The question pertain to aspirations for the future, general attitudes and opinions, biographic and demographic data, family background and relationships, alcohol…

Extinguishing All Hope: Life-without-Parole for Juveniles

ERIC Educational Resources Information Center

Butler, Frank

2010-01-01

Sentencing juveniles to life-without-parole (JLWOP) is a practice fraught with ethical dilemmas. Through in-depth interviews with 11 men living sentences of JLWOP, their narratives of their backgrounds and experiences as juveniles were studied. Common themes were identified, and 3 general categories of cases emerged from the narratives. Ethical…

The PEN&PAD data entry system: from prototype to practical system.

PubMed Central

Kirby, J.; Rector, A. L.

1996-01-01

This paper describes some of the issues addressed in the transition of the PEN&PAD from prototype clinical workstation to practical data entry system for use by general practitioners in the UK. Background and motivation of the PEN&PAD and GALEN projects are presented before the operation of the PEN&PAD user interface is described. A number of issues which have arisen in the development of the PEN&PAD Data Entry System are discussed. PMID:8947757

Impact of medical student origins on the likelihood of ultimately practicing in areas of low vs high socio-economic status.

PubMed

Puddey, Ian B; Playford, Denese E; Mercer, Annette

2017-01-05

Medical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage. The current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles. Those who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001). Widening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.

Managing patient demand: a qualitative study of appointment making in general practice.

PubMed Central

Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

2001-01-01

BACKGROUND: Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. AIM: To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. DESIGN OF STUDY: A qualitative study using participant observation. SETTING: Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. METHOD: Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. RESULTS: Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. CONCLUSION: Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria. PMID:11458480

The impact of patient record access on appointments and telephone calls in two English general practices: a population-based study

PubMed Central

Fitton, Caroline; Fitton, Richard; Hannan, Amir; Morgan, Lawrie; Halsall, David

2014-01-01

Background Government policy expects all patients who wish to have online record access (RA) by 2015. We currently have no knowledge of the impact of patient record access on practice workload. Setting Two urban general practices in Manchester. Question What is the impact of patient RA on telephone calls and appointments in UK general practice? Method We asked patients in two urban general practices who used RA whether it had increased or decreased their use of the practice over the previous year. Using practice data, we calculated the change in appointments, telephone calls and staff cost. We also estimated the reduction in environmental costs and patient time. Results An average of 187 clinical appointments (of which 87 were with doctors and 45 with nurses) and 290 telephone calls were saved. If 30% of patients used RA at least twice a year, these figures suggest that a 10 000-patient practice would save 4747 appointments and 8020 telephone calls per year. Assuming a consultation rate of 5.3% annually, that equates to a release of about 11% of appointments per year, with significant resource savings for patients and the environment. Discussion This is the first such study in the UK. It shows similar results to a study in the USA. We discuss the study limitations, including the issue of patient recall, nature of the practices studied and nature of early adopter patients. Strengths include combining national data, practice data and local reflection. We are confident that the savings observed are the result of RA rather than other factors. We suggest that RA can be part of continuous practice improvement, given its benefits and the support it offers for patient confidence, self-care and shared decision-making. PMID:25949705

Patients with cancer and change of general practice: a Danish population-based cohort study

PubMed Central

Grooss, Kasper; Hjertholm, Peter; Carlsen, Anders H; Vedsted, Peter

2016-01-01

Background General practice plays an important role in the cancer care pathway. Patient dissatisfaction with the diagnostic process may be expressed by changing to another general practice. Aim To compare the frequency of change of practice (COP) in patients with cancer (n = 150 216) with a matched cancer-free control cohort (n = 1 502 114) and to analyse associations with cancer type and patient characteristics. Design and setting A population-based matched cohort study using historical and prospectively collected data from Danish nationwide registers. Method COP was defined as a change of practice list, unrelated to change of address or reorganisation of the practice. Data were analysed monthly in the year before and after a cancer diagnosis. Results More patients with cancer than controls changed general practice (4.1% versus 2.6%) from 7 months before and until 12 months after diagnosis. The COP rate varied by cancer type (rectal cancer served as reference). Before the diagnosis, COP was most often seen among patients with ovarian cancer (risk ratio [RR] 1.51, 95% confidence interval [CI] = 1.10 to 2.08) and multiple myeloma (RR 1.89, 95% CI = 1.34 to 2.67). After the diagnosis, COP was most frequent among patients with brain cancer (RR 1.38, 95% CI = 1.05 to 1.82) and ovarian cancer (RR 1.51, 95% CI = 1.21 to 1.88). Conclusion Patients with cancer changed general practice more frequently than the cancer-free controls. COP variations between cancer types may be attributed to lack of diagnostic timeliness due to clinical complexity of the diagnosis and the role of the GP in the diagnostic process. PMID:27215570

Prescribing Data in General Practice Demonstration (PDGPD) project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

PubMed Central

2012-01-01

Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870. PMID:22913571

Understanding “revolving door” patients in general practice: a qualitative study

PubMed Central

2014-01-01

Background ‘Revolving door’ patients in general practice are repeatedly removed from general practitioners’ (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients. Methods We conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise ‘revolving door’ patients and their impact from professionals’ perspectives. Results ‘Revolving door’ patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when ‘revolving door’ patients interacted with NHS staff. Conclusions We utilise the ‘sensitising concepts’ of legitimacy by drawing on literature about ‘good and bad’ patients and ‘dirty work designations.’ We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with ‘revolving door’ patients. We suggest this may have wider relevance for the problem doctor patient relationship literature. PMID:24524363

Getting the right balance? A mixed logit analysis of the relationship between UK training doctors' characteristics and their specialties using the 2013 National Training Survey.

PubMed

Rodriguez Santana, Idaira; Chalkley, Martin

2017-08-11

To analyse how training doctors' demographic and socioeconomic characteristics vary according to the specialty that they are training for. Descriptive statistics and mixed logistic regression analysis of cross-sectional survey data to quantify evidence of systematic relationships between doctors' characteristics and their specialty. Doctors in training in the United Kingdom in 2013. 27 530 doctors in training but not in their foundation year who responded to the National Training Survey 2013. Mixed logit regression estimates and the corresponding odds ratios (calculated separately for all doctors in training and a subsample comprising those educated in the UK), relating gender, age, ethnicity, place of studies, socioeconomic background and parental education to the probability of training for a particular specialty. Being female and being white British increase the chances of being in general practice with respect to any other specialty, while coming from a better-off socioeconomic background and having parents with tertiary education have the opposite effect. Mixed results are found for age and place of studies. For example, the difference between men and women is greatest for surgical specialties for which a man is 12.121 times more likely to be training to a surgical specialty (relative to general practice) than a woman (p-value<0.01). Doctors who attended an independent school which is proxy for doctor's socioeconomic background are 1.789 and 1.413 times more likely to be training for surgical or medical specialties (relative to general practice) than those who attended a state school (p-value<0.01). There are systematic and substantial differences between specialties in respect of training doctors' gender, ethnicity, age and socioeconomic background. The persistent underrepresentation in some specialties of women, minority ethnic groups and of those coming from disadvantaged backgrounds will impact on the representativeness of the profession into the future. Further research is needed to understand how the processes of selection and the self-selection of applicants into specialties gives rise to these observed differences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A survey of audit activity in general practice.

PubMed Central

Hearnshaw, H; Baker, R; Cooper, A

1998-01-01

BACKGROUND: Since 1991, all general practices have been encouraged to undertake clinical audit. Audit groups report that participation is high, and some local surveys have been undertaken, but no detailed national survey has been reported. AIM: To determine audit activities in general practices and the perceptions of general practitioners (GPs) regarding the future of clinical audit in primary care. METHOD: A questionnaire on audit activities was sent to 707 practices from 18 medical audit advisory group areas. The audit groups had been ranked by annual funding from 1992 to 1995. Six groups were selected at random from the top, middle, and lowest thirds of this rank order. RESULTS: A total of 428 (60.5%) usable responses were received. Overall, 346 (85%) responders reported 125.7 audits from the previous year with a median of three audits per practice. There was no correlation between the number of audits reported and the funding per GP for the medical audit advisory group. Of 997 audits described in detail, changes were reported as 'not needed' in 220 (22%), 'not made' in 142 (14%), 'made' in 439 (44%), and 'made and remeasured' in 196 (20%). Thus, 635 (64%) audits were reported to have led to changes. Some 853 (81%) of the topics identified were on clinical care. Responders made 242 (42%) positive comments on the future of clinical audit in primary care, and 152 (26%) negative views were recorded. CONCLUSION: The level of audit activity in general practice is reasonably high, and most of the audits result in change. The number of audits per practice seems to be independent of the level of funding that the medical audit advisory group has received. Although there is room for improvement in the levels of effective audit activity in general practice, continued support by the professionally led audit groups could enable all practices to undertake effective audit that leads to improvement in patient care. PMID:9624769

Presenting practice financial information.

PubMed

Webster, Lee Ann H

2007-01-01

Medical practice leadership teams, often consisting primarily of physicians with limited financial backgrounds, must make important business decisions and continuously monitor practice operations. In order to competently perform this duty, they need financial reports that are relevant and easy to understand. This article explores financial reporting and decision-making in a physician practice. It discusses reports and tools, such as ratios, graphs, and comparisons, that practices typically include in their reports. Because profitability and cash flow are often the most important financial considerations for physician practices, reports should generally focus on the impact of various activities and potential decisions upon these concerns. This article also provides communication tips for both those presenting practice financial information and those making the decisions. By communicating effectively, these leaders can best use financial information to improve decision-making and maximize financial performance.

Building SAWE Capability as an ANSI Accredited Standards Developer

NASA Technical Reports Server (NTRS)

Cerro, Jeffrey A.; Davis, Ed; Peterson, Eric; Griffiths, William T.; Brooks, Andy; Stratton, Bonnie; Attar, Jose

2014-01-01

This paper presents a 2014 status of the Society of Allied Weight Engineers' process towards becoming an Accredited Standards Developer (ASD) under certification by the United States American National Standards Institute (ANSI). Included is material from the committee's 2013 International presentation, current status, and additional general background material. The document strives to serve as a reference point to assist SAWE Recommended Practice and Standards developers in negotiating United States Standards Strategy, international standards strategy, and the association of SAWE standards and recommended practices to those efforts. Required procedures for SAWE to develop and maintain Recommended Practices and ANSI/SAWE Standards are reviewed.

Patient experience and the role of postgraduate GP training: a cross-sectional analysis of national Patient Survey data in England

PubMed Central

Ashworth, Mark; Schofield, Peter; Durbaba, Stevo; Ahluwalia, Sanjiv

2014-01-01

Background Quality indicators for primary care focus predominantly on the public health model and organisational measures. Patient experience is an important dimension of quality. Accreditation for GP training practices requires demonstration of a series of attributes including patient-centred care. Aim The national GP Patient Survey (GPPS) was used to determine the characteristics of general practices scoring highly in responses relating to the professional skills and characteristics of doctors. Specifically, to determine whether active participation in postgraduate GP training was associated with more positive experiences of care. Design and setting Retrospective cross-sectional study in general practices in England. Method Data were obtained from the national QOF dataset for England, 2011/12 (8164 general practices); the GPPS in 2012 (2.7 million questionnaires in England; response rate 36%); general practice and demographic characteristics. Sensitivity analyses included local data validated by practice inspections. Outcome measures: multilevel regression models adjusted for clustering. Results GP training practice status (29% of practices) was a significant predictor of positive GPPS responses to all questions in the ‘doctor care’ (n = 6) and ‘overall satisfaction’ (n = 2) domains but not to any of the ‘nurse care’ or ‘out-of-hours’ domain questions. The findings were supported by the sensitivity analyses. Other positive determinants were: smaller practice and individual GP list sizes, more older patients, lower social deprivation and fewer ethnic minority patients. Conclusion Based on GPPS responses, doctors in GP training practices appeared to offer more patient-centred care with patients reporting more positively on attributes of doctors such as ‘listening’ or ‘care and concern’. PMID:24567656

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

PubMed Central

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-01-01

Background NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. Aim To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Design and setting Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Method Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report. Results Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Conclusion Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. PMID:29378697

Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey

PubMed Central

Dumesnil, Hélène; Apostolidis, Thémis; Verger, Pierre

2018-01-01

Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area. PMID:29385155

Does the North Staffordshire slot system control demand of orthopaedic referrals from primary care?

PubMed Central

Bridgman, Stephen; Li, Xuefang; Mackenzie, Gilbert; Dawes, Peter

2005-01-01

Background Attempts to manage general practice demand for orthopaedic outpatient consultations have been made in several areas of the NHS, with little robust evidence on whether or not they work. Aim To evaluate the effect of the North Staffordshire ‘orthopaedic slot system’ on the demand for general practice referrals to orthopaedic outpatients. Method A prospective study of 12 general practices in the slot system, 24 controls, and the 63 other general practices in North Staffordshire. Comparison periods were the baseline year (0); the first calendar year (1); and the first half of the second calendar year (2). A multifactor linear regression model was used. Results Mean referral rate decreased 22% in the slot group in period 1, and was maintained in period 2 (9.40, 7.29, 7.31 referrals per 10 000 population per month for periods 0, 1 and 2, respectively). The control and other groups showed a small decrease in period 1, but in period 2 higher referral rates were observed. The reduction in referrals of 20–40% in participating practices compared to other practices equates to 2–4 referrals per 10 000 patients per month. Conclusions Our study suggests that practices willing and able to take up an offer of a slot system for managing their orthopaedic referrals will be able to significantly reduce referral rates for their patients when compared to similar practices who do not. Further research on the generalisability, effectiveness and cost-effectiveness of such systems is warranted. PMID:16176738

Technical writing practically unified through industry

NASA Technical Reports Server (NTRS)

Houston, L. S.

1981-01-01

General background details in the development of a university level technical writing program, based upon the writing tasks of the student's occupations, are summarized. Objectives and methods for unifying the courses of study with the needs of industry are discussed. Four academic course divisions, Industries Technologies, in which preparation and training are offered are: Animal, Horticulture, Agriculture, and Agricultural Business. Occupational competence is cited as the main goal for these programs in which technical writing is to be practically unified through industry. Course descriptions are also provided.

Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

PubMed Central

Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

2009-01-01

Background General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice. PMID:19821964

Prevalence and Incidence of Myocardial Infarction and Cerebrovascular Accident in Ageing Persons with Intellectual Disability

ERIC Educational Resources Information Center

Jansen, J.; Rozeboom, W.; Penning, C.; Evenhuis, H. M.

2013-01-01

Background: Epidemiological information on age-related cardiovascular disease in people with intellectual disability (ID) is scarce and inconclusive. We compared prevalence and incidence of cerebrovascular accident and myocardial infarction over age 50 in a residential population with ID to that in a general practice population. Method: Lifetime…

Teaching as a Primary Therapeutic Intervention for Learners from Refugee Backgrounds

ERIC Educational Resources Information Center

Hayward, Maria

2017-01-01

Refugees almost invariably have a history of traumatic experience and significant loss. However, for some, therapy is neither a practical nor a readily available solution and for others, it may present further challenges in terms of stigma or cultural inappropriateness. On the other hand, a classroom is generally considered unthreatening and, as…

Assessment of postprandial triglycerides in clinical practice: validation in a general population and coronary heart disease patients

USDA-ARS?s Scientific Manuscript database

BACKGROUND: Previous studies have suggested that for clinical purposes, subjects with fasting triglycerides (TGs) between 89-180 mg/dl (1-2 mmol/l) would benefit from postprandial TGs testing. OBJECTIVE: To determine the postprandial TG response in 2 independent studies and validate who should benef...

Flow for Exercise Adherence: Testing an Intrinsic Model of Health Behavior

ERIC Educational Resources Information Center

Petosa, R. Lingyak; Holtz, Brian

2013-01-01

Background: Health behavior theory generally does not include intrinsic motivation as a determinate of health practices. Purpose: The purpose of this study was to test the flow theory of exercise adherence. Flow theory posits that exercise can be intrinsically rewarding if the experiences of self/time transcendence and control/mastery are achieved…

Intersecting Leadership Knowledge from the Field: Diverse Women Secondary Principals

ERIC Educational Resources Information Center

Sherman, Whitney H.; Wrushen, Barbara Rivers

2009-01-01

This qualitative study elucidated differences and commonalities among eight practicing women secondary leaders from different ethnic backgrounds. Its purpose was to add to the existing body of knowledge on women leaders in general and to contribute to the dearth of research on minority women leaders and women in the secondary leadership role in…

Background information: a selected bibliography of books on energy and nuclear power

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

An annotated bibliography of 75 books on energy and nuclear power topics lists selections under the categories of Energy, Nuclear energy, Radiation, Environment, Reference, Proliferation, International, Fiction, and From the Critics. The selections, ranging from philosophical discussions to practical proposals, are generally aimed at the lay reader. (DCK)

Achievement Unlocked: Effective Curriculum Interventions with Low-Income Students

ERIC Educational Resources Information Center

VanTassel-Baska, Joyce

2018-01-01

This article explores the world of curriculum intervention for gifted students from low-income and culturally diverse backgrounds. It delineates both general and specific approaches to practices that can be used in classrooms and beyond. Affective and conative concerns are addressed as they have an impact on motivation and learning. Efforts toward…

Expansive Openness in Teacher Practice

ERIC Educational Resources Information Center

Kimmons, Royce

2016-01-01

Background/Context: Previous work on the use of open educational resources in K-12 classrooms has generally focused on issues related to cost. The current study takes a more expansive view of openness that also accounts for adaptation and sharing in authentic classroom contexts. Purpose/Objective/Research Question/Focus of Study The study seeks to…

The economics of employing a counsellor in general practice: analysis of data from a randomised controlled trial.

PubMed Central

Friedli, K; King, M B; Lloyd, M

2000-01-01

BACKGROUND: Counselling is currently adopted in many general practices, despite limited evidence of clinical and cost effectiveness. AIM: To compare direct and indirect costs of counsellors and general practitioners (GPs) in providing care to people with emotional problems. METHOD: We carried out a prospective, randomized controlled trial of non-directive counselling and routine general practice care in 14 general practices in north London. Counsellors adhered to a Rogerian model of counselling. The counselling sessions ranged from one to 12 sessions over 12 weeks. As reported elsewhere, there were no differences in clinical outcomes between the two groups. Therefore, we conducted a cost minimisation analysis. We present only the economic outcomes in this paper. Main outcome measures were cost data (service utilisation, travel, and work absence) at baseline, three months, and nine months. RESULTS: One hundred and thirty-six patients with emotional problems, mainly depression, took part. Seventy patients were randomised to the counsellors and 66 to the GPs. The average direct and indirect costs for the counsellor was 162.09 Pounds more per patient after three months compared with costs for the GP group; however, over the following six months the counsellor group was 87.00 Pounds less per patient than the GP group. Over the total nine-month period, the counsellor group remained more expensive per patient. CONCLUSIONS: Referral to counselling is no more clinically effective or expensive than GP care over a nine-month period in terms of direct plus indirect costs. However, further research is needed to establish indirect costs of introducing a counsellor into general practice. PMID:10897510

Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey

PubMed Central

Cowling, Thomas E; Harris, Matthew; Majeed, Azeem

2017-01-01

Background The UK government plans to extend the opening hours of general practices in England. The ‘extended hours access scheme’ pays practices for providing appointments outside core times (08:00 to 18.30, Monday to Friday) for at least 30 min per 1000 registered patients each week. Objective To determine the association between extended hours access scheme participation and patient experience. Methods Retrospective analysis of a national cross-sectional survey completed by questionnaire (General Practice Patient Survey 2013–2014); 903 357 survey respondents aged ≥18 years old and registered to 8005 general practices formed the study population. Outcome measures were satisfaction with opening hours, experience of making an appointment and overall experience (on five-level interval scales from 0 to 100). Mean differences between scheme participation groups were estimated using multilevel random-effects regression, propensity score matching and instrumental variable analysis. Results Most patients were very (37.2%) or fairly satisfied (42.7%) with the opening hours of their general practices; results were similar for experience of making an appointment and overall experience. Most general practices participated in the extended hours access scheme (73.9%). Mean differences in outcome measures between scheme participants and non-participants were positive but small across estimation methods (mean differences ≤1.79). For example, scheme participation was associated with a 1.25 (95% CI 0.96 to 1.55) increase in satisfaction with opening hours using multilevel regression; this association was slightly greater when patients could not take time off work to see a general practitioner (2.08, 95% CI 1.53 to 2.63). Conclusions Participation in the extended hours access scheme has a limited association with three patient experience measures. This questions expected impacts of current plans to extend opening hours on patient experience. PMID:27343274

Evaluation of a practice team-supported exposure training for patients with panic disorder with or without agoraphobia in primary care - study protocol of a cluster randomised controlled superiority trial

PubMed Central

2014-01-01

Background Panic disorder and agoraphobia are debilitating and frequently comorbid anxiety disorders. A large number of patients with these conditions are treated by general practitioners in primary care. Cognitive behavioural exposure exercises have been shown to be effective in reducing anxiety symptoms. Practice team-based case management can improve clinical outcomes for patients with chronic diseases in primary care. The present study compares a practice team-supported, self-managed exposure programme for patients with panic disorder with or without agoraphobia in small general practices to usual care in terms of clinical efficacy and cost-effectiveness. Methods/Design This is a cluster randomised controlled superiority trial with a two-arm parallel group design. General practices represent the units of randomisation. General practitioners recruit adult patients with panic disorder with or without agoraphobia according to the International Classification of Diseases, version 10 (ICD-10). In the intervention group, patients receive cognitive behaviour therapy-oriented psychoeducation and instructions to self-managed exposure exercises in four manual-based appointments with the general practitioner. A trained health care assistant from the practice team delivers case management and is continuously monitoring symptoms and treatment progress in ten protocol-based telephone contacts with patients. In the control group, patients receive usual care from general practitioners. Outcomes are measured at baseline (T0), at follow-up after six months (T1), and at follow-up after twelve months (T2). The primary outcome is clinical severity of anxiety of patients as measured by the Beck Anxiety Inventory (BAI). To detect a standardised effect size of 0.35 at T1, 222 patients from 37 general practices are included in each group. Secondary outcomes include anxiety-related clinical parameters and health-economic costs. Trial registration Current Controlled Trials [http://ISCRTN64669297] PMID:24708672

Measuring morale--does practice area deprivation affect doctors' well-being?

PubMed Central

Grieve, S

1997-01-01

BACKGROUND: Morale is a perennial concern in general practice and, over the years, a variety of tools have been used to examine doctors' mental well-being in a range of psychological and sociological studies. Despite perceived associations between low morale and practice area deprivation, this has not been investigated previously. AIM: To devise and apply a measure of mental well-being in general practitioners, and to use this to investigate the effect of practice area deprivation. METHOD: A questionnaire was devised and piloted, then used in an anonymous postal survey of a random sample of 500 London general practitioners, with questions on demography, workload, practice characteristics, patient centredness, and practice area deprivation. RESULTS: A total of 334 (68%) doctors replied to the questionnaire. Of these, 45% often feel exhausted, 46% are often frustrated by trivial consultations, and a third are seriously disenchanted with work. The resulting well-being score had a normal distribution, was reproducible (test-retest reliability = 0.91), and was internally consistent (Cronbach's alpha = 0.76). Comments from respondents suggested good face validity. Low well-being was not associated with practice area deprivation, but was associated with time stress, small practices and primary care teams, and lack of patient centredness. CONCLUSION: The instrument provided a useful tool for examining doctors' well-being and the associations thereof. Well-being was not associated with practice area deprivation. Help for small primary care teams and measures to reduce time stress should help to improve morale. PMID:9406487

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

PubMed Central

2012-01-01

Background Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. Discussion This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. Trial registration ACTRN12610000592044\\ PMID:22958678

The MueLu Tutorial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, Jonathan Joseph; Wiesner, Tobias A.; Prokopenko, Andrey

2014-10-01

The MueLu tutorial is written as a hands-on tutorial for MueLu, the next generation multigrid framework in Trilinos. It covers the whole spectrum from absolute beginners’ topics to expert level. Since the focus of this tutorial is on practical and technical aspects of multigrid methods in general and MueLu in particular, the reader is expected to have a basic understanding of multigrid methods and its general underlying concepts. Please refer to multigrid textbooks (e.g. [1]) for the theoretical background.

Factors Influencing the Location of Rural General Practitioners

PubMed Central

Cordes, Sam M.

1978-01-01

Data on (1) personal background, (2) place of medical education and training, (3) reasons for selecting the present place of practice and (4) previous practice location were gathered and analyzed from 41 general practitioners in rural Washington state. The analysis was done to isolate factors influencing the choice of location by physicians. Results show that most of the physicians had spent at least some of their preadulthood years in small communities and that most had some exposure to the state of Washington before establishing their practices in the state. In addition to the apparent importance of previous exposure to small communities and Washington state, the physicians were also influenced in their locational choice by (1) the professional advantages or appeal of the community, (2) recruitment efforts by persons within the community and (3) economic reasons. The physicians were rather immobile. Most had never practiced in another community and only two of the 41 physicians planned to move to another community. PMID:625975

Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study.

PubMed

Walker, Judith H; Dewitt, Dawn E; Pallant, Julie F; Cunningham, Christine E

2012-01-01

Health workforce shortages are a major problem in rural areas. Australian medical schools have implemented a number of rural education and training interventions aimed at increasing medical graduates' willingness to work in rural areas. These initiatives include recruiting students from rural backgrounds, delivering training in rural areas, and providing all students with some rural exposure during their medical training. However there is little evidence regarding the impact of rural exposure versus rural origin on workforce outcomes. The aim of this study is to identify and assess factors affecting preference for future rural practice among medical students participating in the Australian Rural Clinical Schools (RCS) Program. Questionnaires were distributed to 166 medical students who had completed their RCS term in 2006; 125 (75%) responded. Medical students were asked about their preferred location and specialty for future practice, their beliefs about rural work and life, and the impact of the RCS experience on their future rural training and practice preferences. Almost half the students (47%; n=58) self-reported a 'rural background'. Significantly, students from rural backgrounds were 10 times more likely to prefer to work in rural areas when compared with other students (p<0.001). For those preferring general practice, 80% (n=24) wished to do so rurally. Eighty-five per cent (n=105) of students agreed that their RCS experience increased their interest in rural training and practice with 62% (n=75) of students indicating a preference for rural internship/basic training after their RCS experience. A substantial percentage (86%; n=108) agreed they would consider rural practice after their RCS experience. This baseline study provides significant evidence to support rural medical recruitment and retention through education and training, with important insights into the factors affecting preference for future rural practice. By far the most significant predictor of rural practice intention is recruitment of students with a rural background who also undertake an RCS placement. This research also demonstrates significant demand for post-graduate rural training places, including specialty places, as RCS graduates become junior doctors and vocational trainees.

Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network

PubMed Central

Anabtawi, Mona F.; Gilbert, Gregg H.; Bauer, Michael R.; Reams, Gregg; Makhija, Sonia K.; Benjamin, Paul L.; Williams, O. Dale

2012-01-01

Background The Dental Practice-Based Research Network (DPBRN) provides a venue to investigate whether certain procedures are performed routinely. Study objectives were to: (1) quantify rubber dam use during root canal treatment (RCT) among general dentists; (2) test the hypothesis that certain dentist or practice characteristics are associated with its use. Methods DPBRN practitioner-investigators participated in a questionnaire that included items about rubber dam use and other forms of isolation during root RCT. DPBRN Enrollment Questionnaire data provided certain practitioner and practice characteristics. Results A total of 729 practitioners responded (74%); 524 were general dentists and indicated they do RCT and the percentage of RCT in which they use a rubber dam. Of these 524, 44% use rubber dam for all RCTs; 24% use it for 51%–99% of RCTs; 17% use it for 1%–50%; 15% never use it during RCT. Usage varied significantly by geographic region and practice type. Cotton rolls and other forms of isolation were also reported. Conclusions Similar to other reports in the literature, not all DPBRN general dentists use a rubber dam during RCT. Clinical implications Because the current clinical standard of care is to use a rubber dam during RCT, increasing its use may be important. PMID:23372134

Stemming the Tide of Antibiotic Resistance (STAR): A protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

PubMed Central

Simpson, Sharon A; Butler, Christopher C; Hood, Kerry; Cohen, David; Dunstan, Frank; Evans, Meirion R; Rollnick, Stephen; Moore, Laurence; Hare, Monika; Bekkers, Marie-Jet; Evans, John

2009-01-01

Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. Methods and design We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning) called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not) and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. Discussion This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include feedback of practice level data on antimicrobial resistance and prescribing, use of principles from motivational interviewing, training in enhanced communication skills that incorporates context-bound experience and reflection, and using antibiotic dispensing over one year (as opposed to antibiotic prescribing in a single consultation) as the main outcome. Trial registration Current Controlled Trials ISRCTN63355948. PMID:19309493

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

PubMed Central

2011-01-01

Background Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete. PMID:22145678

Creativity and Learning Jazz: The Practice of "Listening"

ERIC Educational Resources Information Center

Black, Steven P.

2008-01-01

This article is about interaction, culture, and creativity. The ethnographic setting is a set of jazz performance classes at a California university. Although I write about jazz music, the reader need not have a background in studying or performing jazz (or music in general) to understand this article. In the title of the article, the term…

How Much Do Study Habits, Skills, and Attitudes Affect Student Performance in Introductory College Accounting Courses?

ERIC Educational Resources Information Center

Yu, Darwin D.

2011-01-01

Background: Financial accounting is a skills course which to a large extent can be best learned through deliberate practice. Teachers implement this by continuously assigning homeworks, encouraging good study habits, asking students to budget time for studying, and generally exhorting students to "work hard". Aims: This paper examines the impact…

Responding to Individual Needs in Head Start: A Head Start Series on Needs Assessment. Part 1: Working with the Individual Child.

ERIC Educational Resources Information Center

Child Development Services Bureau (DHEW/OCD), Washington, DC. Project Head Start.

This manual, designed for Head Start staff, parents, and others working with handicapped and/or nonhandicapped children, gives general background information on physical, emotional, and cognitive disabilities and offers practical suggestions for handling classroom problems related to these disabilities. Staff planning is discussed in relation to…

Worldviews, Religions, and Beliefs about Teaching and Learning: Perception of Mathematics Teachers with Different Religious Backgrounds

ERIC Educational Resources Information Center

Chan, Yip-Cheung; Wong, Ngai-Ying

2014-01-01

Beliefs about mathematics education and their influences on teaching practices have been widely investigated in recent decades. There have been numerous empirical studies on the influences of religions on teachers' and students' beliefs about subjects such as sciences and language. However, the influences of worldviews in general and…

Becoming a Race-Conscious Social Studies Teacher: The Influence of Personal and Professional Experiences

ERIC Educational Resources Information Center

Martell, Christopher C.; Stevens, Kaylene M.

2017-01-01

In this interpretive case study the researchers examined the beliefs of 13 self-identifying race-conscious secondary social studies teachers from diverse racial or ethnic, gender, and school-context backgrounds. The researchers found that the teachers' beliefs and views of practice were generally aligned with the main assertions of critical race…

Pain and Pain Assessment in People with Intellectual Disability: Issues and Challenges in Practice

ERIC Educational Resources Information Center

Doody, Owen; Bailey, Maria E.

2017-01-01

Background: Individuals with intellectual disability experience the same chronic diseases and conditions as the general population, but are more likely to have physical and psychological co-morbidities, resulting in a higher risk of experiencing pain and having more frequent or severe pain. Method: This position paper aims to highlight the…

Coyle's Information Highway Handbook: A Practical File on the New Information Order.

ERIC Educational Resources Information Center

Coyle, Karen

This book provides a selection of documentary background information on areas of the Information Highway debate that are particularly relevant to libraries. The book is designed for librarians who are online but have little time to explore the general areas of information policy, and for those not yet connected to the Internet who need to…

Creating an Inclusive Society… How Close Are We in Relation to Autism Spectrum Disorder? A General Population Survey

ERIC Educational Resources Information Center

Dillenburger, Karola; McKerr, Lyn; Jordan, Julie Ann; Devine, Paula; Keenan, Mickey

2015-01-01

Background: Children with autism spectrum disorder are increasingly educated in mainstream classrooms in the United Kingdom (Wilkinson & Twist, "Autism and Educational Assessment: UK Policy and Practice." NFER, Slough, 2010), and some employers are now specifically seeking out staff on the autism spectrum. Does that mean that we are…

The Role of Sociocultural Mediational Tools in EFL Teachers' Development: Insights from a Life History Approach

ERIC Educational Resources Information Center

Mirzaee, Alireza; Aliakbari, Mohammad

2017-01-01

The sociocultural orientation in general education, which has gradually leaked into second language teacher education, argues that teachers usually employ social relations, cultural artefacts, and theoretical concepts to mediate their thinking and practice. Against this background, the present study aimed to explore how three male Iranian English…

Addressing Informatics Barriers to Conducting Observational Comparative Effectiveness Research: A Comparative Case Analysis

ERIC Educational Resources Information Center

Boone, Christopher P. D.

2013-01-01

Background: The U.S. health care system has been under immense scrutiny for ever-increasing costs and poor health outcomes for its patients. Comparative Effectiveness Research (CER) has emerged as a generally accepted practice by providers, policy makers, and scientists as an approach to identify the most clinical- and cost-effective interventions…

Analysis of Discourse Accent and Discursive Practices I&W

DTIC Science & Technology

2010-09-01

events in a cultural memory. Episodic discourse encompasses general principles, concepts , symbols and rituals used by actors to address problems in...COGNITIVE/INTEGRATIVE COMPLEXITY PROOF-OF- CONCEPT ............................ 51 5.1 Historical Background and Literature...formal training or expertise in critical discourse analysis. In addition, a proof-of- concept was conducted of an existing methodology for tracking

The research agenda for general practice/family medicine and primary health care in Europe. Part 3. Results: person centred care, comprehensive and holistic approach.

PubMed

Van Royen, Paul; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri E J H; Topsever, Pinar; Ungan, Mehmet; Hummers-Pradier, Eva

2010-06-01

The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In a second article, the results for the two core competencies 'primary care management' and 'community orientation' were presented. This article reflects on the three core competencies, which deal with person related aspects of GP/FM, i.e. 'person centred care', 'comprehensive approach' and 'holistic approach'. Though there is an important body of opinion papers and (non-systematic) reviews, all person related aspects remain poorly defined and researched. Validated instruments to measure these competencies are lacking. Concerning patient-centredness, most research examined patient and doctor preferences and experiences. Studies on comprehensiveness mostly focus on prevention/care of specific diseases. For all domains, there has been limited research conducted on its implications or outcomes.

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice

PubMed Central

Huxley, Caroline J; Atherton, Helen; Watkins, Jocelyn Anstey; Griffiths, Frances

2015-01-01

Background Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. Aim To assess the potential impact of the availability of digital clinician–patient communication on marginalised groups’ access to general practice in the UK. Design and setting Realist review in general practice. Method A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. Results Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician–patient relationship. Conclusion Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction. PMID:26622034

Online data on opening hours of general practices in England: a comparison with telephone survey data

PubMed Central

Richards, Emma C; Cowling, Thomas E; Gunning, Elinor J; Harris, Matthew J; Soljak, Michael A; Nowlan, Naomi; Dharmayat, Kanika; Johari, Nur; Majeed, Azeem

2015-01-01

Background The NHS Choices website (www.nhs.uk) provides data on the opening hours of general practices in England. If the data are accurate, they could be used to examine the benefits of extended hours. Aim To determine whether online data on the opening times of general practices in England are accurate regarding the number of hours in which GPs provide face-to-face consultations. Design and setting Cross-sectional comparison of data from NHS Choices and telephone survey data reported by general practice staff, for a nationally representative sample of 320 general practices (December 2013 to September 2014). Method GP face-to-face consultation times were collected by telephone for each sampled practice for each day of the week. NHS Choices data on surgery times were available online. Analysis was based on differences in the number of surgery hours (accounting for breaks) and the times of the first and last consultations of the day only between the two data sources. Results The NHS Choices data recorded 8.8 more hours per week than the survey data on average (40.1 versus 31.2; 95% confidence interval [CI] = 7.4 to 10.3). This was largely accounted for by differences in the recording of breaks between sessions. The data were more similar when only the first and last consultation times were considered (mean difference = 1.6 hours; 95% CI = 0.9 to 2.3). Conclusion NHS Choices data do not accurately measure the number of hours in which GPs provide face-to-face consultations. They better record the hours between the first and last consultations of the day. PMID:26622033

Family physician practice visits arising from the Alberta Physician Achievement Review

PubMed Central

2013-01-01

Background Licensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice. Methods Retrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group. Results Reports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings – practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence. Conclusion This study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians. PMID:24010980

The role of counsellors in general practice. A qualitative study.

PubMed Central

Sibbald, B.; Addington-Hall, J.; Brenneman, D.; Obe, P. F.

1996-01-01

Counselling services in general practice are now widespread but little is known about their nature or role. We therefore carried out in-depth telephone interviews with a representative sample of 72 general practitioners and 60 of their counsellors who had participated in a previous national survey of counselling services in England and Wales. Our aim was to gain greater insight into the functioning of these services in order to determine the most appropriate focus for future research and development. Interviews were semi-structured and focused on service initiation and duration; counsellors' background and training; working arrangements including sources of funding; types of clients; communication between general practitioners and counsellors; perceived advantages and disadvantages to general practitioners, counsellors, and clients; goals, barriers, and proposed changes. Approximately two thirds of counsellors were employed by district health authorities and attached to practices. One third were employed by the practice with the financial assistance of family health services authorities. Practice-employed counsellors appeared a relatively new service innovation whose growth was facilitated by the general practitioner contract of 1991. Practice-employed counsellors were preferred to practice-attached staff in that general practitioners had greater control over the selection of counsellors and their working arrangements. Problems with interprofessional communication were noted in relation to counsellors' wishes to maintain patient confidentiality by not exchanging information about patients with general practitioners. Counsellors received referrals principally from general practitioners and occasionally from other primary health care staff. Self-referral by patients was rare. The problems for which patients were most commonly referred were: stress/anxiety, relationship problems, depression, and bereavement. The principal therapeutic styles were Rogerian counselling, behavioural therapy, and psychodynamic psychotherapy. A quarter described their style as 'eclectic'. Individual, not group, therapy was the norm. Sessions were usually 50 minutes in duration. However, waiting list times, the frequency of sessions, and overall duration of therapy varied enormously. Overall 28% of counsellors held no formal qualification in counselling or in any of the psychotherapies. Counsellors and general practitioners were generally satisfied with the service and identified a wide range of benefits with few disadvantages. The principal problem was said to be that demand exceeded capacity and the principal change proposed was expansion of the service. The findings provide the most comprehensive account to date of the present state and likely future direction of counselling services in general practice and point to the need to: 1. Evaluate the cost-effectiveness of counselling in the management of common psychiatric disorders such as anxiety and depression 2. Establish a national policy for the training and accreditation of counsellors working in general practice settings 3. Educate general practitioners about the organization and role of counselling services with particular attention to interprofessional communication and the maintenance of patient confidentiality. PMID:9080766

The Approach of General Surgeons to Oncoplastic and Reconstructive Breast Surgery in Turkey: A Survey of Practice Patterns

PubMed Central

Emiroğlu, Mustafa; Sert, İsmail; İnal, Abdullah; Karaali, Cem; Peker, Kemal; İlhan, Enver; Gülcelik, Mehmet; Erol, Varlık; Güngör, Hilmi; Can, Didem; Aydın, Cengiz

2014-01-01

Background: Oncoplastic Breast Surgery (OBS), which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. Aims: To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS) undertaken by general surgeons specializing in breast surgery in Turkey. Study Design: Cross-sectional study. Methods: Between December 2013 and February 2014, an eleven-question survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS), the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS) and informing patients about ORBS preoperatively. Results: Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon). 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. Conclusion: Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques. PMID:25667784

SIMULATION OF GENERAL ANESTHESIA ON THE "SIMMAN 3G" AND ITS EFFICIENCY.

PubMed

Potapov, A F; Matveev, A S; Ignatiev, V G; Ivanova, A A; Aprosimov, L A

2015-01-01

In recent years in medical educational process new innovative technologies are widely used with computer simulation, providing the reality of medical intervations and procedures. Practice-training teaching with using of simulation allows to improve the efficiency of learning material at the expense of creating imaginary professional activity and leading barring material to practical activity. The arm of the investigation is evaluation of the students training efficiency at the Medical Institute on the topic "General Anesthesia with using a modern simulation "SimMan 3 G". The material of the investigation is the results, carried out on the basis of the Centre of Practical skills and medical virtual educational technologies (Simulation Centre) at the Medical Institute of NEFU by M.K. Ammosov. The Object of the investigation was made up by 55 students of the third (3) course of the Faculty of General Medicine of the Medical Institute of NEFU. The investigation was hold during practical trainings (April-May 2014) of the General Surgery Department on the topic "General Anesthesia". A simulation practical course "General Anesthesia" consisted of 12 academic hours. Practical training was carried out using instruments, equipments and facilities to install anesthesia on the SimMan 3G with shooting the process and further discussions of the results. The methods of the investigations were the appreciation of students background knowledge before and after practical training (by 5 points scale) and the analysis of the results. The results of the investigation showed that before the practical course only 23 students (41.8%) had dot positive marks: "Good"--7 students (12.7%) and "Satisfactory"--16 (29.1%) students. The rest 22 (58.2%) students had bad results. The practical trainings using real instruments, equipments and facilities with imitation of installation of preparations for introductory anesthesia, main analgesics and muscle relaxants showed a patients reaction on the virtual trainer SimMan 3 G. Students were divided into anesthetic team, co-assisting of an anesthesiologist, an assistant and nurses anesthetist, who conducted general anesthesia (the mask anesthesia, intravenous anesthesia, endotracheal anesthesia). After finishing the practical course 16 students (29.1%) got 5 marks (Excellent), 35 students (63.6%)--4 (Good) and 4 students (7.3%)--3 mark (Satisfactory).

The learner’s perspective in GP teaching practices with multi-level learners: a qualitative study

PubMed Central

2014-01-01

Background Medical students, junior hospital doctors on rotation and general practice (GP) registrars are undertaking their training in clinical general practices in increasing numbers in Australia. Some practices have four levels of learner. This study aimed to explore how multi-level teaching (also called vertical integration of GP education and training) is occurring in clinical general practice and the impact of such teaching on the learner. Methods A qualitative research methodology was used with face-to-face, semi-structured interviews of medical students, junior hospital doctors, GP registrars and GP teachers in eight training practices in the region that taught all levels of learners. Interviews were audio-recorded and transcribed. Qualitative analysis was conducted using thematic analysis techniques aided by the use of the software package N-Vivo 9. Primary themes were identified and categorised by the co-investigators. Results 52 interviews were completed and analysed. Themes were identified relating to both the practice learning environment and teaching methods used. A practice environment where there is a strong teaching culture, enjoyment of learning, and flexible learning methods, as well as learning spaces and organised teaching arrangements, all contribute to positive learning from a learners’ perspective. Learners identified a number of innovative teaching methods and viewed them as positive. These included multi-level learner group tutorials in the practice, being taught by a team of teachers, including GP registrars and other health professionals, and access to a supernumerary GP supervisor (also termed “GP consultant teacher”). Other teaching methods that were viewed positively were parallel consulting, informal learning and rural hospital context integrated learning. Conclusions Vertical integration of GP education and training generally impacted positively on all levels of learner. This research has provided further evidence about the learning culture, structures and teaching processes that have a positive impact on learners in the clinical general practice setting where there are multiple levels of learners. It has also identified some innovative teaching methods that will need further examination. The findings reinforce the importance of the environment for learning and learner centred approaches and will be important for training organisations developing vertically integrated practices and in their training of GP teachers. PMID:24645670

Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians

PubMed Central

Ramsay, Jean; Rutterford, Clare; Gregory, Alison; Dunne, Danielle; Eldridge, Sandra; Sharp, Debbie; Feder, Gene

2012-01-01

Background Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. Aim To measure selected UK primary care clinicians’ current levels of knowledge, attitudes, and clinical skills in this area. Design and setting Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. Method Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. Results Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. Conclusion Primary care clinicians’ attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services. PMID:22947586

Record keeping in Norwegian general practice.

PubMed

Lönberg, N C; Bentsen, B G

1984-11-01

Routines of medical record keeping were studied in a random sample of 50 out of 228 general practitioners in two counties, Möre & Romsdal and Sör-Tröndelag. One doctor refused to participate and one had retired. The 48 physicians were interviewed and a questionnaire was completed with details about their record keeping. The standard of the records was assessed according to legibility, quality of notes, past history and tidiness using a score system. All general practitioners had records for every patient, but the quality of the records varied considerably. More than 50 per cent used handwriting in progress notes, which varied from diagnostic labels to extended reports. Few records contained accessible background information about the patient concerned, and many records contained large amounts of old and irrelevant papers. The record-scores varied from 3 to maximum 10 with an average of 6.7. Higher Standards of recording in general practice are called for, since the quality of records does not only affect the individual patient, but, in the end, the quality of medical care in general.

Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

PubMed Central

2014-01-01

Background More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice. Methods Data from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis. Results Many practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners’ confidence and motivation to perform HKCs. Conclusion Application of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners’ training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children. PMID:24886520

Using educational outreach and a financial incentive to increase general practices’ contribution to chlamydia screening in South-East London 2003–2011

PubMed Central

2012-01-01

Background The London Boroughs of Lambeth and Southwark have high levels of sexually transmitted infections including Chlamydia trachomatis. Modelling studies suggest that reductions in the prevalence of chlamydia infection will require a high level of population screening coverage and positivity among those screened. General practice has a potentially important role to play in delivering these levels of coverage since large numbers (up to 60%) of young people visit their general practice every year but previous work suggests that there are barriers to delivering screening in this setting. The aim of this study was to evaluate an intervention to increase chlamydia screening in general practice within Primary Care Trusts (PCTs) of Lambeth and Southwark, a strategy combining financial incentives and supportive practice visits to raise awareness and solve problems. Methods Data on age, gender, venue and chlamydia result for tests on under 25 s in Lambeth from 2003–11 was obtained from the National Chlamydia Screening Programme. We analysed the number and percentage of tests generated in general practice, and looked at the number of practices screening more than 10% of their practice cohort of 15–24 year olds, male/female ratio and positivity rates across other screening venues. We also looked at practices screening less than 10% and studied change over time. We compared data from Lambeth and Southwark with London and England. We also studied features of the level and type of educational and financial incentive interventions employed. Results Chlamydia tests performed in general practice increased from 23 tests in 2003–4 to 4813 tests in 2010–11 in Lambeth. In Southwark they increased from 5 tests in 2003/04 to 4321 in 2010/11. In 2011, 44.6% of tests came from GPs in Lambeth and 46% from GP’s in Southwark. In Lambeth 62.7% of practices tested more than 10% of their cohort and in Southwark this was 55.8%. In Lambeth, postivity rate in 2010/11 was 5.8% in men and 6.0% in women. In Southwark positivity rate was 3.9% in men and 5.3% in women. In 2003/04 13% tests in general practice (Lambeth) were from men, this increased to 25% in 2010/11. In Southwark this increased from 20% in 2003/04 to 27.6% in 2010/11. We compared the results with London and national data and showed significant differences between GP testing in Lambeth and Southwark, and GP testing in London and the rest of England. Conclusions General practices can be important potential providers of chlamydia tests. With a combination of sustained support, financial incentives and feedback on performance, general practice may be able to test a large percentage of 15–24 year olds. General practice is also a potentially important provider of chlamydia tests to young men. PMID:22984897

Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection.

PubMed

Cardol, Mieke; Groenewegen, Peter P; Spreeuwenberg, Peter; Van Dijk, Liset; Van Den Bosch, Wil J H M; De Bakker, Dinny H

2006-08-01

Why do contact frequencies with general practice of family members resemble each other? Many aspects related to the clustering of health-care utilisation within families have been studied, but the underlying mechanisms have not been addressed. This article considers whether family similarity in contact frequency with general practice can be explained as (a) a result of shared circumstances, (b) through socialisation, and (c) through homogeneity of background characteristics. Data from the second Dutch national survey of general practice were used to test these mechanisms empirically. This survey recorded all consultations in 2001 for 104 general practices in the Netherlands, serving 385,461 patients. Information about socio-demographic characteristics was collected by means of a patient survey. In a random sample, an extended health interview took place (n=12,699). Overall, we were able to show that having determinants in common through socialisation and shared circumstances can explain similarity in contact frequencies within families, but not all hypotheses could be confirmed. In specific terms, this study shows that resemblances in contact frequencies within families can be best explained by spending more time together (socialisation) and parents and children consulting a general practitioner simultaneously (circumstances of the moment). For general practitioners, the mechanisms identified can serve as a framework for a family case history. The importance of the mechanism of socialisation in explaining similarities in help-seeking behaviour between family members points to the significance of knowledge and health beliefs underlying consultation behaviour. An integrated framework including these aspects can help to better explain health behaviour.

Changing the Logic of Practice: (Re)Drawing Boundaries, (Re)Defining Fields

ERIC Educational Resources Information Center

Smith, Wayne

2012-01-01

Background: The relationship between sport and exercise science (SES) and health and physical education (HPE) has been of interest to those of us involved in the general field of human movement studies in higher education for at least the last four decades. Purpose: The purpose of this research was to determine how the proposed merging of the…

A General Practice-Based Study of the Relationship between Indicators of Mental Illness and Challenging Behaviour among Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Felce, D.; Kerr, M.; Hastings, R. P.

2009-01-01

Background: Existing studies tend to show a positive association between mental illness and challenging behaviour among adults with intellectual disabilities (ID). However, whether the association is direct or artefactual is less clear. The purpose was to explore the association between psychiatric status and level of challenging behaviour, while…

Electronic information and clinical decision support for prescribing: state of play in Australian general practice

PubMed Central

Robertson, Jane; Moxey, Annette J; Newby, David A; Gillies, Malcolm B; Williamson, Margaret; Pearson, Sallie-Anne

2011-01-01

Background. Investments in eHealth worldwide have been mirrored in Australia, with >90% of general practices computerized. Recent eHealth incentives promote the use of up to date electronic information sources relevant to general practice with flexibility in mode of access. Objective. To determine GPs’ access to and use of electronic information sources and computerized clinical decision support systems (CDSSs) for prescribing. Methods. Semi-structured interviews were conducted with 18 experienced GPs and nine GP trainees in New South Wales, Australia in 2008. A thematic analysis of interview transcripts was undertaken. Results. Information needs varied with clinical experience, and people resources (specialists, GP peers and supervisors for trainees) were often preferred over written formats. Experienced GPs used a small number of electronic resources and accessed them infrequently. Familiarity from training and early clinical practice and easy access were dominant influences on resource use. Practice time constraints meant relevant information needed to be readily accessible during consultations, requiring integration or direct access from prescribing software. Quality of electronic resource content was assumed and cost a barrier for some GPs. Conclusions. The current Australian practice incentives do not prescribe which information resources GPs should use. Without integration into practice computing systems, uptake and routine use seem unlikely. CDSS developments must recognize the time pressures of practice, preference for integration and cost concerns. Minimum standards are required to ensure that high-quality information resources are integrated and regularly updated. Without standards, the anticipated benefits of computerization on patient safety and health outcomes will be uncertain. PMID:21109619

Pilot study of six Colorado dental hygiene independent practices.

PubMed

Astroth, D B; Cross-Poline, G N

1998-01-01

The purpose of this pilot study was to gather demographic data about six Colorado dental hygienists who were practicing independently and their practices as well as assess productivity and service mix, evaluate structure and process, and compare the findings in these practices to those of a study of California Health Manpower Pilot Project #139. A convenience sample of six dental hygiene independent practices was studied. A 21-item survey was distributed by mail to obtain demographic and practice information. Weekly surveys tracking patient visits and services provided were completed for three months. A general office audit to evaluate structure and a record audit of 22 patient records to evaluate process were conducted during visits at each practice site. The overall responses for each phase of this study were tabulated and frequencies were calculated using the SPSS/PC+ statistical package. The dental hygienists had practiced for an average of 13 years prior to establishing their practices. Four of the six practices were office-based, one was institution-based, and one was office- and institution-based. Health history, extraoral/intraoral examination, periodontal probing, adult prophylaxis, and oral hygiene instruction were provided during a majority of patient visits. The general office audit revealed compliance with infection control, office protocols for emergency situations, and practice management protocols. The patient record audit indicated a high standard for process of care for the practice sites. The six practices revealed a variety of backgrounds among the dental hygienists and diverse practice characteristics regarding both the populations served and practice settings. The services provided were consistent with allowable services for unsupervised practice. Compliance with specific guidelines was verified during the general office and patient record audits. Consistent with the findings of California Health Manpower Pilot Project #139, the care provided by the Colorado dental hygiene independent practitioners in this study and the environment in which the care was provided do not exhibit any undue risk to the health and safety of the public.

Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices

PubMed Central

Lyratzopoulos, Georgios; Mendonca, Silvia C; Gildea, Carolynn; McPhail, Sean; Peake, Michael D; Rubin, Greg; Singh, Hardeep; Hamilton, William; Walter, Fiona M; Roland, Martin; Abel, Gary A

2018-01-01

Background Lower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use. Aim To examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer. Design and setting Cross-sectional ecological analysis in English general practices. Method Data were taken from the GP Patient Survey and the Cancer Services Public Health Profiles. After adjustment for practice population characteristics, practice-level associations were examined between the use of endoscopy and urgent referrals for suspected cancer, and the ability to book an appointment (used as proxy for ease of access), the ability to see a preferred doctor (used as proxy for relational continuity), and doctor/nurse communication skills. Results Taking into account practice scores for the ability to book an appointment, practices rated higher for the proxy measure of relational continuity used urgent referrals and endoscopies less often (for example, 30% lower urgent referral and 15% lower gastroscopy rates between practices in the 90th/10th centiles, respectively). In contrast, practices rated higher for doctor communication skills used urgent referrals and endoscopies more often (for example, 26% higher urgent referral and 17% higher gastroscopy rates between practices in the 90th/10th centiles, respectively). Patients with cancer in practices that were rated higher for doctor communication skills were less likely to be diagnosed as emergencies (1.7% lower between practices in the 90th than in the 10th centile). Conclusion Practices where patients rated doctor communication highly were more likely to investigate and refer patients urgently but, in contrast, practices where patients could see their preferred doctor more readily were less likely to do so. This article discusses the possible implications of these findings for clinical practice. PMID:29255108

Learning preferences and learning styles: a study of Wessex general practice registrars.

PubMed Central

Lesmes-Anel, J; Robinson, G; Moody, S

2001-01-01

BACKGROUND: Experienced trainers know that individual registrars react very differently to identical learning experiences generated during the year in practice. This divergence reflects differences in registrars' learning styles. Only one study of United Kingdom (UK) general practitioners' learning styles has been undertaken. Learning style theory predicts that matching learning preference with learning style will enhance learning. This paper researches for the first time the evidence in the setting of UK general practice. AIM: To determine, for the general practice registrars within the Wessex Region, the nature of their learning preferences and learning styles and correlations between them. DESIGN OF STUDY: A descriptive confidential postal questionnaire survey. SETTING: Fifty-seven registrars identified in the Wessex Region with a minimum experience of six months in general practice. METHOD: The questionnaire gathered demographic data (sex, age, experience in general practice, years post-registration, and postgraduate qualifications). Learning preferences were elicited using a six-point Likert scale for learning experiences. The Honey and Mumford Learning Style Questionnaire (LSQ) elicited the registrars' learning styles. A second questionnaire was sent to non-responders. RESULTS: The response rate was 74%. Registrars report that interactive learning with feedback is preferred, but more passive learning formats remain valued. A wide range of learning style scores was found. The Honey and Mumford LSQ mean scores fell within the reflector-theorist quadrant. Evidence for correlations between learning preferences and learning styles was also found, in particular for the multiple choice question and audit components of summative assessment. CONCLUSION: A wide range of registrar learning styles exists in Wessex, and initial correlations are described between learning preferences and learning styles as predicted by style theory. This work sets the stage for a shared understanding and use of learning style theory to enhance professional learning throughout a GP's career. More research is needed in this domain. PMID:11462316

Areas of improvement in anticoagulant safety. Data from the CACAO study, a cohort in general practice

PubMed Central

Cogneau, Joël; Gaboreau, Yoann; Abenhaïm, Nathan; Bayen, Marc; Calafiore, Matthieu; Guichard, Claude; Jacquet, Jean-Pierre; Lacoin, François; Bertoletti, Laurent

2017-01-01

Background Real-world studies on anticoagulants are mostly performed on health insurance databases, limited to reported events, and sometimes far from every-day issues in family practice. We assess the presence of data for safe monitoring of oral anticoagulants in general practice, and compare patients’ knowledge of taking an anticoagulant between vitamin K antagonists (VKA) and direct anticoagulants (DOAC), and the general practitioner’s perception of their adherence to anticoagulation. Methods The CACAO study is a national cohort study, conducted by general practitioners on ambulatory patients under oral anticoagulant. In the first phase, investigators provided safety data available from medical records at inclusion. They also evaluated patients’ knowledge about anticoagulation and graded their perception of patients’ adherence. Results Between April and December 2014, 463 general practitioners included 7154 patients. Renal and hepatic function tests were respectively unavailable in 109 (7.5%) and 359 (24.7%) DOAC patients. Among patients with atrial fibrillation, 345 patients (6.9%) had a questionable indication of anticoagulant (CHA2DS2-Vasc<2). One hundred and thirty-three VKA patients (2.3%) and 70 DOAC patients (4.9%) answered they took no anticoagulant (p<0.0001). According to general practitioners’ perception, 430 patients (6.1%) were classified as “not very” or “not adherent”, with no difference between groups. Conclusions Our results highlight the efforts needed to improve anticoagulant safety in daily practice: decreasing the rate of unknown biological data in patients with DOACs or the rate of patients with VKA with no strong indication of anticoagulation, and improving patient knowledge with regard to their anticoagulant. Patients’ adherence seems highly over-estimated by the general practitioners. Clinical trial registration ClinicalTrials.gov NCT02376777 PMID:28384199

High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands

PubMed Central

van den Hombergh, Pieter; Künzi, Beat; Elwyn, Glyn; van Doremalen, Jan; Akkermans, Reinier; Grol, Richard; Wensing, Michel

2009-01-01

Background The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Methods Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Results and discussion Workload and job stress are associated with practice performance. Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care. Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35). Conclusion Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP. PMID:19604386

Patient participation in general practice based undergraduate teaching: a focus group study of patient perspectives

PubMed Central

Park, Sophie E; Allfrey, Caroline; Jones, Melvyn M; Chana, Jasprit; Abbott, Ciara; Faircloth, Sofia; Higgins, Nicola; Abdullah, Laila

2017-01-01

Background Patients make a crucial contribution to undergraduate medical education. Although a national resource is available for patients participating in research, none is as yet available for education. Aim This study aimed to explore what information patients would like about participation in general practice based undergraduate medical education, and how they would like to obtain this information. Design and setting Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching. Method Patients both with and without teaching experience were recruited using leaflets, posters, and patient participation groups. An open-ended topic guide explored three areas: perceived barriers that participants anticipated or had experienced; patient roles in medical education; and what help would support participation. Focus groups were audiorecorded, transcribed, and analysed thematically. Results Patients suggested ways of professionalising the teaching process. These were: making information available to patients about confidentiality, iterative consent, and normalising teaching in the practice. Patients highlighted the importance of relationships, making information available about their GPs’ involvement in teaching, and initiating student–patient interactions. Participants emphasised educational principles to maximise exchange of information, including active participation of students, patient identification of student learner needs, and exchange of feedback. Conclusion This study will inform development of patient information resources to support their participation in teaching and access to information both before and during general practice based teaching encounters. PMID:28360073

A Survey of Practicing Sleep Coaches.

PubMed

Ingram, David G; Mindell, Jodi A; Puzino, Kristina; Walters, Russel M

2018-01-01

Sleep coaches are individuals of various backgrounds who offer services to families struggling with behavioral childhood sleep problems. We conducted a survey of coaches to further elucidate scope of practice, practice patterns, geographic distribution, education, training, and beliefs regarding qualification requirements. A Web-based survey was completed by 142 individuals who identified as a sleep coach. Coaches were distributed across 17 countries and 5 continents. Overall, 65% of coaches served clients in countries beyond their home country. Within the United States, coaches were generally located in more affluent and well-educated zip codes near large metropolitan centers, 91% served clients beyond their home state, and 56% served clients internationally. Educational background varied across coaches (12% high school degree, 51% bachelor's degree, 32% master's degree, 2% doctoral degree, 1.5% JD degree). Few coaches (20%) were or had been licensed health care providers or carried malpractice insurance (38%). Coaches usually provided services for children < 4 months of age to about 6 years of age, and were much less likely to provide services for children with comorbid neurodevelopmental (32%) or significant medical disorders (19%). Coaches reported an average of 3 new and 6 total clients per week and working 20 hr per week on average. Most coaches (76%) felt that a formal sleep coach training program was the most important qualification for practice. These results highlight a diversity of background, training, and geographical distribution of sleep coaches, and may help inform discussions regarding guidelines for training and credentialing of sleep coaches.

An agenda for change in referral--consensus from general practice.

PubMed Central

McColl, E; Newton, J; Hutchinson, A

1994-01-01

BACKGROUND. Wide variations in rates of referral from primary to secondary care have been a matter of concern for many years. Effective strategies for optimizing referral depend on doctors being able to understand what the influences on their referral behaviour are, as well as having the ability to identify priority areas for action and to develop strategies for pushing through effective measures. AIM. This study set out to ascertain general practitioners' priorities for change with respect to the referral process, and to set an agenda for change to be tackled by general practitioners, providers, policy makers and educationalists. METHOD. Through the use of the Delphi technique and focused interviews, general practitioners throughout Northumberland contributed to the consensus view. RESULTS. The main themes to emerge related to hospital waiting lists, open access, flow of information between secondary and primary care and general practitioners' knowledge and training. Ideas for implementing change included the production of directories of hospital services and the development of guidelines for the use of the term 'urgent' in referral letters. CONCLUSION. All of the proposed changes are manageable and share the burden between general practice and other professionals with an interest in the referral process. PMID:8185989

A new model to understand the career choice and practice location decisions of medical graduates.

PubMed

Stagg, P; Greenhill, J; Worley, P S

2009-01-01

Australian medical education is increasingly influenced by rural workforce policy. Therefore, understanding the influences on medical graduates' practice location and specialty choice is crucial for medical educators and medical workforce planners. The South Australian Flinders University Parallel Rural Community Curriculum (PRCC) was funded by the Australian Government to help address the rural doctor workforce shortage. The PRCC was the first community based medical education program in Australia to teach a full academic year of medicine in South Australian rural general practices. The aim of this research was to identify what factors influence the career choices of PRCC graduates. A retrospective survey of all contactable graduates of the PRCC was undertaken. Quantitative data were analysed using SPSS 14.0 for Windows. Qualitative data were entered into NVIVO 7 software for coding, and analysed using content analysis. Usable data were collected from 46 of the 86 contactable graduates (53%). More than half of the respondents (54%) reported being on a rural career path. A significant relationship exists between being on a rural career pathway and making the decision prior to or during medical school (p = 0.027), and between graduates in vocational training who are on an urban career path and making a decision on career specialty after graduation from medical school (p = .004). Graduates in a general practice vocational training program are more likely to be on a rural career pathway than graduates in a specialty other than general practice (p = .003). A key influence on graduates' practice location is geographic location prior to entering medical school. Key influences on graduates choosing a rural career pathway are: having a spouse/partner with a rural background; clinical teachers and mentors; the extended rural based undergraduate learning experience; and a specialty preference for general practice. A lack of rural based internships and specialist training places is influencing both urban- and rural-origin graduates to practise in urban locations. Further analysis of graduates' career pathway choices (rural or urban) and geographic background (rural or urban) was conducted. This resulted in the development of a new model, 'The Four Qs Model'. This model consists of four quadrants derived from the variables career pathway choice (rural or urban) and geographic background (rural or urban). Clustering of consistent demographic and qualitative trends unique to each quadrant was demonstrated. The distinctive clustering that emerged from the data resulted in the quadrants being renamed 'The True Believers', 'The Convertibles' 'The Frustrated' and 'The Metro Docs'. The PRCC is influencing graduates to choose a rural career path. The PRCC program affirms the career preferences of rural origin students while graduates with little rural exposure prior to the PRCC report being positively influenced to pursue a rural career path. The Four Qs Model is a useful model in that it demonstrates consistent themes in the characteristics of PRCC graduates and assists understanding of why they choose a rural medical career. This could be relevant to the selection of medical students into rural medical education programs and in the construction of rural curricula. The model also offers a useful framework for further research in this field.

Adult learning principles for effective teaching in radiology programmes: a review of the literature.

PubMed

Arogundade, R A

2011-01-01

Adult learning processes of acquisition of new knowledge, behaviours, skills, values or preferences generally occur as part of personal professional development. There is need for radiology residency trainers to understand the basic adult learning principles for effective teaching processes. To review the different adult learning styles, learning theories and educational practice as a guide for radiology residency trainers. Literature materials from journals, web articles and reputable textbooks in the last 20 years on adult learning principles in general and radiology in particular were reviewed. Most medical educators, including radiologists, lack appropriate formal training background in educational practice. The adult residency trainee brings to the learning environment high quantity and quality of experiences and some amount of control. Connection of this rich adult experience base to the learning process requires facilitation and motivation by the radiology educator, who must be familiar with the use of appropriate learning theories and educational practices. there is a general agreement about the content of good practice in adult education but a definite comprehensive list does not seem to exist in the literature. Nonetheless, understanding of the basic adult learning principles would aid the concept of guided training, where the adult residency trainee shoulders the bulk of the training responsibilities of acquisition of knowledge.

Factors associated with consultation rates in general practice in England, 2013–2014: a cross-sectional study

PubMed Central

Mukhtar, Toqir K; Bankhead, Clare; Stevens, Sarah; Perera, Rafael; Holt, Tim A; Salisbury, Chris; Hobbs, FD Richard

2018-01-01

Background Workload in general practice has risen during the last decade, but the factors associated with this increase are unclear. Aim To examine factors associated with consultation rates in general practice. Design and setting A cross-sectional study examining a sample of 304 937 patients registered at 316 English practices between 2013 and 2014, drawn from the Clinical Practice Research Datalink. Method Age, sex, ethnicity, smoking status, and deprivation measures were linked with practice-level data on staffing, rurality, training practice status, and Quality and Outcomes Framework performance. Multilevel analyses of patient consultation rates were conducted. Results Consultations were grouped into three types: all (GP or nurse), GP, and nurse. Non-smokers consulted less than current smokers (all: rate ratio [RR] = 0.88, 95% CI = 0.87 to 0.89; GP: RR = 0.88, 95% CI = 0.87 to 0.89; nurse: RR = 0.91, 95% CI = 0.90 to 0.92). Consultation rates were higher for those in the most deprived quintile compared with the least deprived quintile (all: RR = 1.18, 95% CI = 1.16 to 1.19; GP: RR = 1.17, 95% CI = 1.15 to 1.19; nurse: RR = 1.13, 95% CI = 1.11 to 1.15). For all three consultation types, consultation rates increased with age and female sex, and varied by ethnicity. Rates in practices with >8 and ≤19 full-time equivalent (FTE) GPs were higher compared with those with ≤2 FTE GPs (all: RR = 1.26, 95% CI = 1.06 to 1.49; GP: RR = 1.36, 95% CI = 1.19 to 1.56). Conclusion The analyses show consistent trends in factors related to consultation rates in general practice across three types of consultation. These data can be used to inform the development of more sophisticated staffing models, and resource allocation formulae. PMID:29686130

Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice

PubMed Central

Brant, Heather; Atherton, Helen; Ziebland, Sue; McKinstry, Brian; Campbell, John L; Salisbury, Chris

2016-01-01

Background The ubiquitous use of communication technologies has led to an expectation that a similar approach should extend to health care. Despite considerable rhetoric about the need for general practices to offer alternatives to face-to-face consultations, such as telephone, email, and internet video consultations, the extent to which such technologies are actually used at present is unclear. Aim The aim of the survey was to identify the frequency and range of ways in which general practices are providing (or planning) alternatives to face-to-face consultations. Design and setting A postal survey of practices around Bristol, Oxford, Lothian, the Highlands, and the Western Isles of Scotland. Method A postal questionnaire survey was sent to each of the GPs and practice managers of 421 practices between January and May 2015. Results A response was received from 319/421 practices (76%). Although the majority of the practices reported that they were conducting telephone consultations frequently (n = 211/318, 66%), fewer were implementing email consultations (n = 18/318, 6%), and most (n = 169/318, 53%) had no plans to introduce this. None were currently using internet video, and 86% (n = 273/318) had no plans to introduce internet video consultations. These findings were repeated in the reported use of alternatives to face-to-face consultations at an individual GP level. Optional free text responses were completed by 28% of responders, and offered an explanation for the (often perceived) barriers and incentives for implementation. Conclusion Despite policy pressure to introduce consultations by email and internet video, there is a general reluctance among GPs to implement alternatives to face-to-face consultations. This identifies a substantial gap between rhetoric and reality in terms of the likelihood of certain alternatives (email, video) changing practice in the near future. PMID:27215571

Patient-centred care in general dental practice - a systematic review of the literature

PubMed Central

2014-01-01

Background Delivering improvements in quality is a key objective within most healthcare systems, and a view which has been widely embraced within the NHS in the United Kingdom. Within the NHS, quality is evaluated across three key dimensions: clinical effectiveness, safety and patient experience, with the latter modelled on the Picker Principles of Patient-Centred Care (PCC). Quality improvement is an important feature of the current dental contract reforms in England, with “patient experience” likely to have a central role in the evaluation of quality. An understanding and appreciation of the evidence underpinning PCC within dentistry is highly relevant if we are to use this as a measure of quality in general dental practice. Methods A systematic review of the literature was undertaken to identify the features of PCC relevant to dentistry and ascertain the current research evidence base underpinning its use as a measure of quality within general dental practice. Results Three papers were identified which met the inclusion criteria and demonstrated the use of primary research to provide an understanding of the key features of PCC within dentistry. None of the papers identified were based in general dental practice and none of the three studies sought the views of patients. Some distinct differences were noted between the key features of PCC reported within the dental literature and those developed within the NHS Patient Experience Framework. Conclusions This systematic review reveals a lack of understanding of PCC within dentistry, and in particular general dental practice. There is currently a poor evidence base to support the use of the current patient reported outcome measures as indicators of patient-centredness. Further research is necessary to understand the important features of PCC in dentistry and patients’ views should be central to this research. PMID:24902842

Improving the self-efficacy of teachers in schools: results of health promotion program.

PubMed

Farokhzadian, Jamileh; Sabzi, Amirreza; Mangolian Shahrbabaki, Parvin

2018-06-12

Background In order to effectively facilitate behavior change, it is essential to conduct health promotion programs on self-efficacy. Given the importance of the role of teachers in fostering the next generation, it appears that the promotion of self-efficacy in them can greatly contribute to the health of the community. The present study aimed to evaluate the impact of a health promotion training workshop on self-efficacy for health practices and also, on general self-efficacy of teachers in schools. Methods This study was a quasi-experimental study, in which 120 teachers were selected by random sampling and randomly divided into two equal intervention and control groups (60 in each group). A health promotion training workshop was conducted for the intervention group. Data were collected by a three-section questionnaire (demographic, self-rated ability for health practices scale and general self-efficacy) before and 1 month after the training intervention. Results The self-efficacy scores for health practices and general self-efficacy were not significantly different between the intervention and control groups before the intervention (p > 0.05). However, participants in the intervention group reported higher scores on both the self-efficacy for health practices (t = 4.05, p = 0.001) and general self-efficacy (t = 2.92, p = 0.004) compared to those in the control group one month after the intervention. Conclusion The health promotion training program had improving effects on the self-efficacy for health practices and general self-efficacy. This program was potentially a valid community health nursing intervention that can be presented and evaluated in various community settings.

What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

PubMed Central

McKibbon, Kathleen Ann; Wilczynski, Nancy L; Haynes, Robert Brian

2004-01-01

Background We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. Methods We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. Results We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional titles supplied 46.8%. For the disciplines of internal medicine, general/family practice, and mental health (but not general practice nursing), the number of clinically important articles was correlated withScience Citation Index (SCI) Impact Factors. Conclusions Although many clinical journals publish high-quality, clinically relevant and important original studies and systematic reviews, the articles for each discipline studied were concentrated in a small subset of journals. This subset varied according to healthcare discipline; however, many of the important articles for all disciplines in this study were published in broad-based healthcare journals rather than subspecialty or discipline-specific journals. PMID:15350200

Influence of gender and other factors on medical student specialty interest.

PubMed

Boyle, Veronica; Shulruf, Boaz; Poole, Phillippa

2014-09-12

Medical schools must select and educate to meet anticipated health needs. Factors influencing career choice include those of the student and their background as well as subsequent experience. Women have comprised over 50% of medical classes for over 20 years. This study describes gender patterns of current specialty interest among medical students at the University of Auckland, and models the predictive effect of gender compared to other career influencing factors. The study analysed career intention survey data from 711 graduating medical students (response rate, 79%) from 2006 to 2011. Interest level was highest for medicine, followed by subspecialty surgery, general practice and paediatrics. There were differences by gender for most specialties, but not for general practice. Women were more likely than men to be interested in Obstetrics and Gynaecology, Paediatrics, Geriatrics, Public Health or General Medicine, and less interested in Surgery, Anaesthesia, Emergency Medicine or post graduate study. Each specialty had a different pattern of influencing factors with the most important factor being the experience on a clinical attachment. Factors in career choice are complex and vary by gender and specialty. General practice levels of interest are too low for workforce needs. Predictive models need to be validated in longer term studies but may help guide selection and curriculum design.

Suicide prevention in primary care: General practitioners' views on service availability

PubMed Central

2010-01-01

Background Primary care may be a key setting for suicide prevention. However, comparatively little is known about the services available in primary care for suicide prevention. The aims of the current study were to describe services available in general practices for the management of suicidal patients and to examine GPs views on these services. We carried out a questionnaire and interview study in the North West of England. We collected data on GPs views of suicide prevention generally as well as local mental health service provision. Findings During the study period (2003-2005) we used the National Confidential Inquiry Suicide database to identify 286 general practitioners (GPs) who had registered patients who had died by suicide. Data were collected from GPs and practice managers in 167 practices. Responses suggested that there was greater availability of services and training for general mental health issues than for suicide prevention specifically. The three key themes which emerged from GP interviews were: barriers accessing primary or secondary mental health services; obstacles faced when referring a patient to mental health services; managing change within mental health care services Conclusions Health professionals have an important role to play in preventing suicide. However, GPs expressed concerns about the quality of primary care mental health service provision and difficulties with access to secondary mental health services. Addressing these issues could facilitate future suicide prevention in primary care. PMID:20920302

Participatory design of a preliminary safety checklist for general practice

PubMed Central

Bowie, Paul; Ferguson, Julie; MacLeod, Marion; Kennedy, Susan; de Wet, Carl; McNab, Duncan; Kelly, Moya; McKay, John; Atkinson, Sarah

2015-01-01

Background The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use. Aim To identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process. Design and setting Application of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles. Method A multiprofessional ‘expert’ group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise. Results A prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording). Conclusion Hazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally. PMID:25918338

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice.

PubMed

Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M

2011-03-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice

PubMed Central

2011-01-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290

Insightful practice: a reliable measure for medical revalidation

PubMed Central

Guthrie, Bruce; Sullivan, Frank M; Mercer, Stewart W; Russell, Andrew; Bruce, David A

2012-01-01

Background Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback. Setting and participants 60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK. Methods A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a ‘good doctor’ were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice, defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory. Main outcome measures Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation. Results Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83). Conclusions Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed. PMID:22653078

Designing, Implementing, and Evaluating a Department-Wide Service-Learning Program for English Language Learners in Morocco

ERIC Educational Resources Information Center

Seilstad, Brian

2014-01-01

This article describes the theoretical and pedagogical background and results from the first semester of a service-learning program for English learners at a public Moroccan university and the local high school. This study fills a gap in the literature related to service-learning practice and outcomes in Morocco and the Arab world in general. The…

[Changing to a career in general practice - a qualitative study reveals motives of specialists].

PubMed

Schwill, Simon; Magez, Julia; Jäger, Cornelia; von Meißner, Wolfgang Cg; Szecsenyi, Joachim; Flum, Elisabeth

2016-12-01

In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice. The postgraduate training program Verbundweiterbildung plus Baden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team. In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of the challenges of ageing and family life. A major finding was that without the slim-lined program, the majority of participants would not have changed their career. The slim-lined training program in general practice attracts experienced medical doctors. Specialists decide to change career because of the particular ways of working in general practice and with the intention to improve their daily work as a physician, either to improve individual working conditions and/or to improve their individual curative work profile. In addition, specialists are attracted by the concept of self-employment in general practice. Therefore, appreciation of the specific ways of working in general practice as well as management skills are most important during the reduced 2-year training. Further studies should investigate if facilitating a career switch to general practice is a good way to improve the shortage of general practitioners. Copyright © 2016. Published by Elsevier GmbH.

General practice variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease in Denmark: a population-based observational study

PubMed Central

2013-01-01

Background Spirometry testing is essential to confirm an obstructive lung disease, but studies have reported that a large proportion of patients diagnosed with COPD or asthma have no history of spirometry testing. Also, it has been shown that many patients are prescribed medication for obstructive lung disease without a relevant diagnosis or spirometry test registered. General practice characteristics have been reported to influence diagnosis and management of several chronic diseases. However, these findings are inconsistent, and it is uncertain whether practice characteristics influence spirometry testing among patients receiving medication for obstructive lung disease. The aim of this study was therefore to examine if practice characteristics are associated with spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease. Methods A national register-based cohort study was performed. All patients over 18 years receiving first-time prescriptions for medication targeting obstructive lung disease in 2008 were identified and detailed patient-specific data on sociodemographic status and spirometry tests were extracted. Information on practice characteristics like number of doctors, number of patients per doctor, training practice status, as well as age and gender of the general practitioners was linked to each medication user. Results Partnership practices had a higher odds ratio (OR) of performing spirometry compared with single-handed practices (OR 1.24, CI 1.09-1.40). We found a significant association between increasing general practitioner age and decreasing spirometry testing. This tendency was most pronounced among partnership practices, where doctors over 65 years had the lowest odds of spirometry testing (OR 0.25, CI 0.10-0.61). Training practice status was significantly associated with spirometry testing among single-handed practices (OR 1.40, CI 1.10-1.79). Conclusion Some of the variation in spirometry testing among patients receiving first-time prescriptions for medication targeting obstructive lung disease was associated with practice characteristics. This variation in performance may indicate a potential for quality improvement. PMID:23923987

An ethnographic exploration of influences on prescribing in general practice: why is there variation in prescribing practices?

PubMed Central

2013-01-01

Background Prescribing is a core activity for general practitioners, yet significant variation in the quality of prescribing has been reported. This suggests there may be room for improvement in the application of the current best research evidence. There has been substantial investment in technologies and interventions to address this issue, but effect sizes so far have been small to moderate. This suggests that prescribing is a decision-making process that is not sufficiently understood. By understanding more about prescribing processes and the implementation of research evidence, variation may more easily be understood and more effective interventions proposed. Methods An ethnographic study in three Scottish general practices with diverse organizational characteristics. Practices were ranked by their performance against Audit Scotland prescribing quality indicators, incorporating established best research evidence. Two practices of high prescribing quality and one practice of low prescribing quality were recruited. Participant observation, formal and informal interviews, and a review of practice documentation were employed. Results Practices ranked as high prescribing quality consistently made and applied macro and micro prescribing decisions, whereas the low-ranking practice only made micro prescribing decisions. Macro prescribing decisions were collective, policy decisions made considering research evidence in light of the average patient, one disease, condition, or drug. Micro prescribing decisions were made in consultation with the patient considering their views, preferences, circumstances and other conditions (if necessary). Although micro prescribing can operate independently, the implementation of evidence-based, quality prescribing was attributable to an interdependent relationship. Macro prescribing policy enabled prescribing decisions to be based on scientific evidence and applied consistently where possible. Ultimately, this influenced prescribing decisions that occur at the micro level in consultation with patients. Conclusion General practitioners in the higher prescribing quality practices made two different ‘types’ of prescribing decision; macro and micro. Macro prescribing informs micro prescribing and without a macro basis to draw upon the low-ranked practice had no effective mechanism to engage with, reflect on and implement relevant evidence. Practices that recognize these two levels of decision making about prescribing are more likely to be able to implement higher quality evidence. PMID:23799906

Improving general practitioner clinical records with a quality assurance minimal intervention.

PubMed Central

Del Mar, C B; Lowe, J B; Adkins, P; Arnold, E; Baade, P

1998-01-01

BACKGROUND: Although good medical records have been associated with good care, there is considerable room for their improvement in general practice. AIM: To improve the quality of general practice medical records at minimal cost. METHOD: A total of 150 randomly sampled general practitioners (GPs) in suburban Brisbane, Australia, were randomized in a controlled trial to receive or not receive an intervention. The intervention consisted of 6 to 12 one-hour monthly meetings when the pairs of GPs assessed samples of each other's medical records using a 12-item instrument. This was developed previously by a process of consensus of general practice teachers. Mean scores of 10 medical records selected at random from before the intervention started and one year later were compared. RESULTS: After the intervention, the increase in the total score (for which the maximum possible was 18) for the intervention GPs (from a baseline of 11.5 to 12.3) was not significantly greater than for the controls (from 11.4 to 11.7). Legibility and being able to determine the doctor's assessment of the consultation were significantly improved. The post-intervention increase of 1.06 (9.3%) of the total scores of the 47% of intervention GPs who complied with the intervention was significantly greater than that for the controls. CONCLUSION: The quality assurance activity improved some components of the quality of GPs' clinical records. However, the improvement was small, and the search for activities for Australian GPs that demonstrate an improvement in the quality of their practice must continue. Images p1311-a PMID:9747547

Primary Palliative Care for the General Internist: Integrating Goals of Care Discussions into the Outpatient Setting

PubMed Central

Ahia, Chad L.; Blais, Christopher M.

2014-01-01

Background Primary palliative care consists of the palliative care competencies required of all primary care clinicians. Included in these competencies is the ability to assist patients and their families in establishing appropriate goals of care. Goals of care help patients and their families understand the patient's illness and its trajectory and facilitate medical care decisions consistent with the patient's values and goals. General internists and family medicine physicians in primary care are central to getting patients to articulate their goals of care and to have these documented in the medical record. Case Report Here we present the case of a 71-year-old male patient with chronic obstructive pulmonary disorder, congestive heart failure, and newly diagnosed Alzheimer dementia to model pertinent end-of-life care communication and discuss practical tips on how to incorporate it into practice. Conclusion General internists and family medicine practitioners in primary care are central to eliciting patients' goals of care and achieving optimal end-of-life outcomes for their patients. PMID:25598737

Ethics and transparent risk communication start with proper risk assessment methodologies

NASA Astrophysics Data System (ADS)

Oboni, Franco; Oboni, Cesar

2014-05-01

We will use throught this paper a "dialogue" between two professionals. One is aware of the misleading character of many risk assessments and wants to foster better approaches. A discomforting set of statements sets the background of the "story": public reactions to risk assessments are generally negative, the developer find it difficult to understand the reasons for general public negative reactions, many projects get often rejected without valid reasons by the public, anywhere in the world. Common practice approaches in Risk Assessment are discussed from the angle of public rejection, taking into account various studies that explicitly expose common practices limitations and voids. The hiatus between rational and well-balanced risk assessments and common practices is explored. Finally solutions to overcome the limitations of common practices and deliver to the public more realistic risk assessment on which to build a widespread consensus are reviewed. The paper conclusions relate to the need of: properly communicating risk throughout the life of a project, from cradle to grave, avoiding conflict of interest, having estimates that are understandable to foster good understanding of what a risk assessment can bring to better Human existence, in an ethical and fair way. The paper delivers a list of possible remedies and shows that "Common Practices" do not equate to "Best Practices": common practices are not to be proposed/used any longer if we want to avoid public distrust and misrepresentations. Many of the "modern" issues ranging from public distrust to insurance denial could be relieved or mitigated ahead of time if misrepresentation was kept at bay using five simple rules. Common practice Risk Assessments, especially those developed under conflict of interest situations, generally misrepresent risks and fail to give the "big picture", hence do not help taking valid decision and are prone to generating/fostering public distrust.

Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013–2014 and 2014–2015

PubMed Central

Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

2017-01-01

Background NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. Aim To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Design and setting Cross-sectional study of all practices in England, in financial years 2013–2014 and 2014–2015. Method Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Results Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R2 values were 0.359 (2013–2014) and 0.374 (2014–2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Conclusion Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. PMID:27872085

How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

PubMed Central

2013-01-01

Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care. PMID:23356401

Medical student selection criteria as predictors of intended rural practice following graduation.

PubMed

Puddey, Ian B; Mercer, Annette; Playford, Denese E; Pougnault, Sue; Riley, Geoffrey J

2014-10-14

Recruiting medical students from a rural background, together with offering them opportunities for prolonged immersion in rural clinical training environments, both lead to increased participation in the rural workforce after graduation. We have now assessed the extent to which medical students' intentions to practice rurally may also be predicted by either medical school selection criteria and/or student socio-demographic profiles. The study cohort included 538 secondary school-leaver entrants to The University of Western Australia Medical School from 2006 to 2011. On entry they completed a questionnaire indicating intention for either urban or rural practice following graduation. Selection factors (standardised interview score, percentile score from the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance (Australian Tertiary Admissions Rank), together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and an index of rurality) were examined in relation to intended rural or urban destination of practice. In multivariate logistic regression, students from a rural background had a nearly 8-fold increase in the odds of intention to practice rurally after graduation compared to those from urban backgrounds (OR 7.84, 95% CI 4.10, 14.99, P < 0.001). Those intending to be generalists rather than specialists had a more than 4-fold increase in the odds of intention to practice rurally (OR 4.36, 95% CI 1.69, 11.22, P < 0.001). After controlling for these 2 factors, those with rural intent had significantly lower academic entry scores (P = 0.002) and marginally lower interview scores (P = 0.045). UMAT percentile scores were no different. Those intending to work in a rural location were also more likely to be female (OR 1.93, 95% CI 1.08, 3.48, P = 0.027), to come from the lower eight IRSAD deciles (OR 2.52, 95% CI 1.47, 4.32, P = 0.001) and to come from Government vs independent schools (OR 2.02, 95% CI 1.15, 3.55, P = 0.015). Very high academic scores generally required for medical school entry may have the unintended consequence of selecting fewer graduates interested in a rural practice destination. Increased efforts to recruit students from lower socioeconomic backgrounds may be beneficial in terms of an ultimate intended rural practice destination.

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

PubMed Central

Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

2016-01-01

Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). Conclusion Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation. PMID:27087294

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

PubMed Central

2011-01-01

Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298). Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions. PMID:21569613

The feasibility of introducing advanced minimally invasive surgery into surgical practice

PubMed Central

Birch, Daniel W.; Misra, Monali; Farrokhyar, Forough

2007-01-01

Background This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. Methods We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. Results Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. Conclusion Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons. PMID:17897513

Linearization instability for generic gravity in AdS spacetime

NASA Astrophysics Data System (ADS)

Altas, Emel; Tekin, Bayram

2018-01-01

In general relativity, perturbation theory about a background solution fails if the background spacetime has a Killing symmetry and a compact spacelike Cauchy surface. This failure, dubbed as linearization instability, shows itself as non-integrability of the perturbative infinitesimal deformation to a finite deformation of the background. Namely, the linearized field equations have spurious solutions which cannot be obtained from the linearization of exact solutions. In practice, one can show the failure of the linear perturbation theory by showing that a certain quadratic (integral) constraint on the linearized solutions is not satisfied. For non-compact Cauchy surfaces, the situation is different and for example, Minkowski space having a non-compact Cauchy surface, is linearization stable. Here we study, the linearization instability in generic metric theories of gravity where Einstein's theory is modified with additional curvature terms. We show that, unlike the case of general relativity, for modified theories even in the non-compact Cauchy surface cases, there are some theories which show linearization instability about their anti-de Sitter backgrounds. Recent D dimensional critical and three dimensional chiral gravity theories are two such examples. This observation sheds light on the paradoxical behavior of vanishing conserved charges (mass, angular momenta) for non-vacuum solutions, such as black holes, in these theories.

When the group practice breaks up: a qualitative study

PubMed Central

2013-01-01

Background Group practices are increasingly common for primary care physicians worldwide. Although breakups are likely to happen frequently within group practices, their process has not been studied to date. The aims of this study were therefore to explore the reasons for breakups of group practices of general practitioners and to describe the associated feelings. Methods We conducted a qualitative study consisting of in-depth interviews of 21 general practitioners and one secretary from past group practices in the Rhône-Alpes region, France, who experienced a breakup. Results When getting started in group practice for the first time, young doctors did not feel ready and supported, and did not necessarily share the same expectations as their partners. The reasons for the breakups involved imbalances within the groups, contrasting working and management styles, and breakdowns in communication. The breakup process often generated long-persistent feelings of suffering and failure for almost every partner who experienced a breakup, particularly for the partner who was leaving. Conclusions Weakening factors exist from the very beginning of a partnership, and problems are likely to increase at every change or event occurring in the group. We provide several recommendations, including fair management, a shared project based on a precise contract, the consultation of third parties as necessary and, in the worst case scenario, leaving the group practice in time. PMID:23642277

A General Practice-Based Prevalence Study of Epilepsy among Adults with Intellectual Disabilities and of Its Association with Psychiatric Disorder, Behaviour Disturbance and Carer Stress

ERIC Educational Resources Information Center

Matthews, T.; Weston, N.; Baxter, H.; Felce, D.; Kerr, M.

2008-01-01

Background: Although the elevated occurrence of epilepsy in people with intellectual disabilities (ID) is well recognized, the nature of seizures and their association with psychopathology and carer strain are less clearly understood. The aims were to determine the prevalence and features of epilepsy in a community-based population of adults with…

Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

PubMed

von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin

2018-01-01

Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

Teachers' perceptions on primary science teaching

NASA Astrophysics Data System (ADS)

Kijkuakul, Sirinapa

2018-01-01

This qualitative research aimed to review what primary teachers think about how to teach science in rural school contexts. Three primary schools in Thailand were purposively chosen for this study. Eleven primary science teachers of these schools were the research participants. Questionnaires, interviews, and observations were implemented to reveal the primary school teachers' educational backgrounds, science teaching context, and need for self-driven professional development. Content and discourse analysis indicated that the non-science educational background and the science teaching context implied a need for self-driven professional development. The non-science educational background teachers were generally unfamiliar with the current national science curriculum, and that they would not be comfortable when the researcher observed their science teaching practice. They also believed that experimentation was the only one strategy for teaching science, and that the priority for their teaching support was teaching media rather than their understanding of scientific concepts or teaching strategies. As implication of this research, subsequent developments on science teacher profession in rural context, therefore, need to promote teachers' understandings of nature of science and technological and pedagogical content knowledge. In addition, they should be challenged to practice on critically participatory action research for academic growth and professional learning community.

Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice.

PubMed Central

Hull, Sally; Hagdrup, Nicola; Hart, Ben; Griffiths, Chris; Hennessy, Enid

2002-01-01

BACKGROUND: Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60% and 70%. Almost all influenza immunisation in the UK is done within general practice. Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies. AIM: To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practices. DESIGN OF STUDY: Randomised controlled trial. SETTING: Three research general practices within the East London and Essex network of researchers (ELENoR). METHOD: Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice. The intervention, during October 2000, was a telephone call from the practice receptionist to intervention group households, offering an appointment for influenza immunisation at a nurse-run. clinic Main outcome measures were the numbers of individuals in each group receiving immunisation, and practice costs of a telephone-appointing programme. RESULTS: intention to treat analysis showed an immunisation rate in the control group of 44%, compared with 50% in the intervention group (odds ratio = 1.29, 95% confidence interval = 1.03 to 1.63). Of the patients making a telephone appointment, 88% recieved immunisation, while 22% of those not wanting an appointment went on to be immunised. In the controlgroup, income generated was 11.35 pounds per immunisation, for each additional immunisation in the intervention group the income was 5.20 pounds. The 'number needed to telephone' was 17. CONCLUSION: Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6% using a simple intervention by receptionists. Immunisation rates in this low-risk group fell well short of the 60% government target. Improving immunisation rates will require a sustained public health campaign. Retaining the item-of-service payments to practices should support costs of practice-based interventions. PMID:12236273

Patients' evaluation of quality of care in general practice: what are the cultural and linguistic barriers?

PubMed

Harmsen, J A M; Bernsen, R M D; Bruijnzeels, M A; Meeuwesen, L

2008-07-01

Increased migration implies increased contacts for physicians with patients from diverse cultural backgrounds who have different expectations about healthcare. How satisfied are immigrant patients, and how do they perceive the quality of care? This study investigated which patient characteristics (such as cultural views and language proficiency) are related to patients' satisfaction and perceived quality of care. Patients (n=663) from 38 general practices in Rotterdam (The Netherlands) were interviewed. General satisfaction with the general practitioner (GP) was measured by a report mark. Perceived quality of care was measured using the 'Quote-mi' scale (quality of care through the patient's eyes-for migrants), which contains an ethnic-specific subscale and a communication process subscale. Using multilevel regression techniques, the relation between patient characteristics (ethnicity, age, education, Dutch language proficiency, cultural views) and satisfaction and perceived quality of care was analysed. In general, patients seemed fairly satisfied. Non-Western patients perceived less quality of care and were less satisfied than Dutch-born patients. The older the patients and the more modern cultural views they had, the more satisfied they were about the GP in general, as well as about the communication process. However, non-Western patients holding more modern views were the most critical regarding the ethnic-specific quality items. The poorer patients' Dutch language proficiency, the more negative they were about the communication process. It is concluded that next to communication aspects, especially when the patient's proficiency in Dutch is poor, physician awareness about the patient's cultural views is very important during the consultation. This holds especially true when the immigrant patient seems to be more or less acculturated. Medical students and physicians should be trained to become aware of the relevance of patients' different cultural backgrounds. It is also recommended to offer facilities to bridge the language barrier, by making use of interpreters or cultural mediators.

Integrating a family-focused approach into child obesity prevention: Rationale and design for the My Parenting SOS study randomized control trial

PubMed Central

2011-01-01

Background More than 20% of US children ages 2-5 yrs are classified as overweight or obese. Parents greatly influence the behaviors their children adopt, including those which impact weight (e.g., diet and physical activity). Unfortunately, parents often fail to recognize the risk for excess weight gain in young children, and may not be motivated to modify behavior. Research is needed to explore intervention strategies that engage families with young children and motivate parents to adopt behaviors that will foster healthy weight development. Methods This study tests the efficacy of the 35-week My Parenting SOS intervention. The intervention consists of 12 sessions: initial sessions focus on general parenting skills (stress management, effective parenting styles, child behavior management, coparenting, and time management) and later sessions apply these skills to promote healthier eating and physical activity habits. The primary outcome is change in child percent body fat. Secondary measures assess parent and child dietary intake (three 24-hr recalls) and physical activity (accelerometry), general parenting style and practices, nutrition- and activity-related parenting practices, and parent motivation to adopt healthier practices. Discussion Testing of these new approaches contributes to our understanding of how general and weight-specific parenting practices influence child weight, and whether or not they can be changed to promote healthy weight trajectories. Trial Registration ClinicalTrials.gov: NCT00998348 PMID:21639940

Background of SAM atom-fraction profiles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ernst, Frank

Atom-fraction profiles acquired by SAM (scanning Auger microprobe) have important applications, e.g. in the context of alloy surface engineering by infusion of carbon or nitrogen through the alloy surface. However, such profiles often exhibit an artifact in form of a background with a level that anti-correlates with the local atom fraction. This article presents a theory explaining this phenomenon as a consequence of the way in which random noise in the spectrum propagates into the discretized differentiated spectrum that is used for quantification. The resulting model of “energy channel statistics” leads to a useful semi-quantitative background reduction procedure, which ismore » validated by applying it to simulated data. Subsequently, the procedure is applied to an example of experimental SAM data. The analysis leads to conclusions regarding optimum experimental acquisition conditions. The proposed method of background reduction is based on general principles and should be useful for a broad variety of applications. - Highlights: • Atom-fraction–depth profiles of carbon measured by scanning Auger microprobe • Strong background, varies with local carbon concentration. • Needs correction e.g. for quantitative comparison with simulations • Quantitative theory explains background. • Provides background removal strategy and practical advice for acquisition.« less

An application of programmatic assessment for learning (PAL) system for general practice training.

PubMed

Schuwirth, Lambert; Valentine, Nyoli; Dilena, Paul

2017-01-01

Aim: Programmatic assessment for learning (PAL) is becoming more and more popular as a concept but its implementation is not without problems. In this paper we describe the design principles behind a PAL program in a general practice training context. Design principles: The PAL program was designed to optimise the meaningfulness of assessment information for the registrar and to make him/her use that information to self regulate their learning. The main principles in the program were cognitivist and transformative. The main cognitive principles we used were fostering the understanding of deep structures and stimulating transfer by making registrars constantly connect practice experiences with background knowledge. Ericsson's deliberate practice approach was built in with regard to the provision of feedback combined with Pintrich's model of self regulation. Mezirow's transformative learning and insights from social network theory on collaborative learning were used to support the registrars in their development to become GP professionals. Finally the principal of test enhanced learning was optimised. Epilogue: We have provided this example explain the design decisions behind our program, but not want to present our program as the solution to any given situation.

Personality characteristics and attributes of international medical graduates in general practice training: Implications for supporting this valued Australian workforce.

PubMed

Laurence, Caroline O; Eley, Diann S; Walters, Lucie; Elliott, Taryn; Cloninger, Claude Robert

2016-10-01

To describe the personality profiles of International Medical Graduates (IMGs) undertaking General Practice (GP) training in Australia. A better understanding of the personal characteristics of IMGs may inform their training and enhance support for their vital contribution to the Australian rural workforce. Cross-sectional self-report questionnaires. Independent variables included socio-demographics, prior training, the Temperament and Character Inventory, and the Resilience Scale. GP registrars (IMGs = 102; AMGs = 350) training in the Australian General Practice Training rural and general pathway and the Australian College of Rural and Remote Medicine independent pathway. Univariate analysis explored the differences in levels of traits between IMG and AMG registrars. Compared to the general population both groups have moderately high resilience, and well-organised characters with high Self-directedness, high Cooperativeness and low Self-transcendence, supported by temperaments which were high in Persistence and Reward Dependence. IMGs were different than AMGs in two temperament traits, Novelty Seeking and Persistence and two character traits, Self-directedness and Cooperativeness. Factors such as cultural and training backgrounds, personal and professional expectations, and adjustments necessary to assimilate to a new lifestyle and health system are likely to be responsible for differences found between groups. Understanding the personality profiles of IMGs provides opportunities for targeted training and support which may in turn impact on their retention in rural areas. © 2016 National Rural Health Alliance Inc.

The discipline of ergonomics in Cuba within the occupational health framework: background and trends.

PubMed

Torres, Yaniel; Rodríguez, Yordán; Viña, Silvio

2013-01-01

The concept of ergonomics was introduced in Cuba at the beginning of the 1970s. More than 40 years later, the prevailing approach to workers' health is still generally reactive rather than proactive, despite the commitment of the government to the subject. A factor influencing this issue is, generally, lack of recognition of the benefits of establishing ergonomic principles within most occupational activities. Recent progress to move occupational health practice toward a more preventive approach has been conducted, frequently with international support. The introduction of a set of Cuban standards proposing the necessity of ergonomic evaluations is an example of this progress. The main challenge for Cuban ergonomists is to transfer knowledge to occupational health practitioners in order to be in concordance with basic standards and regulations regarding ergonomics. The article offers a short description of the history of ergonomics and an overview of ergonomics practice in Cuba.

Computer Assisted Chronic Disease Management: Does It Work? A Pilot Study Using Mixed Methods

PubMed Central

Jones, Kay M.; Biezen, Ruby; Piterman, Leon

2013-01-01

Background. Key factors for the effective chronic disease management (CDM) include the availability of practical and effective computer tools and continuing professional development/education. This study tested the effectiveness of a computer assisted chronic disease management tool, a broadband-based service known as cdmNet in increasing the development of care plans for patients with chronic disease in general practice. Methodology. Mixed methods are the breakthrough series methodology (workshops and plan-do-study-act cycles) and semistructured interviews. Results. Throughout the intervention period a pattern emerged suggesting GPs use of cdmNet initially increased, then plateaued practice nurses' and practice managers' roles expanded as they became more involved in using cdmNet. Seven main messages emerged from the GP interviews. Discussion. The overall use of cdmNet by participating GPs varied from “no change” to “significant change and developing many the GPMPs (general practice management plans) using cdmNet.” The variation may be due to several factors, not the least, allowing GPs adequate time to familiarise themselves with the software and recognising the benefit of the team approach. Conclusion. The breakthrough series methodology facilitated upskilling GPs' management of patients diagnosed with a chronic disease and learning how to use the broadband-based service cdmNet. PMID:24959576

Practice assistants in primary care in Germany – associations with organizational attributes on job satisfaction

PubMed Central

2013-01-01

Background Job satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations. Methods This observational study was based on a job satisfaction survey and measurement of organizational attributes in general practices in the German federal state of Baden-Wuerttemberg. Job satisfaction was measured with the 10-item ‘Warr-Cook-Wall job satisfaction scale’. Organizational attributes were evaluated with the 21-items ‘survey of organizational attributes for primary care’ (SOAPC). Linear regression analyses were performed in which each of SOAPC scales and the overall score of SOAPC was treated as outcome variables. Results 586 practice assistants out of 794 respondents (73.8%) from 234 general practices completed the questionnaire. Practice assistants were mostly satisfied with their colleagues and least of all satisfied with their income and recognition for their work. The regression analysis showed that ‘freedom of working method’ and ‘recognition of work’, the employment status of practice assistants and the mode of practice were almost always significantly associated with each subscale and overall score of SOAPC. Conclusions Job satisfaction is highly associated with different aspects of organizational attributes for primary care (‘communication’, ‘decision-making’ and ‘stress’). Consequently, improved job satisfaction could lead to a better-organized primary care team. This implication should be investigated directly in further intervention studies with a special focus on improving the recognition for work and income. PMID:23915225

Clinical peripherality: development of a peripherality index for rural health services

PubMed Central

Swan, Gillian M; Selvaraj, Sivasubramaniam; Godden, David J

2008-01-01

Background The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. Methods Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. Results Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. Conclusion Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may assist planners in conceptualising the effects on general practices of centralising specialist clinical services or administrative and educational facilities. PMID:18221533

Perceptions of gender-based discrimination during surgical training and practice

PubMed Central

Bruce, Adrienne N.; Battista, Alexis; Plankey, Michael W.; Johnson, Lynt B.; Marshall, M. Blair

2015-01-01

Background Women represent 15% of practicing general surgeons. Gender-based discrimination has been implicated as discouraging women from surgery. We sought to determine women's perceptions of gender-based discrimination in the surgical training and working environment. Methods Following IRB approval, we fielded a pilot survey measuring perceptions and impact of gender-based discrimination in medical school, residency training, and surgical practice. It was sent electronically to 1,065 individual members of the Association of Women Surgeons. Results We received 334 responses from medical students, residents, and practicing physicians with a response rate of 31%. Eighty-seven percent experienced gender-based discrimination in medical school, 88% in residency, and 91% in practice. Perceived sources of gender-based discrimination included superiors, physician peers, clinical support staff, and patients, with 40% emanating from women and 60% from men. Conclusions The majority of responses indicated perceived gender-based discrimination during medical school, residency, and practice. Gender-based discrimination comes from both sexes and has a significant impact on women surgeons. PMID:25652117

Perceptions of gender-based discrimination during surgical training and practice.

PubMed

Bruce, Adrienne N; Battista, Alexis; Plankey, Michael W; Johnson, Lynt B; Marshall, M Blair

2015-01-01

Background Women represent 15% of practicing general surgeons. Gender-based discrimination has been implicated as discouraging women from surgery. We sought to determine women's perceptions of gender-based discrimination in the surgical training and working environment. Methods Following IRB approval, we fielded a pilot survey measuring perceptions and impact of gender-based discrimination in medical school, residency training, and surgical practice. It was sent electronically to 1,065 individual members of the Association of Women Surgeons. Results We received 334 responses from medical students, residents, and practicing physicians with a response rate of 31%. Eighty-seven percent experienced gender-based discrimination in medical school, 88% in residency, and 91% in practice. Perceived sources of gender-based discrimination included superiors, physician peers, clinical support staff, and patients, with 40% emanating from women and 60% from men. Conclusions The majority of responses indicated perceived gender-based discrimination during medical school, residency, and practice. Gender-based discrimination comes from both sexes and has a significant impact on women surgeons.

The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

PubMed Central

2012-01-01

Background There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians’ detection of risk-taking and emotional distress, young people’s intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol. Methods PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff’s self-perceived competency in young people’s care and clinicians’ detection and response to risk taking behaviours and emotional distress in 14–24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation. Discussion The PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months. Trial registration ISRCTN16059206 PMID:22672481

Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre

PubMed Central

2010-01-01

Background Against the background of a decreasing number of general practitioners (GPs) in rural regions in Germany, the AGnES-concept (AGnES = GP-supporting, community-based, e-health-assisted, systemic intervention) supports the delegation of regular GP-home visits to qualified practice assistants. The concept was implemented and evaluated in different model projects in Germany. To explore the economic effects of this concept, the development of the number of home visits in an ambulatory healthcare centre was analysed and compared with the number of home visits in the surrounding county. Methods Information about GP-home visits was derived from reimbursement data of the ambulatory healthcare centre and a statutory health insurance. Information about home visits conducted by AGnES-practice assistants was collected from the project documentation over a time period of 12 consecutive quarter years, four quarter years before the beginning of the project and 8 quarter years while the project was implemented, considering background temporal trends on the population level in the study region. Results Within the ambulatory healthcare centre, the home visits by the GPs significantly decreased, especially the number of medically urgent home visits. However, the overall rate of home visits (conducted by the GPs and the AGnES-practice assistants together) did not change significantly after implementation of the AGnES-concept. In the surrounding county, the home visit rates of the GPs were continuous; the temporal patterns were approximately equal for both usual and urgent home visits. Conclusion The results of the analyses show that the support by AGnES-practice assistants led to a decrease of GP-home visits rather than an induction of additional home visits by the AGnES-practice assistants. The most extended effect is related to the medically urgent home visits rather than to the usual home visits. PMID:20529307

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.

PubMed

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-09-01

The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice

PubMed Central

2011-01-01

Background Australian General Practitioners (GPs) are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs) use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld) general practice. Methods The results of the needs assessment survey of Qld general practitioners (GPs) informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1) utilisation of the resource (2) perceived quality, usefulness and satisfaction with the resource and (3) perceived impact of the resource on their knowledge, attitudes, and practice of CMs. Results Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs. Conclusion Further educational interventions on CMs need to be provided to GPs to increase their knowledge of CMs and to improve their communication with patients about their CMs use. PMID:21933434

Improving patient safety culture in general practice: an interview study

PubMed Central

Verbakel, Natasha J; de Bont, Antoinette A; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM

2015-01-01

Background When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for improving safety culture. Aim To gain insight into how two interventions affected patient safety culture in everyday practice. Design and setting After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general practices to aid interpretation of the previous quantitative findings. Method Interviews were conducted at practice locations (n = 27) with 24 GPs and 24 practice nurses. The theory of communities of practice — in particular, its concepts of a domain, a community, and a practice — was used to interpret the findings by examining which elements were or were not present in the participating practices. Results Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily practice. Conclusion In order for patient safety culture to improve, the safety culture questionnaire was more successful when accompanied by a practice workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal. PMID:26622035

Laparoscopic entry: a review of Canadian general surgical practice

PubMed Central

Compeau, Christopher; McLeod, Natalie T.; Ternamian, Artin

2011-01-01

Background Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons. Methods We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. Results The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. Conclusion General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice. PMID:21774882

At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine

PubMed Central

2013-01-01

Background HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. Methods As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. Results The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the ‘coalface’ and the ‘cutting edge’, and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. Conclusions Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce. PMID:23517462

Primary care Identification and Referral to Improve Safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial

PubMed Central

2010-01-01

Background Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse. Methods/Design This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate. Discussion This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision. Trial registration ISRCTN74012786 PMID:20122266

Depressive disorder in the last phase of life in patients with cardiovascular disease, cancer, and COPD: data from a 20-year follow-up period in general practice

PubMed Central

Warmenhoven, Franca; Bor, Hans; Lucassen, Peter; Vissers, Kris; van Weel, Chris; Prins, Judith; Schers, Henk

2013-01-01

Background Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods. Aim To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from cardiovascular disease, cancer or COPD, in a sample of primary care patients. Design and setting A historic cohort study, using a 20-year period registration database of medical records in four Dutch general practices (a dynamic population based on the Continuous Morbidity Registration database). Method Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used. Results In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%. Conclusion The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general practice. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general practice is recommended to improve the diagnosis and treatment of mood disorders in patients in the last phase of life. PMID:23643227

AAC services for multilingual populations: South African service provider perspectives.

PubMed

Tönsing, Kerstin M; van Niekerk, Karin; Schlünz, Georg I; Wilken, Ilana

In South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. The study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Fifteen AAC service providers were purposefully chosen to participate in one of three focus groups - two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Four overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides' orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Although service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers' language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics. Copyright © 2018 Elsevier Inc. All rights reserved.

Attitudes Toward Adoption of Evidence-Based Practice Among Physical Therapists and Social Workers: A Lesson for Interprofessional Continuing Education.

PubMed

Gudjonsdottir, Bjorg; Arnadottir, Hervor A; Gudmundsson, Halldor S; Juliusdottir, Sigrun; Arnadottir, Solveig A

2017-01-01

Professionals who embrace evidence-based practice (EBP) continually search for research evidence, appraise, and apply it, while interacting with each client in his/her situation. This dynamic learning process takes a substantial commitment from professionals and requires a positive attitude toward EBP. The main objective of this research was to explore the following: 1) distinct dimensions of attitudes toward adoption of EBP among physical therapists and social workers and 2) the relationship between these dimensions of attitudes and selected background characteristics of the compared professions. Cross-sectional web-based surveys were conducted in 2012 and 2013 on a population-based sample from the Icelandic Physical Therapy Association and the Icelandic Association of Social Workers. The participants were 214 physical therapists (76.3% women) and 163 social workers (92.2% women). The Evidence-Based Practice Attitude Scale (EBPAS) and its four subscales were used to survey dimensions of attitudes toward EBP. Scores on the total EBPAS range from zero to five, with a higher score indicating a more positive attitude toward EBPs. Linear regression was used to explore the relationship between the EBPAS scales and selected background variables. The overall response rate was 39%. Both professions generally held positive attitudes toward adoption of EBP, with an average EBPAS total score of 3.06 (SD = 0.46). The professionals' background characteristics were independently related to at least one dimension of attitudes toward EBP. More positive attitudes were associated with being a physical therapist, a woman, in a younger age group, having a graduate degree, working with individual clients, and having at least five same-profession coworkers. The results may be useful to design continuing education focusing on EBP. Such inventions should be targeted to professional attitudes, background, and other contextual factors.

Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with systematic urine sampling

PubMed Central

O’Brien, Kathryn; Edwards, Adrian; Hood, Kerenza; Butler, Christopher C

2013-01-01

Background Urinary tract infection (UTI) in children may be associated with long-term complications that could be prevented by prompt treatment. Aim To determine the prevalence of UTI in acutely ill children ≤ 5 years presenting in general practice and to explore patterns of presenting symptoms and urine sampling strategies. Design and setting Prospective observational study with systematic urine sampling, in general practices in Wales, UK. Method In total, 1003 children were recruited from 13 general practices between March 2008 and July 2010. The prevalence of UTI was determined and multivariable analysis performed to determine the probability of UTI. Result Out of 597 (60.0%) children who provided urine samples within 2 days, the prevalence of UTI was 5.9% (95% confidence interval [CI] = 4.3% to 8.0%) overall, 7.3% in those < 3 years and 3.2% in 3–5 year olds. Neither a history of fever nor the absence of an alternative source of infection was associated with UTI (P = 0.64; P = 0.69, respectively). The probability of UTI in children aged ≥3 years without increased urinary frequency or dysuria was 2%. The probability of UTI was ≥5% in all other groups. Urine sampling based purely on GP suspicion would have missed 80% of UTIs, while a sampling strategy based on current guidelines would have missed 50%. Conclusion Approximately 6% of acutely unwell children presenting to UK general practice met the criteria for a laboratory diagnosis of UTI. This higher than previously recognised prior probability of UTI warrants raised awareness of the condition and suggests clinicians should lower their threshold for urine sampling in young children. The absence of fever or presence of an alternative source of infection, as emphasised in current guidelines, may not rule out UTI in young children with adequate certainty. PMID:23561695

Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study)

PubMed Central

2014-01-01

Background There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Methods Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. Results We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Conclusions Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for research governance approval and intervention implementation. Pretrial data analyses should inform trial design and analysis plans. Trial registration Current Controlled Trials ISRCTN 47558792 and ISRCTN 35701810 (both registered on 17 March 2010). PMID:24919485

Pharmacists Views and Practices in Regard to Sales of Antibiotics Without a Prescription in Madinah, Saudi Arabia.

PubMed

Bahnassi, Anas

2016-09-01

The aim of this study was to investigate pharmacists views and practices in Madinah, Saudi Arabia, through conducting direct interviews including direct questions and hypothetical scenarios. A purposeful sample of 150 community pharmacists of different ethnic and educational backgrounds were approached to participate in the study. Semistructured interviews including general questions and 5 hypothetical scenarios were used for the investigation. Complete transcripts of the interviews were prepared. All transcripts were coded and categorized into main themes using a computer software. Fifty-four pharmacists agreed to participate (response rate, 36%). Sale of antibiotics without prescription is commonly practiced in Saudi Arabia. Lack of legislation enforcement has exacerbated this practice. Economic hardship, patient's age, emotional factors, and pharmacists' self confidence in diagnosing and prescribing medications in general and antibiotics in particular were the themes included in the interviews and influenced pharmacists' decision to sell antibiotics without a prescription.Many pharmacists did not see the practice as a problem and felt capable of continuing to dispense antibiotics without a prescription. Pharmacists who saw the practice as a problem sees legislation enforcement to be the solution of the problem. Pharmacist views and practices are alarming. The results of this study show that this practice will continue to spread unless strict enforcement is put in place, Lack of clear understanding of the limitations of pharmacist's scope of practice. Results of these studies can be extrapolated to other countries in the region and other countries of the similar social and professional development status.

The pattern of anxiolytic and hypnotic management by Australian general practice trainees.

PubMed

Holliday, Simon M; Morgan, Simon; Tapley, Amanda; Henderson, Kim M; Dunlop, Adrian J; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrence A; Ball, Jean; Oldmeadow, Christopher J; Magin, Parker J

2017-03-01

Guidelines recommend anxiolytics and hypnotics (A/H) as second-line, short-term medications. We aimed to establish prevalence and associations of A/H prescribing by Australian general practice (GP) trainees. A cross-sectional analysis from a cohort study of vocational trainees from four GP Regional Training Providers during 2010-2013. General practice trainees act as independent practitioners (including for prescribing purposes) while having recourse to advice from a GP supervisor. Practice and trainee demographic data were collected as well as patient, clinical and educational data from 60 consecutive consultations of each trainee each training term. Analysis was at the level of individual problem managed, with the outcome factor being prescription of any anxiolytic or hypnotic. Overall, 645 registrars (response rate 94.0%) prescribed 68 582 medications in 69 621 consultations (with 112 890 problems managed). A/Hs were prescribed for 1.3% of problems managed and comprised 2.2% of all prescriptions. They were prescribed particularly for insomnia (28.2%) or anxiety (21.8%), but also for many 'off-label' indications. Significant associations of A/H prescriptions were: patient-level (greater age, Aboriginal and Torres Strait Islander status, English-speaking background, being new to the trainee but not to the practice); trainee-level (male) and consultation-level (longer duration, pre-existing problem, specialist referral not being made). Prescribing was significantly lower in one of the four Regional Training Providers. GP trainees, inconsistent with most guideline recommendations, prescribe A/Hs mainly as maintenance therapy to unfamiliar and older patients. Our results suggest that changes in management approaches are needed which may be facilitated by support for psychotherapeutic training. [Holliday SM, Morgan S, Tapley A, Henderson KM, Dunlop AJ, van Driel ML, Spike NA, McArthur LA, Ball J, Oldmeadow CJ, Magin PJ. The pattern of anxiolytic and hypnotic management by Australian general practice trainees. Drug Alcohol Rev 2017;36:261-269]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

PubMed Central

Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

2016-01-01

Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. PMID:26306608

Early psychosocial interventions after disasters, terrorism and other shocking events: is there a gap between norms and practice in Europe?

PubMed Central

Te Brake, Hans

2013-01-01

Background Internationally, several initiatives exist to describe standards for post-disaster psychosocial care. Objective This study explored the level of consensus of experts within Europe on a set of recommendations on early psychosocial intervention after shocking events (Dutch guidelines), and to what degree these standards are implemented into mental health care practice. Methods Two hundred and six (mental) health care professionals filled out a questionnaire to assess the extent to which they consider the guidelines’ scope and recommendations relevant and part of the regular practice in their own country. Forty-five European experts from 24 EU countries discussed the guidelines at an international seminar. Results The data suggest overall agreement on the standards although many of the recommendations appear not (yet) to be embedded in everyday practice. Conclusions Although large consensus exists on standards for early psychosocial care, a chasm between norms and practice appears to exist throughout the EU, stressing the general need for investments in guideline development and implementation. PMID:23393613

Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights?

PubMed Central

2014-01-01

Background Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis. Methods Qualitative research interviews were conducted with seven GPs, all Christians. Transcripts were analysed using systematic text condensation. Results Informants displayed a marked ambivalence towards their own refusal practices. Five main topics emerged in the interviews: 1) carrying out conscientious objection in practice, 2) justification for conscientious objection, 3) challenges when relating to colleagues, 4) ambivalence and consistency, 5) effects on the doctor-patient relationship. Conclusions Norwegian GP conscientious objectors were given to consider both pros and cons when evaluating their refusal practices. They had settled on a practical compromise, the precise form of which would vary, and which was deemed an acceptable middle way between competing interests. PMID:24571955

Music-supported therapy for stroke motor recovery: theoretical and practical considerations.

PubMed

Chen, Joyce L

2018-05-08

Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu. © 2018 New York Academy of Sciences.

Understanding the Role of Context in the Interpretation of Complex Battlespace Intelligence

DTIC Science & Technology

2006-01-01

Level 2 Fusion)" that there remains a significant need for higher levels of information fusion such as those required for generic situation awareness ... information in a set of reports, 2) general background knowledge e.g., doctrine, techniques, practices) plus 4) known situation-specific information (e.g... aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information

Becoming a general practitioner - Which factors have most impact on career choice of medical students?

PubMed Central

2011-01-01

Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. Results 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. Conclusions This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase the number of aspirants for general practice. PMID:21549017

Preferences for general practice jobs: a survey of principals and sessional GPs

PubMed Central

Wordsworth, Sarah; Skåtun, Diane; Scott, Anthony; French, Fiona

2004-01-01

Background: Many countries are experiencing recruitment and retention problems in general practice, particularly in rural areas. In the United Kingdom (UK), recent contractual changes aim to address general practitioner (GP) recruitment and retention difficulties. However, the evidence base for their impact is limited, and preference differences between principals and sessional GPs (previously called non-principals) are insufficiently explored. Aim: To elicit GP principals' and sessional GPs' preferences for alternative jobs in general practice, and to identify the most important work attributes. Design of study: A discrete choice experiment. Setting: National Health Service (NHS) general practices throughout Scotland. Method: A postal questionnaire was sent to 1862 principals and 712 sessional GPs. The questionnaire contained a discrete choice experiment to quantify GPs' preferences for different job attributes. Results: A response rate of 49% (904/1862) was achieved for principals and 54% (388/712) for sessional GPs. Of responders, most principals were male (60%), and sessional GPs female (75%), with the average age being 42 years. All GPs preferred a job with longer consultations, no increase in working hours, but an increase in earnings. A job with outside commitments (for example, a health board or hospital) was preferable; one with additional out-of-hours work was less preferable. Sessional GPs placed a lower value on consultation length, were less worried about hours of work, and a job offering sufficient continuing professional development was less important. Conclusion: The differences in preferences between principals and sessional GPs, and also between different personal characteristics, suggests that a general contract could fail to cater for all GPs. Recruitment and retention of GPs may improve if the least preferred aspects of their jobs are changed. However, the long-term success of contractual reform will require enhancement of the positive aspects of working, such as patient contact. PMID:15469673

General and Food-Specific Parenting: Measures and Interplay

PubMed Central

Sleddens, Ester; Gerards, Sanne; Gubbels, Jessica; Rodenburg, Gerda; Gevers, Dorus; van Assema, Patricia

2013-01-01

Abstract Background Parental influence on child food intake is typically conceptualized at three levels—parenting practices, feeding style, and parenting style. General parenting style is modeled at the most distal level of influence and food parenting practices are conceptualized as the most proximal level of influence. The goal of this article is to provide insights into contents and explanatory value of instruments that have been applied to assess food parenting practices, feeding style, and parenting style. Methods Measures of food parenting practices, feeding style, and parenting style were reviewed, compared, and contrasted with regard to contents, explanatory value, and interrelationships. Results Measures that are used in the field often fail to cover the full scope and complexity of food parenting. Healthy parenting dimensions have generally been found to be positively associated with child food intake (i.e., healthier dietary intake and less intake of energy-dense food products and sugar-sweetened beverages), but effect sizes are low. Evidence for the operation of higher-order moderation has been found, in which the impact of proximal parental influences is moderated by more distal levels of parenting. Conclusions Operationalizing parenting at different levels, while applying a contextual higher-order moderation approach, is advocated to have surplus value in understanding the complex process of parent–child interactions in the area of food intake. A research paradigm is presented that may guide future work regarding the conceptualization and modeling of parental influences on child dietary behavior. PMID:23944921

Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children

PubMed Central

Drinkwater, Jessica; Stanley, Nicky; Szilassy, Eszter; Larkins, Cath; Hester, Marianne; Feder, Gene

2017-01-01

Background Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family. Aim To explore how and why general practice clinicians document DVA in families with children. Design and setting A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England. Method Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes. Results Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians. Conclusion Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access. PMID:28137783

Management competencies: intrinsic or acquired? What competencies are required to move into speech pathology management and beyond?

PubMed

Pilling, Samantha; Slattery, Justine

2004-01-01

Speech pathology managers frequently move into careers beyond their clinical discipline. As practicing speech pathology managers and students of business leadership, we were curious about the nature of career transitions out of speech pathology management. We conducted an exploratory descriptive study investigating the perceived competencies that facilitate such career transitions and when further education is required to effectively equip one for such transition. The perceived skills related to a speech pathology background are identified along with the gaps in competence for moving into general management positions. Career management practices that facilitate this type of career transition are provided as recommendations for career planning.

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed Central

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-01-01

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

New paths in post-graduate medical training in general practice - 8 years of experience with the pilot project Verbundweiterbildungplus Baden-Württemberg.

PubMed

Schwill, Simon; Magez, Julia; Joos, Stefanie; Steinhäuser, Jost; Ledig, Thomas; Rubik, Aline; Niebling, Wilhelm; Szecsenyi, Joachim; Flum, Elisabeth

2017-01-01

Background: In face of the looming shortage of general practitioners, primary healthcare providers and post-graduate training in general practice are increasingly becoming part of the political agenda in Germany. In 2009 the program "Verbundweiterbildung plus Baden-Württemberg" (VWB plus BW) was developed by the Competence Center for General Practice in Baden-Wuerttemberg to ensure primary healthcare in the future by enhancing the attractiveness of general medicine. This paper describes the experiences that have been gathered in developing a post-graduate training-program for physicians undergoing specialist training in general practice. Project description: The Competence Center for General Practice in Baden-Wuerttemberg supports the organization of regional networks dedicated to post-graduate medical education. First core element of the VWB plus BW program is a special seminar series for physicians pursuing post-graduate training. This seminar program is aligned with the German competency-based curriculum in general medicine and is meant to promote medical expertise and other related competencies, such as business and medical practice management and communication skills. Mentoring and advising the physicians regarding professional and personal planning form the second core element. The third core element is seen in the train-the-trainer seminars that address the competencies of the trainers. In order to focus the program's content closely on the needs of the target groups, scientifically based evaluations and research are carried out. Results: Since starting in 2009, 685 physicians have entered the program and 141 have passed the examination to become medical specialists (as of December 2016). In total, 31 networks, 60 hospitals and 211 general practices have participated. The seminar sessions have been rated on average with 1.43 on a six-point Likert scale by the physician trainees (1=extremely satisfied, 6=extremely dissatisfied). Alongside the medical training, these physicians viewed the exchange of information and experiences with other physicians as very positive and important. In 185 seminars lasting 90 minutes each, the seminar program has presently covered 250 out of 320 units in the competency-based curriculum for general medicine. A total of 281 trainers have been trained in 13 train-the-trainer courses and have rated this course on average with 1.36 on a six-point Likert scale. Above all, the trainers emphasized the exchange of information and experiences with other trainers as very positive. In 2013 the DEGAM concept for its Verbundweiterbildung plus program was developed based on that of the VWB plus BW. Since 2008 over 40 articles on the topic of post-graduate medical education have been published. Conclusion: The steadily increasing number of participants over the years demonstrates that the VWB plus BW is relevant for recent medical graduates and contributes to the attractiveness of general practice. The consistently excellent evaluations of the training program and the train-the-trainer course affirm the focus on the needs of the target groups. The post-graduate VWB plus BW program advances structured, competency-based and quality-oriented specialist training and fosters professional sharing between physicians - something that could also be relevant for other fields. The increasing numbers of participating physicians and specialists in general practice in Baden-Württemberg lead to the conclusion that the VWB plus BW program positively influences the number of general practitioners.

Evaluation of an education and activation programme to prevent chronic shoulder complaints: design of an RCT [ISRCTN71777817

PubMed Central

Bruijn, Camiel De; de Bie, Rob; Geraets, Jacques; Goossens, Marielle; Köke, Albère; van den Heuvel, Wim; van der Heijden, Geert; Dinant, Geert-Jan

2005-01-01

Background About half of all newly presented episodes of shoulder complaints (SC) in general practice are reported to last for at least six months. Early interventions aimed at the psychological and social determinants of SC are not common in general practice, although such interventions might prevent the development of chronic SC. The Education and Activation Programme (EAP) consists of an educational part and a time-contingent activation part. The aim of the EAP is to provide patients with the proper cognitions by means of education, and to stimulate adequate behaviour through advice on activities of daily living. Design The article describes the design of a randomised clinical trial (RCT) to evaluate the effectiveness and cost-effectiveness of an EAP in addition to usual care, compared to usual care only, in the prevention of chronic SC after six months. It also describes the analysis of the cost and effect balance. Patients suffering from SC for less than three months are recruited in general practice and through open recruitment. A trained general practitioner or a trained therapist administers the EAP. Primary outcome measures are patient-perceived recovery, measured by self-assessment on a seven-point scale, and functional limitations in activities of daily living. Questionnaires are used to study baseline measures, prognostic measures, process measures and outcome measures. Discussion The inclusion of patients in the study lasted until December 31st 2003. Data collection is to end in June 2004. PMID:15715914

Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care.

PubMed

O'Hare, J P; Hopper, A; Madhaven, C; Charny, M; Purewell, T S; Harney, B; Griffiths, J

1996-03-16

To evaluate whether adding retinal photography improved community screening for diabetic retinopathy. Mobile screening unit at rural and urban general practices in south west England. 1010 diabetic patients from primary care. Prospective study; patients were examined by ophthalmoscopy by general practitioners or opticians without fundal photographs and again with photographs, and assessments were compared to those of an ophthalmologist. Whether fundal photography improved the sensitivity of detection of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by the specialist. Diabetic retinopathy was detected by the ophthalmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4.9%). The sensitivity of the general practitioners and opticians for referrable retinopathy with ophthalmoscopy was 65%, and improved to 84% with retinal photographs. General practitioners' sensitivity in detecting background retinopathy improved with photographs from 22% to 65%; opticians' sensitivity in detecting background retinopathy improved from 43% to 71%. The sensitivity of detecting referrable retinopathy by general practitioners improved from 56% to 80% with photographs; for opticians it improved from 75% to 88%. Combining modalities of screening by providing photography with specialist review of all films in addition to direct ophthalmoscopy through dilated pupils improves assessment and referral for diabetic retinopathy by general practitioners and opticians. With further training and experience, primary care screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening programme for this condition.

Prevalence and Cost of Full-Time Research Fellowships During General Surgery Residency – A National Survey

PubMed Central

Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.

2009-01-01

Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692

Cancer screening in a middle-aged general population: factors associated with practices and attitudes

PubMed Central

Cullati, Stéphane; Charvet-Bérard, Agathe I; Perneger, Thomas V

2009-01-01

Background The aim of this study was to identify factors associated with cancer screening practices and with general attitudes toward cancer screening in a general population. Methods Mailed survey of 30–60 year old residents of Geneva, Switzerland, that included questions about screening for five cancers (breast, cervix uteri, prostate, colon, skin) in the past 3 years, attitudes toward screening, health care use, preventive behaviours and socio-demographic characteristics. Cancer screening practice was dichotomised as having done at least one screening test in the past 3 years versus none. Results The survey response rate was 49.3% (2301/4670). More women than men had had at least one cancer screening test in the past 3 years (83.2% vs 34.5%, p < 0.001). A majority of women had had a cervical smear (76.6%) and a mammography (age 30–49: 35.0%; age 50 and older: 90.3%); and 55.1% of men 50–60 years old had been screened for prostate cancer. Other factors associated with screening included older age, higher income, a doctor visit in the past 6 months, reporting a greater number of preventive behaviours and a positive attitude toward screening. Factors linked with positive attitudes included female gender, higher level of education, gainful employment, higher income, a doctor visit in the past 6 months and a personal history of cancer. Conclusion Attitudes play an important role in cancer screening practices among middle-aged adults in the general population, independent of demographic variables (age and sex) that determine in part screening recommendations. Negative attitudes were the most frequent among men and the most socio-economically disadvantaged. The moderate participation rate raises the possibility of selection bias. PMID:19402895

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies

PubMed Central

Patterson, Fiona; Lievens, Filip; Kerrin, Máire; Munro, Neil; Irish, Bill

2013-01-01

Background The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study Aim To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. Design and setting A three-part longitudinal predictive validity study of selection into training for UK general practice. Method In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). Results Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. Conclusion In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered. PMID:24267856

Presentation of self and symptoms in primary care consultations involving patients from non-English speaking backgrounds.

PubMed

Roberts, Celia; Sarangi, Srikant; Moss, Becky

2004-01-01

This paper draws on the PLEDGE research project (Patients with Limited English and Doctors in General Practice) 1 The Patients with Limited English and Doctors in General Practice (PLEDGE) project was funded by Sir Siegmund Warburg's Voluntary Settlement (2001-2003). The research team was: Celia Roberts, Roger Jones, Becky Moss, Srikant Sarangi and Val Wass. which has a database of 232 video-recorded interactions from GP surgeries in South East London. We focus on the opening episodes-the first opportunity the patient has to report on why they have come to see the doctor-to explore some of the contrasts in self presentation and the interactional work that doctors do when faced with the unexpected. Patients who speak a local London or standard variety of English present three aspects: a description of symptoms, the context in which they occurred, and an affective or epistemic stance. These 'micro discourse routines' are accomplished interactionally through the design of figure/ground relationships, framing and metacommunication and presentation of the 'moral self'. Although some patients from non-English speaking backgrounds use broadly similar 'micro discourse routines', the majority configure the relationship between medically salient facts, adequate contextual information and the stance which conveys the 'moral self' in different and apparently less 'orderly' ways. So openings often become protracted and harder work interactionally for both sides. While conversation analytic studies and communication skills textbooks represent the medical consultations as orderly, we suggest that such apparent orderliness must, at least, be partly the result of ironing out linguistic and cultural diversity. Interactional sociolinguistic analysis is used to shed light on the design of these routines and to provide analytic frameworks for doctors in reflecting on their own practice in ways which challenge patient-centred models.

General Practice On-the-Job Training in Chinese Urban Community: A Qualitative Study on Needs and Challenges

PubMed Central

Wang, Bo; Wu, Tao; Huang, Yafang; Guo, Aimin

2014-01-01

Background On-the-job training is an important strategy for general practitioners to deliver appropriately community health services in China. The development of basic professional competence for general practitioners is the main goal of on-the-job training program. The aim of this study was to explore the needs of and the challenges to on-the-job training for general practitioners, and to provide advices for policy-makers to carry out this program more effectively. Methods We conducted 3 nominal group techniques, 17 in-depth interviews and 3 focus groups to identify the status of, needs of and challenges to on-the-job training for general practitioners in Liaoning, Ningxia, and Fujian provinces from September 2011 until December 2011. Audiotapes and transcripts were analyzed to identify major themes. Content analysis of the data was completed from January 2012 to March 2012. Results Basic theoretical knowledge and clinical skills were the main needs for general practitioners during on-the-job training. The challenges during training included the time contradiction between work and training, deficiencies of qualified preceptors, and lack of training funds. Participants gave recommendations how to resolve the above problems. Conclusions In order to improve the outcomes of general practice on-the-job training, it is necessary for government officials to resolve the contradiction between work and training, train preceptors continuously, and increase financial support in the training program. PMID:24728399

Working with Practicing Teachers in a High-Stakes Teaching Context to Rethink Their Pedagogical Practices with Children of Diverse Backgrounds

ERIC Educational Resources Information Center

Brown, Christopher P.; Weber, Natalie Babiak

2016-01-01

The public education system in the United States continues to struggle in educating children of diverse backgrounds. Many have addressed this issue by documenting how certain practices teach children particular types of knowledge and skills. This developmental focus on what should be happening to children of diverse backgrounds tends to ignore the…

The impact of a general practice group intervention on prescribing costs and patterns.

PubMed Central

Walker, Jane; Mathers, Nigel

2002-01-01

BACKGROUND: The formation of primary care groups (PCGs) and trusts (PCTs) has shifted the emphasis from individual practice initiatives to group-based efforts to control rising prescribing costs. However, there is a paucity of literature describing such group initiatives. We report the results of a multilevel group initiative, involving input from a pharmaceutical adviser, practice comparison feedback, and peer review meetings. AIM: To determine the impact of a prescribing initiative on the prescribing patterns of a group of general practices. DESIGN OF STUDY: A comparative study with non-matched controls. SETTING: Nine semi-rural/rural practices forming a commissioning group pilot, later a PCG, in Southern Derbyshire with nine practices as controls. METHOD: Practice data were collated for overall prescribing and for therapeutic categories, between the years 1997/1998 and 1998/1999 and analysed statistically. Prescribing expenditure trends were also collated. RESULTS: Although both groups came well within their prescribing budgets, in the study group this was for the first time in five years. Their rate of increase in expenditure slowed significantly following the initiative compared with that of the comparison group, which continued to rise (median practice net ingredient cost/patient unit (nic/PU) increase: Pound Sterling0.69 and Pound Sterling3.80 respectively; P = 0.03). The study group's nic/PU dropped below, and stayed below, that of the comparison group one month after the start of the initiative. For most therapeutic categories the study group had lower increases in costs and higher increases in percentage of generic items than the comparison group. Quality markers were unaffected. CONCLUSION: We suggest that practices with diverse prescribing patterns can work together effectively within a PCT locality to control prescribing costs. PMID:12030659

Comparison of software packages for detecting differential expression in RNA-seq studies

PubMed Central

Seyednasrollah, Fatemeh; Laiho, Asta

2015-01-01

RNA-sequencing (RNA-seq) has rapidly become a popular tool to characterize transcriptomes. A fundamental research problem in many RNA-seq studies is the identification of reliable molecular markers that show differential expression between distinct sample groups. Together with the growing popularity of RNA-seq, a number of data analysis methods and pipelines have already been developed for this task. Currently, however, there is no clear consensus about the best practices yet, which makes the choice of an appropriate method a daunting task especially for a basic user without a strong statistical or computational background. To assist the choice, we perform here a systematic comparison of eight widely used software packages and pipelines for detecting differential expression between sample groups in a practical research setting and provide general guidelines for choosing a robust pipeline. In general, our results demonstrate how the data analysis tool utilized can markedly affect the outcome of the data analysis, highlighting the importance of this choice. PMID:24300110

Comparison of software packages for detecting differential expression in RNA-seq studies.

PubMed

Seyednasrollah, Fatemeh; Laiho, Asta; Elo, Laura L

2015-01-01

RNA-sequencing (RNA-seq) has rapidly become a popular tool to characterize transcriptomes. A fundamental research problem in many RNA-seq studies is the identification of reliable molecular markers that show differential expression between distinct sample groups. Together with the growing popularity of RNA-seq, a number of data analysis methods and pipelines have already been developed for this task. Currently, however, there is no clear consensus about the best practices yet, which makes the choice of an appropriate method a daunting task especially for a basic user without a strong statistical or computational background. To assist the choice, we perform here a systematic comparison of eight widely used software packages and pipelines for detecting differential expression between sample groups in a practical research setting and provide general guidelines for choosing a robust pipeline. In general, our results demonstrate how the data analysis tool utilized can markedly affect the outcome of the data analysis, highlighting the importance of this choice. © The Author 2013. Published by Oxford University Press.

[General background and practical implementation of the health management service institution in Korea].

PubMed

Okahara, Shintaro; Lee, Byeong-Woo; Ogasawara, Takayuki; Mori, Koji

2014-09-01

The Korean Occupational Safety and Health Act requires an employer with more than 50 employees to assign a health manager or an occupational physician. However, there are many cases where it is difficult for medium-scale enterprises to perform occupational health practices autonomously because their financial base is weaker than that of large-scale enterprises. The Korean Occupational Safety and Health Act was amended in 1990 so that medium-scale enterprises could entrust a health management service institution with their health management tasks. This system is similar to the outsourcing of medical examinations, occupational physicians, or the measurement of the working environment in Japan, but its legal background and actual activities are korea-specific, and it has some different points. In particular, the quality control of health management service institutions by legal and administrative regulations, and the multidisciplinary provision of services contribute to the development of occupational health in medium-scale enterprises. This will be a good reference for occupational health services in small- and medium-scale enterprises in the future in Japan.

Establishing generic remediation goals for the polycyclic aromatic hydrocarbons: critical issues.

PubMed Central

LaGoy, P K; Quirk, T C

1994-01-01

Polycyclic aromatic hydrocarbons (PAHs) were one of the first classes of compounds identified as carcinogens and are often chemicals of concern at hazardous waste sites. Remediation goals established by regulatory agencies for carcinogenic PAHs in soil are generally either risk based or based on the method detection limits. PAHs are products of incomplete combustion, are components of petroleum, and as such, are prevalent in the environment from both natural and anthropogenic sources. Background concentrations are often above risk- or detection limit-based criteria, and therefore these remediation goals are of limited practical use as target criteria. In addition, the approaches used to establish target criteria do not account for several factors that may produce over- or underestimates of risk associated with the PAHs. Because of the frequency with which these compounds are detected, it is imperative that reasonably achievable and practical remediation goals be established. This paper examines the various factors that contribute to over- and underestimates of risks associated with PAHs and presents an approach for establishing cleanup criteria that takes into account health risks, background concentrations, and achievability. Images p348-a PMID:7925174

Attracting and retaining GPs: a stakeholder survey of priorities

PubMed Central

Lorant, Vincent; Geerts, Charlotte; Duchesnes, Christiane; Goedhuys, Jo; Ryssaert, Lynn; Remmen, Roy; D'hoore, William

2011-01-01

Background Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform. Aim To identify political priorities for improving GPs' attraction to the profession and their retention within it. Design and setting Stakeholder face-to-face survey in Belgium, 2008. Method A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from –3 to +3) for each type of policy — training, financing, work–life balance, practice organisation, and governance — and for innovative versus conservative policies. Results Practice organisation policies and training policies received the highest scores (mean score ≥1.11). Financing policies, governance, and work–life balance policies scored poorly (mean score ≤0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = –0.16, 95% confidence interval = –0.28 to –0.03). Conclusion The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access. PMID:21722449

Patients' experiences of continuity in the care of type 2 diabetes: a focus group study in primary care

PubMed Central

Alazri, Mohammed H; Neal, Richard D; Heywood, Phil; Leese, Brenda

2006-01-01

Background Continuity of care is fundamental to general practice and type 2 diabetes is a common chronic disease with major health and social impacts. Nevertheless continuity, as experienced by patients with type 2 diabetes, remains a neglected area. Aim To explore perceptions and experiences of continuity of care in general practice from the perspectives of patients with type 2 diabetes, focusing on the advantages and disadvantages of different types of continuity. Design of study Focus groups with patients. Setting Seven practices with different organisational structures in Leeds, UK. Method Seventy-nine patients with type 2 diabetes were recruited. Focus group interviews were conducted with 79 patients with type 2 diabetes from seven practices in Leeds, UK. Results Patients experienced three different types of continuity: relational (or longitudinal) continuity, cross-boundary (or team) continuity, and continuity of information. Patients' perceptions of continuity were influenced by several factors including a personal relationship between themselves and their healthcare professional, their own beliefs and behaviours, presence of diabetes, and the systems and structures of general practices. Patients identified the advantages and disadvantages of two types of continuity. Relational or longitudinal continuity was important in providing psychosocial care, but with a risk of misdiagnosis. The advantages of cross-boundary or team continuity were to provide physical care, whereas the main disadvantages were the absence of personal care and patient confusion. Conclusion Perceptions of continuity by patients with type 2 diabetes were influenced by several factors; they perceived several advantages and disadvantages associated with different types of continuity. Patients might expect certain healthcare benefits by following certain types of continuity. PMID:16834874

The integration of minimally invasive surgery in surgical practice in a Canadian setting: results from 2 consecutive province-wide practice surveys of general surgeons over a 5-year period

PubMed Central

Hallet, Julie; Mailloux, Olivier; Chhiv, Mony; Grégoire, Roger C.; Gagné, Jean-Pierre

2015-01-01

Background Although minimally invasive surgery (MIS) has been quickly embraced, the introduction of advanced procedures appears more complex. We assessed the evolution of MIS in the province of Quebec over a 5-year period to identify areas for improvement in the modern surgical era. Methods We developed, test-piloted and conducted a self-administered questionnaire among Quebec general surgeons in 2007 and 2012 to examine stated MIS practice, MIS training and barriers and facilitators to the use of MIS. Results Response rates were 51.3% (251 of 489) in 2007 and 31.3% (153 of 491) in 2012. A significant increase was observed for performance of most advanced MIS procedures, especially for colectomy for benign (66.0% v. 84.3%, p < 0,001) and malignant diseases (43.3% v. 77.8%, p < 0,001) and for rectal surgery for malignancy (21.0% v. 54.6%, p < 0.001). More surgeons practised 3 or more advanced MIS procedures in 2012 than in 2007 (82.3% v. 64.3%, p < 0,001). At multivariate analysis, the 2007 survey administration was associated with fewer surgeons practising advanced MIS (odds ratio 0.13, 95% confidence interval 0.06–0.29). In 2012, more respondents stated they gained their skills during residency (p = 0.028). Conclusion From 2007 to 2012 there was a significant increase in advanced MIS procedures practised by general surgeons in Québec. This technique appears well established in current surgical practice. The growing place of MIS in residency training seems to be a paramount part of this development. Results from this study could be used as a baseline for studies focusing on ways to further improve the MIS practice. PMID:25598180

Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening

PubMed Central

Raine, Rosalind; Duffy, Stephen W; Wardle, Jane; Solmi, Francesca; Morris, Stephen; Howe, Rosemary; Kralj-Hans, Ines; Snowball, Julia; Counsell, Nicholas; Moss, Sue; Hackshaw, Allan; von Wagner, Christian; Vart, Gemma; McGregor, Lesley M; Smith, Samuel G; Halloran, Stephen; Handley, Graham; Logan, Richard F; Rainbow, Sandra; Smith, Steve; Thomas, Mary C; Atkin, Wendy

2016-01-01

Background: There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual's general practice (GP endorsement; GPE) reduced this gradient. Methods: A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Results: We enrolled 265 434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04–1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78 000). Conclusions: Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP. PMID:26742011

A Review of the Medical Education Literature for Graduate Medical Education Teachers

PubMed Central

Locke, Kenneth A.; Bates, Carol K.; Karani, Reena; Chheda, Shobhina G.

2013-01-01

Background A rapidly evolving body of literature in medical education can impact the practice of clinical educators in graduate medical education. Objective To aggregate studies published in the medical education literature in 2011 to provide teachers in general internal medicine with an overview of the current, relevant medical education literature. Review We systematically searched major medical education journals and the general clinical literature for medical education studies with sound design and relevance to the educational practice of graduate medical education teachers. We chose 12 studies, grouped into themes, using a consensus method, and critiqued these studies. Results Four themes emerged. They encompass (1) learner assessment, (2) duty hour limits and teaching in the inpatient setting, (3) innovations in teaching, and (4) learner distress. With each article we also present recommendations for how readers may use them as resources to update their clinical teaching. While we sought to identify the studies with the highest quality and greatest relevance to educators, limitation of the studies selected include their single-site and small sample nature, and the frequent lack of objective measures of outcomes. These limitations are shared with the larger body of medical education literature. Conclusions The themes and the recommendations for how to incorporate this information into clinical teaching have the potential to inform the educational practice of general internist educators as well as that of teachers in other specialties. PMID:24404262

Audit of preventive activities in 16 inner London practices using a validated measure of patient population, the 'active patient' denominator. Healthy Eastenders Project.

PubMed Central

Robson, J; Falshaw, M

1995-01-01

BACKGROUND. Reliable comparison of the results of audit between general practices and over time requires standard definitions of numerators and denominators. This is particularly relevant in areas of high population turnover and practice list inflation. Without simple validation to remove supernumeraries, population coverage and professional activity may be underestimated. AIM. This audit study aimed to define a standard denominator, the 'active patient' denominator, to enable comparison of professional activity and population coverage for preventive activities between general practices and over time. It also aimed to document the extent to which computers were used for recording such activities. METHOD. A random sample of people in the age group 30-64 years was drawn from the computerized general practice registers of the 16 inner London general practices that participated in the 'healthy eastenders project'. A validation procedure excluded those patients who were likely to have died or moved away, or who for administrative reasons were unable to contribute to the numerator; this allowed the creation of the active patient denominator. An audit of preventive activities with numerators drawn from both paper and computerized medical records was carried out and results were presented so that practices could compare their results with those of their peers and over time. RESULTS. Of the original sample of 2331 people, 25% (practice range 13%-37%) were excluded as a result of the validation procedure. A denominator based on the complete, unexpurgated practice register rather than the validated active patient denominator would have reduced the proportion of people with blood pressure recorded within the preceding five years from 77% to 61%, recording of smoking status from 68% to 53% and recording of cervical smears from 80% to 66%. Only 53% of the last recordings, within the preceding five years, of blood pressure and only 54% of those of smoking status were recorded on the practice computer. In contrast, 82% of recorded cervical smears were recorded on computer. CONCLUSION. The active patient denominator produces a more accurate estimate of population coverage and professional activity, both of which are underestimated by the complete, unexpurgated practice register. A standard definition of the denominator also allows comparisons to be made between practices and over time. As only half of the recordings of some preventive activities were recorded on computer, it is doubtful whether it is advisable to rely on computers for audit where paper records are also maintained. PMID:7546868

Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial

PubMed Central

2014-01-01

Background Chronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners’ adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners’ adherence to guidelines. Methods/Design A pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians’ adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients’ records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care. Discussion The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care. Trial registration This trial has been registered with Clinical Trials Protocol Registration System. Trial number: NCT01893476. PMID:24708623

Level of Satisfaction of Older Persons with Their General Practitioner and Practice: Role of Complexity of Health Problems

PubMed Central

Poot, Antonius J.; den Elzen, Wendy P. J.; Blom, Jeanet W.; Gussekloo, Jacobijn

2014-01-01

Background Satisfaction is widely used to evaluate and direct delivery of medical care; a complicated relationship exists between patient satisfaction, morbidity and age. This study investigates the relationships between complexity of health problems and level of patient satisfaction of older persons with their general practitioner (GP) and practice. Methods and Findings This study is embedded in the ISCOPE (Integrated Systematic Care for Older Persons) study. Enlisted patients aged ≥75 years from 59 practices received a written questionnaire to screen for complex health problems (somatic, functional, psychological and social). For 2664 randomly chosen respondents (median age 82 years; 68% female) information was collected on level of satisfaction (satisfied, neutral, dissatisfied) with their GP and general practice, and demographic and clinical characteristics including complexity of health problems. Of all participants, 4% was dissatisfied with their GP care, 59% neutral and 37% satisfied. Between these three categories no differences were observed in age, gender, country of birth or education level. The percentage of participants dissatisfied with their GP care increased from 0.4% in those with 0 problem domains to 8% in those with 4 domains, i.e. having complex health problems (p<0.001). Per additional health domain with problems, the risk of being dissatisfied increased 1.7 times (95% CI 1.4–2.14; p<0.001). This was independent of age, gender, and demographic and clinical parameters (adjusted OR 1.4, 95% CI 1.1–1.8; p = 0.021). Conclusion In older persons, dissatisfaction with general practice is strongly correlated with rising complexity of health problems, independent of age, demographic and clinical parameters. It remains unclear whether complexity of health problems is a patient characteristic influencing the perception of care, or whether the care is unable to handle the demands of these patients. Prospective studies are needed to investigate the causal associations between care organization, patient characteristics, indicators of quality, and patient perceptions. PMID:24710557

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study.

PubMed

Doekhie, Kirti D; Buljac-Samardzic, Martina; Strating, Mathilde M H; Paauwe, Jaap

2017-12-28

Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals' perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions. Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving. Research and practice should take into account the misalignment between primary care professionals' perceptions of primary care teams, as our study notes variations in the conceptualization of primary care teams. To enhance teamwork between professionals from different disciplinary backgrounds, professionals acknowledge the importance of three underlying conditions: team familiarity, regular and structured knowledge exchange between all professionals involved in the care process and realizing and believing in the added value for patients of working as a team.

Fundholders' referral patterns and perceptions of service quality in hospital provision of elective general surgery.

PubMed Central

Whynes, D K; Reed, G

1994-01-01

BACKGROUND. The introduction of fundholding established an internal market in public sector health care, involving purchasers and providers contracting for the supply of health care. AIM. This study set out to examine fundholders' hospital referral patterns, and to evaluate the quality of the service provided to patients undergoing elective general surgery, as perceived by fundholding general practitioners. METHOD. A questionnaire was posted to the senior partners of all fundholding practices in the Trent Regional Health Authority area. This questionnaire requested assessments of the importance of 13 specified aspects of service quality and the quality of provision by general practitioners' most frequently-used hospitals. Five-point scales were employed in each case. Respondents were asked to provide additional details about their practice. RESULTS. A 67% response rate was achieved. Confidence in the consultant's ability, short waiting times and informative feedback from the providers emerged as the most important elements in referral decisions, while the cost of treatment and patient convenience received lower importance ratings. In terms of how well their providers were seen to perform, fundholders ranked confidence in the consultant and patient convenience highest, and style of hospital management lowest. The majority of referrals seemed to be local. CONCLUSION. Judged in terms of fundholders' perceptions, sizeable variations in service quality between hospital providers of general surgery are evident. PMID:7748666

General practitioner turnover and migration in England 1990-94.

PubMed Central

Taylor, D H; Leese, B

1998-01-01

BACKGROUND: In tandem with fears about a GP workforce crisis, increasing attention is being focused on the supply and distribution of primary care services: on general practitioners in particular. Differential turnover and migration across health authority boundaries could lead to a maldistribution of GPs, yet comprehensive studies of GP turnover are non-existent. AIM: To quantify general practitioner (GP) turnover and migration in England from 1990 to 1994. METHOD: Yearly data from 1 October 1990 to 1 October 1994 were collected on GPs in England practising full time, including average yearly turnover, rates of entry to and exit from general practice, and net migration among GPs. All were calculated at the family health service authority (now the new health authorities) level. RESULTS: Average yearly GP turnover ranges from 2.9% in Shropshire to 7.8% in Kensington, Chelsea and Westminster; turnover is associated with deprivation and high-need areas. Migration of GPs across health authority borders was rare. Entry and exit rates were also positively related to measures of deprivation and need. Relatively underprovided health authorities lost 23 GPs over the study period as a result of migration; relatively overprovided ones gained three. CONCLUSION: Turnover is driven primarily by exits from general practice and is related to deprivation and high need. Retention appears to be the main problem in ensuring an adequate GP supply in relatively deprived and underprovided health authorities. PMID:9624750

Tolerance of ambiguity, perfectionism and resilience are associated with personality profiles of medical students oriented to rural practice.

PubMed

Eley, Diann S; Leung, Janni K; Campbell, Narelle; Cloninger, C Robert

2017-05-01

Resilience, coping with uncertainty and learning from mistakes are vital characteristics for all medical disciplines - particularly rural practice. Levels of coping constructs were examined in medical students with and without a rural background or an interest in rural practice. Cross-sectional surveys identified two personality profiles, and their association with levels of Tolerance of Ambiguity, Resilience, Perfectionism-High Standards and Concern over mistakes as constructs indicative of coping. Medical students (N = 797) were stratified by rural background and degree of rural interest. Mediation analysis tested the effect of personality profile on levels of the coping constructs. More (72%) rural background students had Profile 1 which was associated with higher levels of Tolerance of Ambiguity, High standards, and Resilience, but lower Concern over mistakes. Non-rural background students reporting a strong rural interest also had Profile 1 (64%) and similar levels of coping constructs. Personality profile mediated the association between rural interest and levels of coping constructs regardless of background. Having a rural background or strong rural interest are associated with a personality profile that indicates a better capacity for coping. Personality may play a part in an individual's interest in rural practice. Rural workforce initiatives through education should encourage and nurture students with a genuine interest in rural practice - regardless of background.

How medical ethical principles are applied in treatment with artificial insemination by donors (AID) in Hunan, China: effective practice at the Reproductive and Genetic Hospital of CITIC-Xiangya

PubMed Central

Li, L; Lu, G

2005-01-01

This paper investigates the efficiency of application of medical ethics principles in the practice of artificial insemination by donors (AID) in China, in a culture characterised by traditional ethical values and disapproval of AID. The paper presents the ethical approach to AID treatment as established by the Reproduction and Genetics Hospital of CITIC-Xiangya (CITIC Hunan-Yale Approach) in the central southern area of China against the social ethical background of China and describes its general features. The CITIC-Xiangya Approach facilitates the implementation of ethical relations between clinicians and patients participating in AID treatment procedures in Hunan-Yale. PMID:15923480

Capturing patient experience: a qualitative study of implementing real-time feedback in primary care

PubMed Central

Carter, Mary; Davey, Antoinette; Wright, Christine; Elmore, Natasha; Newbould, Jenny; Roland, Martin; Campbell, John; Burt, Jenni

2016-01-01

Background In recent years, hospitals have made use of new technologies, such as real-time feedback, to collect patient experience information. This approach is currently rarely used in primary care settings, but may provide practices with a useful tool that enables them to take prompt, focused action to improve their services. Aim To identify the factors inhibiting and enabling the implementation of real-time feedback in general practices. Design and setting Qualitative study embedded within an exploratory trial (July 2014 to February 2015) of a real-time feedback intervention targeting patient experience in general practices in south-west England and Cambridgeshire. Method Semi-structured interviews (n = 22) and focus groups (n = 4, total of 28 attendees) with practice staff were audiorecorded, transcribed, and analysed thematically, using a framework based on constructs from normalisation process theory. Results Staff engagement with real-time feedback varied considerably, and staff made sense of real-time feedback by comparing it with more familiar feedback modalities. Effective within-team communication was associated with positive attitudes towards real-time feedback. Timing of requests for feedback was important in relation to patient engagement. Real-time feedback may offer potential as a means of informing practice development, perhaps as a component of a wider programme of capturing and responding to patients’ comments. Conclusion Successful implementation of real-time feedback requires effective communication across the practice team to engender thorough engagement. Feedback processes should be carefully introduced to fit with existing patient and practice routines. Future studies should consider making real-time feedback content relevant to specific practice needs, and support participation by all patient groups. PMID:27621292

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

PubMed Central

2013-01-01

Background A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Discussion Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Summary Answers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity. PMID:23919296

Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

PubMed Central

2010-01-01

Background The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Methods Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. Results The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Conclusion Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program. Trial registration Current Controlled Trials ISRCTN63355948 PMID:20459655

Validity of peak expiratory flow measurement in assessing reversibility of airflow obstruction.

PubMed Central

Dekker, F W; Schrier, A C; Sterk, P J; Dijkman, J H

1992-01-01

BACKGROUND: Assessing the reversibility of airflow obstruction by peak expiratory (PEF) measurements would be practicable in general practice, but its usefulness has not been investigated. METHODS: PEF measurements were performed (miniWright peak flow meter) in 73 general practice patients (aged 40 to 84) with a history of asthma or chronic obstructive lung disease before and after 400 micrograms inhaled sulbutamol. The change in PEF was compared with the change in forced expiratory volume in one second (FEV1). Reversible airflow obstruction was analysed in two ways according to previous criteria. When defined as a 9% or greater increase in FEV1 expressed as a percentage of predicted values reversibility was observed in 42% of patients. Relative operating characteristic analysis showed that an absolute improvement in PEF of 60 l/min or more gave optimal discrimination between patients with reversible and irreversible airflow obstruction (the sensitivity and specificity of an increase of 60 l/min in detecting a 9% or more increase in FEV1 as a percentage of predicted values were 68% and 93% respectively, with a positive predictive value of 87%). When defined as an increase of 190 ml or more in FEV1, reversible airflow obstruction was observed in 53% of patients. Again an absolute improvement in PEF of 60 l/min or more gave optimal discrimination between patients with reversible and irreversible airflow obstruction (sensitivity 56%, specificity 94%, and positive predictive value 92%). CONCLUSION: Absolute changes in PEF can be used as a simple technique to diagnose reversible airflow obstruction in patients from general practice. PMID:1519192

Unfashionable tales: narratives about what is (still) great in NHS general practice

PubMed Central

Spooner, Sharon

2016-01-01

Background There is clear evidence that general practice has become a less popular career choice and among GPs there are high levels of dissatisfaction and demotivation. Little empirical evidence has emerged to indicate which factors contribute intrinsic value to the working lives of GPs and sustain their ongoing commitment. Aim To understand which aspects of work continue to motivate and engage senior GPs by exploring their narrative accounts. Design and setting This was part of a qualitative study in which senior GPs and hospital specialists contributed narratives in which they reflected on their working lives. Method Individual, open interviews were conducted with eight GPs who had graduated in the early 1980s. Thematic analysis and situational analysis mapping were used to identify and connect related themes. Results During interviews in which doctors drew on a wide range of encounters and experiences, they revealed which aspects of work were associated with greater intrinsic rewards and contributed to their continuing motivation. Having chosen careers that suited their preferred settings and working practices, they recounted adjustments made in response to new challenges and confirmed experiencing greater enjoyment when performing roles affirming their sense of providing valued health care. Conclusion This study’s findings offer an alternative angle from which to consider the current unpopularity of general practice careers. The article proposes that long-term engagement of practitioners may be achieved through provision of adequate supportive resources to allow them to enact a sense of medical identity that matches with their acquired expectations of their role in the NHS. PMID:26740605

Which functionalities are available in the electronic health record systems used by French general practitioners? An assessment study of 15 systems.

PubMed

Darmon, David; Sauvant, Rémy; Staccini, Pascal; Letrilliart, Laurent

2014-01-01

Whereas an unprecedented effort is currently under way worldwide for the implementation of electronic health record (EHR) systems, their capabilities are poorly understood, especially in primary care. The objective of this study was to assess the main functionalities of the EHR systems used in French general practices. Among the 20 EHR systems marketed in France, we assessed the 15 systems used by more than 1500 general practitioners in the Provence-Alpes-Côte d'Azur region in the southeast part of France. Each EHR system was assessed in a general practice office, using two clinical vignettes describing virtual patient consultations. The evaluation criteria were derived from the EuroRec requirements for EHR system quality. The assessment scale included 37 criteria grouped into three sets: background data, consultation data, and exchange functionalities. The scoring system used, totalling 64 points, was based on the validation of the criteria and was adjusted based on the possibility of standardising the data. A high score indicated a good EHR system quality. The median global score was 32 points out of a possible 64 (range: 20-39). The median score was 12 points out of 22 (range: 6-15) for the background data set, 16 points out of 32 (range: 9-22) for the consultation data set, and four points out of 10 (range: 0-6) for the exchange functionalities. No association was found between the number of users and the assessment score of the EHR systems (p=0.79). One third of the EHR systems lacked a problem list and only one of them supported the episode of care. Functionalities noticeably vary among the EHR systems currently used in French primary care. Whereas these systems are globally very focused on drug prescriptions, several core functionalities are frequently lacking. They are also poorly interoperable for healthcare professionals and patients. Further research is necessary to assess their actual use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Reasoning and Data Representation in a Health and Lifestyle Support System.

PubMed

Hanke, Sten; Kreiner, Karl; Kropf, Johannes; Scase, Marc; Gossy, Christian

2017-01-01

Case-based reasoning and data interpretation is an artificial intelligence approach that capitalizes on past experience to solve current problems and this can be used as a method for practical intelligent systems. Case-based data reasoning is able to provide decision support for experts and clinicians in health systems as well as lifestyle systems. In this project we were focusing on developing a solution for healthy ageing considering daily activities, nutrition as well as cognitive activities. The data analysis of the reasoner followed state of the art guidelines from clinical practice. Guidelines provide a general framework to guide clinicians, and require consequent background knowledge to become operational, which is precisely the kind of information recorded in practice cases; cases complement guidelines very well and helps to interpret them. It is expected that the interest in case-based reasoning systems in the health.

[Computerized monitoring for integrated cervical screening. Rationale, methods and indicators of participation].

PubMed

Bucchi, L; Pierri, C; Caprara, L; Cortecchia, S; De Lillo, M; Bondi, A

2003-02-01

This paper presents a computerised system for the monitoring of integrated cervical screening, i.e. the integration of spontaneous Pap smear practice into organised screening. The general characteristics of the system are described, including background and rationale (integrated cervical screening in European countries, impact of integration on monitoring, decentralised organization of screening and levels of monitoring), general methods (definitions, sections, software description, and setting of application), and indicators of participation (distribution by time interval since previous Pap smear, distribution by screening sector--organised screening centres vs public and private clinical settings--, distribution by time interval between the last two Pap smears, and movement of women between the two screening sectors). Also, the paper reports the results of the application of these indicators in the general database of the Pathology Department of Imola Health District in northern Italy.

Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study

PubMed Central

Wadley, Greg; Sanci, Lena Amanda

2018-01-01

Background Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. Objective The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. Methods We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. Results A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app’s administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. Conclusions The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings. PMID:29691209

Motives of former interns in general practice for speciality-choice − Results of a cross-sectional study among graduates 2007 to 2012

PubMed Central

Abendroth, Jens; Schnell, Ute; Lichte, Thomas; Oemler, Matthias; Klement, Andreas

2014-01-01

Background: The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates’ choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g. work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. Method: A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. Results: The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r=-.5; p<.01). However, if the IGP had an influence on speciality choice, it was correlated with a new perception of general practice (r=.36; p<.01). This new perception was associated with a positive influence of the medical teacher during the IGP. Conclusion: The final-year IGP is an opportunity to change the perception of general practice in students who are still undecided. This can lead to different speciality choices in a subgroup. Personal attitudes and concepts of personal life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated. PMID:24575153

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour. PMID:28704407

Immigrant general practitioners in Norway: a special resource? A qualitative study.

PubMed

Díaz, Esperanza; Hjörleifsson, Stefán

2011-05-01

To explore whether and how immigrant general practitioners (GPs) in two major cities in Norway think that their own ethnic background affects their practices and their work. Qualitative focus group and individual interviews with seven immigrant GPs, five men and two women, age 36-65 years. Their clinical experience in Norwegian primary health care ranged from four to 30 years. Analysis was conducted by systematic text condensation. First, immigrant GPs described a gradual process of becoming bicultural: the GPs communicate with immigrant patients on their own terms and draw upon their special knowledge from abroad to help selected patients, while also adapting to Norwegian cultural expectations of the GP's role. Second, the GPs described being aware of cultural issues in consultations with immigrant and Norwegian patients, but rarely making these issues explicit. The GPs ventured that cultural awareness, together with their personal experience in their own countries and as immigrants in Norway, made them able to sometimes help immigrant patients better than Norwegian GPs. Third, immigrant GPs experienced a big workload related to immigrant patients, but they accepted this as a natural part of their work. Fourth, immigrant GPs felt that they had to work harder and be more careful than their Norwegian colleagues in order to avoid complaints from patients, and to be accepted by colleagues. Immigrant GPs express broad cultural competence and keen cultural awareness in their consultations. The immigrant background of these GPs could be considered as a special resource for clinical practice.

Measuring the effects of acupuncture and homoeopathy in general practice: An uncontrolled prospective documentation approach

PubMed Central

Güthlin, Corina; Lange, Oliver; Walach, Harald

2004-01-01

Background Despite the increasing demand for acupuncture and homoeopathy in Germany, little is known about the effects of these treatments in routine care. We set up a pragmatic documentation study in general practice funded within the scope of project launched by a German health insurer. Patients were followed-up for up to four years. Methods The aim of the project was to study the effects and benefits of acupuncture and/or homoeopathy, and to assess patient satisfaction within a prospective documentation of over 5000 acupuncture and over 900 homoeopathy patients. As data sources, we used the documentation made available by therapists on every individual visit and a standardised quality-of-life questionnaire (MOS SF-36); these were complemented by questions concerning the patient's medical history and by questions on patient satisfaction. The health insurer provided us with data on work absenteeism. Results Descriptive analyses of the main outcomes showed benefit of treatment with middle to large-sized effects for the quality of life questionnaire SF-36 and about 1 point improvement on a rating scale of effects, given by doctors. Data on the treatment and the patients' and physicians' background suggests chronically ill patients treated by fairly regular schemes. Conclusion Since the results showed evidence of a subjective benefit for patients from acupuncture and homoeopathy, this may account for the increase in demand for these treatments especially when patients are chronically ill and unsatisfied with the conventional treatment given previously. PMID:15113434

A retrospective review of general surgery training outcomes at the University of Toronto

PubMed Central

Compeau, Christopher; Tyrwhitt, Jessica; Shargall, Yaron; Rotstein, Lorne

2009-01-01

Background Surgical educators have struggled with achieving an optimal balance between the service workload and education of surgical residents. In Ontario, a variety of factors during the past 12 years have had the net impact of reducing the clinical training experience of general surgery residents. We questioned what impact the reductions in trainee workload have had on general surgery graduates at the University of Toronto. Methods We evaluated graduates from the University of Toronto general surgery training program from 1995 to 2006. We compared final-year In-Training Evaluation Reports (ITERs) of trainees during this interval. For purposes of comparison, we subdivided residents into 4 groups according to year of graduation (1995–1997, 1998–2000, 2001–2003 and 2004–2006). We evaluated postgraduate “performance” by categorizing residents into 1 of 4 groups: first, residents who entered directly into general surgery practice after graduation; second, residents who entered into a certification subspecialty program of the Royal College of Physicians and Surgeons of Canada (RCPSC); third, residents who entered into a noncertification program of the RCPSC; and fourth, residents who entered into a variety of nonregulated “clinical fellowships.” Results We assessed and evaluated 118 of 134 surgical trainees (88%) in this study. We included in the study graduates for whom completed ITER records were available and postgraduate training records were known and validated. The mean scores for each of the 5 evaluated residency training parameters included in the ITER (technical skills, professional attitudes, application of knowledge, teaching performance and overall performance) were not statistically different for each of the 4 graduating groups from 1995 to 2006. However, we determined that there were statistically fewer general surgery graduates (p < 0.05) who entered directly into general surgery practice in the 2004–2006 group compared with the 1998–2000 and 2001–2003 groups. The graduates from 2004 to 2006 who did not enter into general surgery practice appeared to choose a clinical fellowship. Conclusion These observations may indicate that recent surgical graduates possess an acceptable skill set but may lack the clinical confidence and experience to enter directly into general surgery practice. Evidence seems to indicate that the clinical fellowship has become an unregulated surrogate extension of the training program whereby surgeons can gain additional clinical experience and surgical expertise. PMID:19865542

Evaluation of features to support safety and quality in general practice clinical software

PubMed Central

2011-01-01

Background Electronic prescribing is now the norm in many countries. We wished to find out if clinical software systems used by general practitioners in Australia include features (functional capabilities and other characteristics) that facilitate improved patient safety and care, with a focus on quality use of medicines. Methods Seven clinical software systems used in general practice were evaluated. Fifty software features that were previously rated as likely to have a high impact on safety and/or quality of care in general practice were tested and are reported here. Results The range of results for the implementation of 50 features across the 7 clinical software systems was as follows: 17-31 features (34-62%) were fully implemented, 9-13 (18-26%) partially implemented, and 9-20 (18-40%) not implemented. Key findings included: Access to evidence based drug and therapeutic information was limited. Decision support for prescribing was available but varied markedly between systems. During prescribing there was potential for medicine mis-selection in some systems, and linking a medicine with its indication was optional. The definition of 'current medicines' versus 'past medicines' was not always clear. There were limited resources for patients, and some medicines lists for patients were suboptimal. Results were provided to the software vendors, who were keen to improve their systems. Conclusions The clinical systems tested lack some of the features expected to support patient safety and quality of care. Standards and certification for clinical software would ensure that safety features are present and that there is a minimum level of clinical functionality that clinicians could expect to find in any system.

Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

PubMed Central

Kwok, Wing-Yee; de Kwaadsteniet, Marjolein CE; Harmsen, Mirjam; van Suijlekom-Smit, Lisette WA; Schellevis, François G; van der Wouden, Johannes C

2006-01-01

Background We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. Method During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. Results The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. Conclusion This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral. PMID:16584577

Interest and applicability of acute care surgery among surgeons in Quebec: a provincial survey

PubMed Central

Joos, Émilie; Trottier, Vincent; Thauvette, Daniel

2013-01-01

Background Acute care surgery (ACS) comprises trauma and emergency surgery. The purpose of this new specialty is to involve trauma and nontrauma surgeons in the care of acutely ill patients with a surgical pathology. In Quebec, few acute care surgery services (ACSS) exist, and the concept is still poorly understood by most general surgeons. This survey was meant to determine the opinions and interest of Quebec general surgeons in this new model. Methods We created a bilingual electronic survey using a Web interface and sent it by email to all surgeons registered with the Association québécoise de chirurgie. A reminder was sent 2 weeks later to boost response rates. Results The response rate was 36.9%. Most respondents had academic practices, and 16% worked in level 1 trauma centres. Most respondents had a high operative case load, and 66% performed at least 10 urgent general surgical cases per month. Although most (88%) thought that ACS was an interesting field, only 45% were interested in participating in an ACSS. Respondents who deemed this concept least applicable to their practices were more likely to be working in nonacademic centres. Conclusion Despite a strong interest in emergency general surgery, few surgeons were interested in participating in an ACSS. This finding may be explained by lack of comprehension of this new model and by comfort with traditional practice. We aim to change this paradigm by demonstrating the feasibility and benefits of the new ACSS at our centre in a follow-up study. PMID:23883506

Immersive audiomotor game play enhances neural and perceptual salience of weak signals in noise

PubMed Central

Whitton, Jonathon P.; Hancock, Kenneth E.; Polley, Daniel B.

2014-01-01

All sensory systems face the fundamental challenge of encoding weak signals in noisy backgrounds. Although discrimination abilities can improve with practice, these benefits rarely generalize to untrained stimulus dimensions. Inspired by recent findings that action video game training can impart a broader spectrum of benefits than traditional perceptual learning paradigms, we trained adult humans and mice in an immersive audio game that challenged them to forage for hidden auditory targets in a 2D soundscape. Both species learned to modulate their angular search vectors and target approach velocities based on real-time changes in the level of a weak tone embedded in broadband noise. In humans, mastery of this tone in noise task generalized to an improved ability to comprehend spoken sentences in speech babble noise. Neural plasticity in the auditory cortex of trained mice supported improved decoding of low-intensity sounds at the training frequency and an enhanced resistance to interference from background masking noise. These findings highlight the potential to improve the neural and perceptual salience of degraded sensory stimuli through immersive computerized games. PMID:24927596

Immersive audiomotor game play enhances neural and perceptual salience of weak signals in noise.

PubMed

Whitton, Jonathon P; Hancock, Kenneth E; Polley, Daniel B

2014-06-24

All sensory systems face the fundamental challenge of encoding weak signals in noisy backgrounds. Although discrimination abilities can improve with practice, these benefits rarely generalize to untrained stimulus dimensions. Inspired by recent findings that action video game training can impart a broader spectrum of benefits than traditional perceptual learning paradigms, we trained adult humans and mice in an immersive audio game that challenged them to forage for hidden auditory targets in a 2D soundscape. Both species learned to modulate their angular search vectors and target approach velocities based on real-time changes in the level of a weak tone embedded in broadband noise. In humans, mastery of this tone in noise task generalized to an improved ability to comprehend spoken sentences in speech babble noise. Neural plasticity in the auditory cortex of trained mice supported improved decoding of low-intensity sounds at the training frequency and an enhanced resistance to interference from background masking noise. These findings highlight the potential to improve the neural and perceptual salience of degraded sensory stimuli through immersive computerized games.

A Survey to Assess Family Physicians’ Motivation to Teach Undergraduates in Their Practices

PubMed Central

May, Marcus; Mand, Peter; Biertz, Frank; Hummers-Pradier, Eva; Kruschinski, Carsten

2012-01-01

Background In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs’ motivation to teach medical students in their practices is lacking. Purpose To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. Methods The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. Results A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). ‘Helping others’ and ‘interest’ were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. Conclusion German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods. PMID:23029272

A Standard of Knowledge for the Professional Practice of Toxicology

PubMed Central

Kinter, Lewis B.; Kelman, Bruce

2015-01-01

Background Employers, courts, and the general public judge the credibility of professionals based on credentials such as academic degrees, publications, memberships in professional organizations, board certifications, and professional registrations. However, the relevance and merit of these credentials can be difficult to determine objectively. Board certification can be a reliable indicator of proficiency if the certifying organization demonstrates, through regularly scheduled independent review, that its processes meet established standards and when a certificate holder is required to periodically demonstrate command of a body of knowledge that is essential to current professional practice. Objective We report herein a current Standard of Knowledge in general toxicology compiled from the experience and opinions of 889 certified practicing professional toxicologists. Discussion An examination is the most commonly used instrument for testing a certification candidate’s command of the body of knowledge. However, an examination-based certification is only creditable when the body of knowledge, to which a certification examination tests, is representative of the current knowledge, skills, and capabilities needed to effectively practice at the professional level. Thus, that body of knowledge must be the current “Standard of Knowledge” for the profession, compiled in a transparent fashion from current practitioners of the profession. Conclusion This work was conducted toward ensuring the scientific integrity of the products produced by professional toxicologists. Citation Hulla JE, Kinter LB, Kelman B. 2015. A Standard of Knowledge for the professional practice of toxicology. Environ Health Perspect 123:743–748; http://dx.doi.org/10.1289/ehp.1408643 PMID:25782181

Ethnographic study of ICT-supported collaborative work routines in general practice

PubMed Central

2010-01-01

Background Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations. Methods/design Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations. Discussion Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice. PMID:21190583

Rapid assessment of injection practices in Cambodia, 2002

PubMed Central

Vong, Sirenda; Perz, Joseph F; Sok, Srun; Som, Seiharath; Goldstein, Susan; Hutin, Yvan; Tulloch, James

2005-01-01

Background Injection overuse and unsafe injection practices facilitate transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Anecdotal reports of unsafe and unnecessary therapeutic injections and the high prevalence of HBV (8.0%), HCV (6.5%), and HIV (2.6%) infection in Cambodia have raised concern over injection safety. To estimate the magnitude and patterns of such practices, a rapid assessment of injection practices was conducted. Methods We surveyed a random sample of the general population in Takeo Province and convenience samples of prescribers and injection providers in Takeo Province and Phnom Penh city regarding injection-related knowledge, attitudes, and practices. Injection providers were observed administering injections. Data were collected using standardized methods adapted from the World Health Organization safe injection assessment guidelines. Results Among the general population sample (n = 500), the overall injection rate was 5.9 injections per person-year, with 40% of participants reporting receipt of ≥ 1 injection during the previous 6 months. Therapeutic injections, intravenous infusions, and immunizations accounted for 74%, 16% and 10% of injections, respectively. The majority (>85%) of injections were received in the private sector. All participants who recalled their last injection reported the injection was administered with a newly opened disposable syringe and needle. Prescribers (n = 60) reported that 47% of the total prescriptions they wrote included a therapeutic injection or infusion. Among injection providers (n = 60), 58% recapped the syringe after use and 13% did not dispose of the used needle and syringe appropriately. Over half (53%) of the providers reported a needlestick injury during the previous 12 months. Ninety percent of prescribers and injection providers were aware HBV, HCV, and HIV were transmitted through unsafe injection practices. Knowledge of HIV transmission through "dirty" syringes among the general population was also high (95%). Conclusion Our data suggest that Cambodia has one of the world's highest rates of overall injection usage, despite general awareness of associated infection risks. Although there was little evidence of reuse of needles and syringes, support is needed for interventions to address injection overuse, healthcare worker safety and appropriate waste disposal. PMID:15929800

Beyond ADHD: How Well Are We Doing?

PubMed Central

Stein, Ruth EK; Storfer-Isser, Amy; Kerker, Bonnie D.; Garner, Andrew; Szilagyi, Moira; Hoagwood, Kimberly E.; O’Connor, Karen G.; Horwitz, Sarah McCue

2017-01-01

Background and Objectives There has been increasing emphasis on the role of the pediatrician with respect to behavioral, learning and mental health (MH) issues, and developmental behavioral rotations are now required in pediatric residency programs. We sought to examine whether this newer emphasis on MH is reflected in pediatricians’ reports of their current practices. Methods Data from two Periodic Surveys (PS) conducted in 2004 and 2013 by the American Academy of Pediatrics (AAP) were examined to see whether there were differences in self-reported behaviors of usually inquiring/screening, treating/managing/co-managing, or referring patients for ADHD, anxiety, depression, behavioral problems or learning problems. We examined patterns for all practicing members and for those who practiced general pediatrics exclusively. Results There were few changes over the decade in the percentage who inquired or screened among all clinicians; among those exclusively practicing general pediatrics, the percentage who inquired or screened increased about 10% for ADHD and depression. ADHD remained the only condition for which the majority of respondents treated/managed/co-managed (57%). While there was some increase in the percentages who treated other conditions, the other conditions were usually treated by < 30% of respondents. A similar pattern of results was observed in analyses adjusted for physician, practice, and patient characteristics. Conclusions Despite the changing nature of pediatric practice and increased efforts to emphasize the importance of behavior, learning and MH, the pediatric community appears to be making little progress toward providing for the long-term behavioral, learning and MH needs of children and adolescents in its care. PMID:26514649

Identifying factors associated with experiences of coronary heart disease patients receiving structured chronic care and counselling in European primary care

PubMed Central

2012-01-01

Background Primary care for chronic illness varies across European healthcare systems. In patients suffering from coronary heart disease (CHD), factors associated with patients’ experiences of receiving structured chronic care and counselling at the patient and practice level were investigated. Methods In an observational study comprising 140 general practices from five European countries (Austria, Germany, the Netherlands, Switzerland and the United Kingdom), 30 patients with Coronary Heart Disease (CHD) per practice were chosen at random to partake in this research. Patients were provided with a questionnaire and the Patient Assessment of Chronic Illness Care (PACIC-5A) - instrument. Practice characteristics were assessed through a practice questionnaire and face to face interviews. Data were aggregated to obtain two practice scores representing quality management and CHD care, respectively. A hierarchical multilevel analysis was performed to examine the impact of patient and practice characteristics on PACIC scores. Results The final sample included 1745 CHD-patients from 131 general practices with a mean age of 67.8 (SD 9.9) years. The overall PACIC score was 2.84 (95%CI: 2.79; 2.89) and the 5A score reflecting structured lifestyle counselling was 2.75 (95% CI: 2.69; 2.79). At the patient level, male gender, more frequent practice contact and fewer related or unrelated conditions were associated with higher PACIC scores. At the practice level, performance scores reflecting quality management (p = 0.013) and CHD care (p = 0.009) were associated with improved assessment of the structured chronic care and counselling received. Conclusions Patients’ perceived quality of care varies. However, good practice management and organisation of care were positively reflected in patients’ assessments of receiving structured chronic illness care. This highlights the importance of integrating patient experiences into quality measurements to provide feedback to health care professionals. PMID:22838403

Techniques and Materials Used by General Dentists during Root Canal Treatment Procedures: Findings from the National Dental Practice-Based Research Network

PubMed Central

Eleazer, Paul D.; Gilbert, Gregg H.; Funkhouser, Ellen; Reams, G.J.; Law, A.S.; Benjamin, Paul L.

2015-01-01

Background Little is known about which materials and techniques general dentists (GDs) use during root canal procedures. The objectives were to: (1) quantify GD’s use of specific endodontic armamentarium; (2) quantify inappropriate use; and (3) ascertain if inappropriate use is associated with dentists’ practice characteristics. Methods GDs in the National Dental Practice-Based Research Network reported in a questionnaire materials and techniques they use during root canal procedures. Results 1,490 (87%) of eligible GDs participated. Most (93%; n=1,383) used sodium hypochlorite to irrigate. The most commonly used sealers were zinc oxide-eugenol (43%) and resin (40%), followed by calcium hydroxide (26%). A majority (62%; n=920) used a compaction obturation technique; 36% (n=534) used a carrier-based method. Most (96%; n=1,423) used gutta percha as a filler; 5% used paste fillers. Few used irrigants (n=46), sealers (n=4), techniques (n=49) or fillers (n=10) that investigators classified as ‘inappropriate’. Conclusions GDs use a broad range of endodontic techniques and materials, often adapting to newer technologies as they become available. Few GDs use armamentarium that the investigators classified as inappropriate. Practical Implications GDs use many types of endodontic techniques and materials, but only a very small percentage is not appropriate. PMID:26562726

Prenatal screening for congenital anomalies: exploring midwives’ perceptions of counseling clients with religious backgrounds

PubMed Central

2014-01-01

Background In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives’ perceptions and practices regarding taking client’s religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives’ knowledge of whether pregnancy termination is allowed in Islam. Methods This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in the Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study. Results Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client’s religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives’ own religious backgrounds were independent of whether they paid attention to the clients’ religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups. Conclusion While many midwives took client’s religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients. PMID:25037919

Prevalence of chronic stress in general practitioners and practice assistants: Personal, practice and regional characteristics

PubMed Central

Kersting, Christine; Thielmann, Anika; Weltermann, Birgitta

2017-01-01

Background The majority of studies investigating stress in primary care have focused either on general practitioners (GPs) or practice assistants (PAs), but did not measure stress on a practice level. We analyzed the prevalence of chronic stress for both professional groups and on a practice level and investigated personal, practice, and regional characteristics. Methods Chronic stress was measured in GPs and PAs from 136 German practices using the standardized, self-administered TICS-SSCS questionnaire (12 items). Based on a sum-score, participants per professional group were categorized as having low or high strain due to chronic stress (≤ 25th and ≥ 75th percentile of the study population´s distribution, respectively). For a cluster-level analysis, the mean of all practice means was used to categorize low- and high-stress practices. The intra-class correlation coefficient (ICC) was calculated using ANOVA. Prevalence Ratios (PR) were used to compare low versus high strain due to stress, stratified for personal, practice and regional characteristics. Results The response rate was 74.1% (n = 137/185). Data from 214 GPs (34.1% female), 500 PAs (99.4% female), and 50 PAs in training (98.0% female) were analyzed. Chronic stress was highest in female GPs (median 19, IQR (interquartile range) 11.5), followed by PAs (16, IQR 12.25) and male GPs (15, IQR 10). On a practice level, 26.3% of the practice personnel reported a high stress level. We observed an overall ICC of 0.25, with higher ICCs when stratifying by professional group (PAs: ICC 0.36, GPs in group practices: ICC 0.51). High chronic stress was observed as the number of working hours per week increased (GPs: PR 2.03, 95% CI 1.16–3.56; PAs: PR 2.02, 95% CI 1.22–3.35). There were no differences for practice type (solo/group) and the various regional characteristics. Conclusion Personal and practice characteristics were associated with chronic stress in GPs, PAs, and on a practice level. The high ICCs indicate a need for stress-reduction strategies geared at both professions on a practice level. PMID:28489939

Contradictory Literacy Practices of Mexican-Background Students: An Ethnography From the Rural Midwest

ERIC Educational Resources Information Center

Godina, Heriberto

2004-01-01

This ethnographic study explores the contradictory literacy practices of 10 high school students of Mexican background from the rural Midwest. The author uses the term "Mexican background" to encompass both settled Mexican Americans and recent-immigrant Mexicanos. Literacy is investigated through English and Spanish in a sociocultural…

Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial

PubMed Central

Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM

2015-01-01

Background A constructive safety culture is essential for the successful implementation of patient safety improvements. Aim To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. Design and setting A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. Method The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. Results The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. Conclusion Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. PMID:25918337

Do patient and practice characteristics confound age-group differences in preferences for general practice care? A quantitative study

PubMed Central

2013-01-01

Background Previous research showed inconsistent results regarding the relationship between the age of patients and preference statements regarding GP care. This study investigates whether elderly patients have different preference scores and ranking orders concerning 58 preference statements for GP care than younger patients. Moreover, this study examines whether patient characteristics and practice location may confound the relationship between age and the categorisation of a preference score as very important. Methods Data of the Consumer Quality Index GP Care were used, which were collected in 32 general practices in the Netherlands. The rank order and preference score were calculated for 58 preference statements for four age groups (0–30, 31–50, 51–74, 75 years and older). Using chi-square tests and logistic regression analyses, it was investigated whether a significant relationship between age and preference score was confounded by patient characteristics and practice location. Results Elderly patients did not have a significant different ranking order for the preference statements than the other three age groups (r = 0.0193; p = 0.41). However, in 53% of the statements significant differences were found in preference score between the four age groups. Elderly patients categorized significantly less preference statements as ‘very important’. In most cases, the significant relationships were not confounded by gender, education, perceived health, the number of GP contacts and location of the GP practice. Conclusion The preferences of elderly patients for GP care concern the same items as younger patients. However, their preferences are less strong, which cannot be ascribed to gender, education, perceived health, the number of GP contacts and practice location. PMID:23800156

Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

PubMed Central

2013-01-01

Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare. PMID:23617833

Smartphone Application of Primary Care Guidelines used in Education of Medical Students

PubMed Central

Waldmann, Uta-Maria; Weckbecker, Klaus

2013-01-01

Background and Objective: The guidelines of the German College of General Practitioners and Family Physicians (DEGAM) on frequent and important reasons for encounter in Primary Care play a central role in the teaching of Family Medicine. They were edited by the authors into an app for mobile phones, making them available at all times to General Practitioners and medical students. This study examines the issue: how useful do students consider this application within their learning process in Family Medicine? Method: The short versions of the 15 DEGAM guidelines were processed as a web app (for all smartphone software systems) including offline utilisation, and offered to students in the Family Medicine course, during clinical attachments in General Practice, on elective compulsory courses or for their final year rotation in General Practice. The evaluation was made with a structured survey using the feedback function of the Moodle learning management system [http://www.elearning-allgemeinmedizin.de] with Likert scales and free-text comments. Results: Feedback for evaluation came from 14 (25%) of the student testers from the Family Medicine course (9), the clinical attachment in General Practice (1), the final year rotation in General Practice (1) and elective compulsory courses (4). Students rated the app as an additional benefit to the printed/pdf-form. They use it frequently and successfully during waiting periods and before, during, or after lectures. In addition to general interest and a desire to become acquainted with the guidelines and to learn, the app is consulted with regard to general (theoretical) questions, rather than in connection with contact with patients. Interest in and knowledge of the guidelines is stimulated by the app, and on the whole the application can be said to be well suited to the needs of this user group. Discussion: The students evaluated the guidelines app positively: as a modern way of familiarising them with the guidelines and expanding their knowledge, particularly through its use in waiting periods and the attractive medium smartphone. However, the latter prevents a mandatory curricular use in compulsory courses, since not all students use smartphones. It is a meaningful addition to existing teaching materials and supports evidence-based teaching in Family Medicine and is suitable for use not only in university course teaching but also during clinical training. PMID:23467657

Oral Health Knowledge, Attitude, and Practices of Sharjah Mothers of Preschool Children, United Arab Emirates.

PubMed

Mahmoud, Noura; Kowash, Mawlood; Hussein, Iyad; Hassan, Amar; Al Halabi, Manal

2017-01-01

The improvement of children's oral health, a world global health target, is essential to general health and quality of life. Hence, the aim of this study was to assess the knowledge, attitude, and practices of mothers toward their children's oral health in Sharjah, United Arab Emirates (UAE). A cross-sectional interview-based study was conducted among 383 mothers of preschool children (average age 3.49 [+1.63 years]) attending Sharjah Dental Center, UAE. Statistical analysis was performed using SPSS software for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Adequate knowledge was found among 58.2% of mothers, 99% exhibited excellent attitude, and only 20% followed good practices toward their children's oral health. Poor knowledge and practice of mothers were significantly associated with mothers' occupation and education. Employed mothers had a significantly higher score of knowledge. Mothers with secondary education and university qualifications had significantly higher scores of practice compared with mothers with primary education. Although mothers had better than average knowledge and excellent attitude toward their children's oral health issues; most of them carried out improper practices. Mothers' educational and employment backgrounds were significant influencing factors.

Newborn Care Practices among Mother-Infant Dyads in Urban Uganda

PubMed Central

Kayom, Violet Okaba; Kakuru, Abel; Kiguli, Sarah

2015-01-01

Background. Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods. A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results. Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion. The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators. PMID:26713096

Oral Health Knowledge, Attitude, and Practices of Sharjah Mothers of Preschool Children, United Arab Emirates

PubMed Central

Mahmoud, Noura; Kowash, Mawlood; Hussein, Iyad; Hassan, Amar; Al Halabi, Manal

2017-01-01

Objective: The improvement of children's oral health, a world global health target, is essential to general health and quality of life. Hence, the aim of this study was to assess the knowledge, attitude, and practices of mothers toward their children's oral health in Sharjah, United Arab Emirates (UAE). Materials and Methods: A cross-sectional interview-based study was conducted among 383 mothers of preschool children (average age 3.49 [+1.63 years]) attending Sharjah Dental Center, UAE. Statistical analysis was performed using SPSS software for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Adequate knowledge was found among 58.2% of mothers, 99% exhibited excellent attitude, and only 20% followed good practices toward their children's oral health. Poor knowledge and practice of mothers were significantly associated with mothers' occupation and education. Employed mothers had a significantly higher score of knowledge. Mothers with secondary education and university qualifications had significantly higher scores of practice compared with mothers with primary education. Conclusions: Although mothers had better than average knowledge and excellent attitude toward their children's oral health issues; most of them carried out improper practices. Mothers’ educational and employment backgrounds were significant influencing factors. PMID:29387613

Obstructions to Bell CMB experiments

NASA Astrophysics Data System (ADS)

Martin, Jérôme; Vennin, Vincent

2017-09-01

We present a general and systematic study of how a Bell experiment on the cosmic microwave background could be carried out. We introduce different classes of pseudo-spin operators and show that, if the system is placed in a two-mode squeezed state as inflation predicts, they all lead to a violation of the Bell inequality. However, we also discuss the obstacles that one faces in order to realize this program in practice and show that they are probably insurmountable. We suggest alternative methods that could reveal the quantum origin of cosmological structures without relying on Bell experiments.

Effect of the Web-Based Intervention MyPlan 1.0 on Self-Reported Fruit and Vegetable Intake in Adults Who Visit General Practice: A Quasi-Experimental Trial

PubMed Central

Crombez, Geert; Van der Mispel, Celien; Verloigne, Maite; Van Stappen, Vicky; De Bourdeaudhuij, Ilse

2016-01-01

Background Web-based interventions typically have small intervention effects on adults’ health behavior because they primarily target processes leading to an intention to change leaving individuals in an intention-behavior gap, they often occur without contact with health care providers, and a limited amount of feedback is provided only at the beginning of these interventions, but not further on in the behavior change process. Therefore, we developed a Web-based intervention (“MyPlan 1.0”) to promote healthy behavior in adults. The intervention was based on a self-regulation perspective that also targets postintentional processes and guides individuals during all phases of behavior change. Objective The study investigated the effectiveness of MyPlan1.0 on fruit and vegetable intake of Flemish adults visiting general practice (3 groups: control group, intervention group recruited by researchers, and intervention group recruited and guided by general practitioners [GPs]). Second, it examined whether there was a larger intervention effect for the intervention group guided by GPs compared to the intervention group recruited by researchers. Methods Adults (≥18 years) were recruited in 19 Flemish general practices. In each general practice, patients were systematically allocated by a researcher either for the intervention group (researchers’ intervention group) or the waiting-list control group that received general advice. In a third group, the GP recruited adults for the intervention (GPs intervention group). The two intervention groups filled in evaluation questionnaires and received MyPlan 1.0 for a behavior of choice (fruit, vegetable, or physical activity). The waiting-list control group filled in the evaluation questionnaires and received only general information. Self-reported fruit and vegetable intake were assessed at baseline (T0), 1 week (T1), and 1 month (T2) postbaseline. Three-level (general practice, adults, time) linear regression models were conducted in MLwiN. Results A total of 426 adults initially agreed to participate (control group: n=149; GPs’ intervention group: n=41; researchers’ intervention group: n=236). A high attrition rate was observed in both intervention groups (71.8%, 199/277) and in the control group (59.1%, 88/149). In comparison to no change in the control group, both the GPs’ intervention group (fruit: χ2 1=10.9, P=.004; vegetable: χ2 1=5.3, P=.02) and the researchers’ intervention group (fruit: χ2 1=18.0, P=.001; vegetable: χ2 1=12.8, P<.001) increased their intake of fruit and vegetables. Conclusions A greater increase in fruit and vegetable intake was found when the Web-based intervention MyPlan 1.0 was used compared to usual care of health promotion in general practice (ie, flyers with general information). However, further investigation on which (or combinations of which) behavior change techniques are effective, how to increase response rates, and the influence of delivery mode in routine practice is required. Trial Registration ClinicalTrials.gov NCT02211040; https://clinicaltrials.gov/ct2/show/NCT02211040 (Archived by WebCite® at http://www.webcitation.org/6f8yxTRii) PMID:26929095

Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients

PubMed Central

Vermeulen, Joan; Friele, Roland D; van Schayck, Onno CP; de Jong, Judith D; de Witte, Luc P

2015-01-01

Background The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. Conclusions Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role. PMID:26601596

Culture.

PubMed

Smith, Timothy B; Rodríguez, Melanie Domenech; Bernal, Guillermo

2011-02-01

This article summarizes the definitions, means, and research of adapting psychotherapy to clients' cultural backgrounds. We begin by reviewing the prevailing definitions of cultural adaptation and providing a clinical example. We present an original meta-analysis of 65 experimental and quasi-experimental studies involving 8,620 participants. The omnibus effect size of d = .46 indicates that treatments specifically adapted for clients of color were moderately more effective with that clientele than traditional treatments. The most effective treatments tended to be those with greater numbers of cultural adaptations. Mental health services targeted to a specific cultural group were several times more effective than those provided to clients from a variety of cultural backgrounds. We recommend a series of research-supported therapeutic practices that account for clients' culture, with culture-specific treatments being more effective than generally culture-sensitive treatments. © 2010 Wiley Periodicals, Inc.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

PubMed Central

Avery, Anthony J; Rodgers, Sarah; Cantrill, Judith A; Armstrong, Sarah; Elliott, Rachel; Howard, Rachel; Kendrick, Denise; Morris, Caroline J; Murray, Scott A; Prescott, Robin J; Cresswell, Kathrin; Sheikh, Aziz

2009-01-01

Background Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken. Trial registration Current controlled trials ISRCTN21785299 PMID:19409095

Flame Retardant Exposure among Collegiate U.S. Gymnasts

PubMed Central

Carignan, Courtney C.; Heiger-Bernays, Wendy; McClean, Michael D.; Roberts, Simon C.; Stapleton, Heather M.; Sjödin, Andreas; Webster, Thomas F.

2013-01-01

Gymnastics training facilities contain large volumes of polyurethane foam, a material that often contains additive flame retardants such as PentaBDE. While investigations of human exposure to flame retardants have focused on the general population, potentially higher than background exposures may occur in gymnasts and certain occupational groups. Our objectives were to compare PentaBDE body burden among gymnasts to the general U.S. population and characterize flame retardants levels in gym equipment, air and dust. We recruited 11 collegiate female gymnasts (ages 18–22) from one gym in the Eastern U.S. The geometric mean (GM) concentration of BDE-153 in gymnast sera (32.5 ng/g lipid) was 4–6.5 times higher than general U.S. population groups. Median concentrations of PentaBDE, TBB and TBPH in paired handwipe samples were 2–3 times higher after practice compared to before, indicating the gymnasts contacted these flame retardants during practice. GM concentrations of PentaBDE, TBB and TBPH were 1-3 orders of magnitude higher in gym air and dust than in residences. Our findings suggest that these collegiate gymnasts experienced higher exposures to PentaBDE flame retardants compared to the general U.S. population and that gymnasts may also have increased exposure to other additive flame retardants used in polyurethane foam such as TBB and TBPH. PMID:24195753

Referrals and relationships: in-practice referrals meetings in a general practice.

PubMed

Rowlands, G; Willis, S; Singleton, A

2001-08-01

GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted the complexity of decision making in general practice and the likely impact of historical background and a variety of internal and external pressures on this self-directive educational intervention. The practice members described the individual and group learning needs identified as a result of the meetings. The findings of this study raise important questions for developing practice-based learning. The outcomes of self-directive interventions in practices will be influenced by internal and external events both past and present. Such outcomes may be qualitative and difficult to measure. They are likely to differ from outcomes seen when interventions are applied to groups of doctors who are not all members of the same practice.

Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial

PubMed Central

Charles, Daniel; Heal, Clare F.; Delpachitra, Meth; Wohlfahrt, Michael; Kimber, Debbie; Sullivan, Julie; Browning, Sheldon; Saednia, Sabine; Hardy, Alexandra; Banks, Jennifer; Buttner, Petra

2017-01-01

BACKGROUND: Preoperative skin antisepsis is routine practice. We compared alcoholic chlorhexidine with aqueous chlorhexidine for skin antisepsis to prevent surgical site infection after minor skin excisions in general practice. METHODS: We conducted this prospective, multicentre, randomized controlled trial in 4 private general practices in North Queensland, Australia, from October 2015 to August 2016. Consecutive adult patients presenting for minor skin excisions were randomly assigned to undergo preoperative skin antisepsis with 0.5% chlorhexidine in 70% ethanol (intervention) or 0.5% chlorhexidine aqueous solution (control). Our primary outcome was surgical site infection within 30 days of excision. We also measured the incidence of adverse reactions. RESULTS: A total of 916 patients were included in the study: 454 underwent antisepsis with alcoholic chlorhexidine and 462 with aqueous chlorhexidine. Of these, 909 completed follow-up. In the intention-to-treat analysis of cases available at follow-up, there was no significant difference in the incidence of surgical site infection between the alcoholic chlorhexidine arm (5.8%, 95% confidence interval [CI] 3.6% to 7.9%) and the aqueous chlorhexidine arm (6.8%, 95% CI 4.5% to 9.1%). The attributable risk reduction was 0.010 (95% CI –0.021 to 0.042), the relative risk was 0.85 (95% CI 0.51 to 1.41), and the number needed to treat to benefit was 100. Per protocol and sensitivity analyses produced similar results. The incidence of adverse reactions was low, with no difference between groups (p = 0.6). INTERPRETATION: There was no significant difference in efficacy between alcoholic and aqueous chlorhexidine for the prevention of surgical site infection after minor skin excisions in general practice. Trial registration: https://www.anzctr.org.au, no. ACTRN12615001045505 PMID:28790056

Detection methods for non-Gaussian gravitational wave stochastic backgrounds

NASA Astrophysics Data System (ADS)

Drasco, Steve; Flanagan, Éanna É.

2003-04-01

A gravitational wave stochastic background can be produced by a collection of independent gravitational wave events. There are two classes of such backgrounds, one for which the ratio of the average time between events to the average duration of an event is small (i.e., many events are on at once), and one for which the ratio is large. In the first case the signal is continuous, sounds something like a constant hiss, and has a Gaussian probability distribution. In the second case, the discontinuous or intermittent signal sounds something like popcorn popping, and is described by a non-Gaussian probability distribution. In this paper we address the issue of finding an optimal detection method for such a non-Gaussian background. As a first step, we examine the idealized situation in which the event durations are short compared to the detector sampling time, so that the time structure of the events cannot be resolved, and we assume white, Gaussian noise in two collocated, aligned detectors. For this situation we derive an appropriate version of the maximum likelihood detection statistic. We compare the performance of this statistic to that of the standard cross-correlation statistic both analytically and with Monte Carlo simulations. In general the maximum likelihood statistic performs better than the cross-correlation statistic when the stochastic background is sufficiently non-Gaussian, resulting in a gain factor in the minimum gravitational-wave energy density necessary for detection. This gain factor ranges roughly between 1 and 3, depending on the duty cycle of the background, for realistic observing times and signal strengths for both ground and space based detectors. The computational cost of the statistic, although significantly greater than that of the cross-correlation statistic, is not unreasonable. Before the statistic can be used in practice with real detector data, further work is required to generalize our analysis to accommodate separated, misaligned detectors with realistic, colored, non-Gaussian noise.

Prevalence of EGFR Mutations in Lung Cancer in Uruguayan Population

PubMed Central

Touya, Diego; Bertoni, Bernardo; Osinaga, Eduardo; Varangot, Mario

2017-01-01

Background Incorporation of molecular analysis of the epidermal growth factor receptor (EGFR) gene into routine clinical practice represents a milestone for personalized therapy of the non-small-cell lung cancer (NSCLC). However, the genetic testing of EGFR mutations has not yet become a routine clinical practice in developing countries. In view of different prevalence of such mutations among different ethnicities and geographic regions, as well as the limited existing data from Latin America, our aim was to study the frequency of major types of activating mutations of the EGFR gene in NSCLC patients from Uruguay. Methods We examined EGFR mutations in exons 18 through 21 in 289 NSCLC Uruguayan patients by PCR-direct sequencing. Results EGFR mutations were detected in 53 of the 289 (18.3%) patients, more frequently in women (23.4%) than in men (14.5%). The distribution by exon was similar to that generally reported in the literature. Conclusions This first epidemiological study of EGFR mutations in Uruguay reveals a wide spectrum of mutations and an overall prevalence of 18.3%. The background ethnic structure of the Uruguayan population could play an important role in explaining our findings. PMID:28744312

[Medical services on an inspection ship in the north Atlantic].

PubMed

Kjaer, A

1990-10-29

The Danish Naval Inspection Ships sail in the North Atlantic waters with a doctor on board. The object of this investigation was to illustrate the medical services on board and to elucidate the significance of various factors to predict seeking medical advice. During a period of three months, all of the medical services and certain basic factors were registered. The crew was interviewed about consumption of alcohol and tobacco, previous life at sea and family background. A total of 305 consultations were used by the crew of 72 men. This figure is five times the anticipated figure in general practice. Low rank and low age were predictors for frequent medical consultations. The diagnosis groups of traumata/injuries, dermatological conditions and disease in the nervous system or organs of sense were relatively overrepresented. A series of factors may possibly have influenced the pattern of seeking medical help so that this differs from general practice. It is concluded that the dangerous working environment and poor possibilities for good hygiene are important factors whereas the mental stress is of lesser significance.

Predictors of Treatment with Duloxetine or Venlafaxine XR among Adult Patients Treated for Depression in Primary Care Practices in the United Kingdom

PubMed Central

Shi, Nianwen; Durden, Emily; Torres, Amelito; Cao, Zhun; Happich, Michael

2012-01-01

Background. Knowledge about real-world use of duloxetine and venlafaxine XR to treat depression in the UK is limited. Aims. To identify predictors of duloxetine or venlafaxine XR initiation. Method. Adult depressed patients who initiated duloxetine or venlafaxine XR between January 1, 2006 and September 30, 2007 were identified in the UK's General Practice Research Database. Demographic and clinical predictors of treatment initiation with duloxetine and venlafaxine XR were identified using logistic regression. Results. Patients initiating duloxetine (n = 909) were 4 years older than venlafaxine XR recipients (n = 1286). Older age, preexisting unexplained pain, respiratory disease, and pre-period use of anticonvulsants, opioids, and antihyperlipidemics were associated with increased odds of initiating duloxetine compared to venlafaxine XR. Pre-period anxiety disorder was associated with decreased odds of receiving duloxetine. Conclusion. Initial treatment choice with duloxetine versus venlafaxine XR was primarily driven by patient-specific mental and medical health characteristics. General practitioners in the UK favor duloxetine over venlafaxine XR when pain conditions coexist with depression. PMID:22720149

Choose and Book: a sociological analysis of 'resistance' to an expert system.

PubMed

Greenhalgh, Trisha; Stones, Rob; Swinglehurst, Deborah

2014-03-01

In 2004, the English Department of Health introduced a technology (Choose and Book) designed to help general practitioners and patients book hospital outpatient appointments. It was anticipated that remote booking would become standard practice once technical challenges were overcome. But despite political pressure and financial incentives, Choose and Book remained unpopular and was generally used reluctantly if at all. Policymakers framed this as a problem of 'clinician resistance'. We considered Choose and Book from a sociological perspective. Our dataset, drawn from a qualitative study of computer use in general practice, comprised background documents, field notes, interviews, clinical consultations (directly observed and videotaped) and naturally occurring talk relating to referral to hospital in four general practices. We used strong structuration theory, Giddens' conceptualisation of expert systems, and sensitivity to other sociological perspectives on technology, institutions and professional values to examine the relationship between the external environment, the evolving technology and actions of human agents (GPs, administrators, managers and patients). Choose and Book had the characteristics of an expert system. It served to 'empty out' the content of the consultation as the abstract knowledge it contained was assumed to have universal validity and to over-ride the clinician's application of local knowledge and practical wisdom. Sick patients were incorrectly assumed to behave as rational choosers, able and willing to decide between potential options using abstracted codified information. Our analysis revealed four foci of resistance: to the policy of choice that Choose and Book symbolised and purported to deliver; to accommodating the technology's socio-material constraints; to interference with doctors' contextual judgements; and to adjusting to the altered social relations consequent on its use. We conclude that 'resistance' is a complex phenomenon with socio-material and normative components; it is unlikely to be overcome using the behaviourist techniques recommended in some health informatics and policy literature. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Gender differences in health and health care utilisation in various ethnic groups in the Netherlands: a cross-sectional study

PubMed Central

Gerritsen, Annette AM; Devillé, Walter L

2009-01-01

Background To determine gender differences in health and health care utilisation within and between various ethnic groups in the Netherlands. Methods Data from the second Dutch National Survey of General Practice (2000–2002) were used. A total of 7,789 persons from the indigenous population and 1,512 persons from the four largest migrant groups in the Netherlands – Morocco, Netherlands Antilles, Turkey and Surinam – aged 18 years and older were interviewed. Self-reported health outcomes studied were general health status and the presence of acute (past 14 days) and chronic conditions (past 12 months). And self-reported utilisation of the following health care services was analysed: having contacted a general practitioner (past 2 months), a medical specialist, physiotherapist or ambulatory mental health service (past 12 months), hospitalisation (past 12 months) and use of medication (past 14 days). Gender differences in these outcomes were examined within and between the ethnic groups, using logistic regression analyses. Results In general, women showed poorer health than men; the largest differences were found for the Turkish respondents, followed by Moroccans, and Surinamese. Furthermore, women from Morocco and the Netherlands Antilles more often contacted a general practitioner than men from these countries. Women from Turkey were more hospitalised than Turkish men. Women from Morocco more often contacted ambulatory mental health care than men from this country, and women with an indigenous background more often used over the counter medication than men with an indigenous background. Conclusion In general the self-reported health of women is worse compared to that of men, although the size of the gender differences may vary according to the particular health outcome and among the ethnic groups. This information might be helpful to develop policy to improve the health status of specific groups according to gender and ethnicity. In addition, in some ethnic groups, and for some types of health care services, the use by women is higher compared to that by men. More research is needed to explain these differences. PMID:19379499

'Can he have the test for bipolar, doctor? His dad's got it': exploring the potential of general practitioners to work with children and young people presenting in primary care with common mental health problems - a clinical initiative.

PubMed

Roberts, Jane H; Bernard, Paul M

2012-06-01

Background General practitioners (GPs) play a key role in assessing and managing adult mental health problems, but this input is not seen in their management of child and adolescent mental health. Mental health problems in 5-19-year-olds are common, yet detection rates in primary care are low. The symptoms of most adult diagnoses of mental health problems are present by mid-adolescence, yet the typical time from onset to diagnosis is 5-15 years. The role of general practice in this area has been underexplored. Aim This pilot study explores the potential of GPs to respond to common mental health problems in children and adolescents. Design Children and young people who would have ordinarily been referred to Child and Adolescent Mental Health Services (CAMHS) were seen in a GP setting. In a UK general practice surgery serving a disadvantaged population. Method Children and young people were seen for an initial biopsychosocial assessment and formulation of the presenting concerns. GP-based interventions were offered as appropriate or referred to CAMHS. Results Data from the first 50 children (2-19 years) are presented. Twenty younger children (10 years and under) and 30 older children (11 years and above) were seen. Eighteen referrals were made to CAMHS. GP interventions included watchful waiting, brief behavioural interventions, non-directive counselling, brief cognitive- behavioural therapy (CBT) and liaison with colleagues in education, CAMHS and the voluntary sector. Conclusion This clinical pilot demonstrates that with adequate time, access to supervision and practice support, children and young people experiencing emotional and behavioural problems associated with common mental health issues can be helped in primary care.

'Most young men think you have to be naked in front of the GP': a qualitative study of male university students' views on barriers to sexual health.

PubMed

Ewert, Cameron; Collyer, Archibald; Temple-Smith, Meredith

2016-04-01

Background In Australia, 15- to 29-year-olds account for 75% of all sexually transmissible infection (STI) diagnoses. STI rates among young men are rising, with most diagnosed in general practice. Young men less frequently attend general practice than young women, and rarely present with sexual health issues, making it difficult for general practitioners (GPs) to offer opportunistic STI education and screening. Little is known of the barriers preventing male university students accessing general practice for sexual health care, or what would facilitate this. Semi-structured interviews were conducted with young men aged 18-24 years attending university between 2012 and 2014. Interviews were recorded, transcribed and analysed using content and thematic analysis. Twenty-eight interviews of 26-50min duration found self-imposed views of masculinity, privacy and embarrassment as key barriers to accessing GPs for sexual health care. This was compounded by poor STI knowledge and not knowing when or where to go for care. Participants, except if they were international students, acknowledged school as an important source of sexual health education. The need for sexual health education at university was identified. While the Internet was a popular source, there were mixed views on the benefits of social media and text messaging for sexual health promotion. Current expectations of young male university students to seek sexual health care or acquire sexual health information from medical care may be misplaced. Universities have an excellent opportunity to provide young men with appropriate sexual health information and could offer novel strategies to help young men look after their sexual health.

Are medical educators in general practice untapped potential to increase training capacity in sexual and reproductive healthcare? Results of a survey in London, UK

PubMed Central

Ma, Richard; Shah, Radhika

2016-01-01

Abstract Background Long waiting times for training in sexual and reproductive healthcare (SRH) including long acting reversible contraception (LARC) might lead to attrition from training programmes, leading to reduced capacity for sexual health services, and reduced access to such contraception for women. Setting General practice in London, UK. Question Can medical educators in general practice be used as untapped potential to train other health care professionals in sexual and reproductive healthcare? Method We conducted an online survey to find out the qualifications, skills and willingness of established educators in primary care in London to train other clinicians in sexual and reproductive healthcare, including LARC. Results We received 124 responses from medical educators (10.1% response rate from general practitioner (GP) trainers and 59.0% of clinical supervisors for Foundation Year doctors). 86 (69.9%) had diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) qualification and further 18 (14.6%) were interested in obtaining this qualification. Eleven respondents were trained to fit intrauterine contraception only, three for contraceptive implants only and 37 were trained to fit both. 50 (40.3%) of 124 respondents were willing get involved in DFSRH training; 74% of these were willing to teach on any component of DFSRH including LARC. Discussion There is a shortage of training places and long waiting list for clinicians who wish to train in SRH. This survey suggests there is a pool of GP educators with skills and experience in SRH and are willing to train others. This can potentially increase the training capacity and improve overall access to good contraception and LARC for women. PMID:28250840

General Practice as a career choice among undergraduate medical students in Greece

PubMed Central

Mariolis, Anargiros; Mihas, Constantinos; Alevizos, Alevizos; Gizlis, Vasilis; Mariolis, Theodoros; Marayiannis, Konstantinos; Tountas, Yiannis; Stefanadis, Christodoulos; Philalithis, Anastas; Creatsas, George

2007-01-01

Background Although General Practice (GP) was recognized as a medical specialty in Greece in 1986, the number of GPs is insufficient to cover needs and only few medical graduates choose GP as a career option. In the present study we investigated the profile of medical students in terms of their decisions regarding specialization and the possible association of career choices different from GP with the status of undergraduate training regarding GP. Methods The sample consisted of final year students in the Medical School of the University of Athens, Greece. Students filled in a self-reported questionnaire focusing on medical specialization, and GP in particular. Results Response rate was 82.5% with 1021 questionnaires collected, out of 1237 eligible medical students. Only 44 out of the 1021 (4.3%) respondents stated that GP is -or could be- among their choices for specialty. The most popular medical specialty was General Surgery (10.9%), followed by Cardiology (9.6%), Endocrinology (8.7%) and Obstetrics-Gynaecology (8.3%). The most common criterion for choosing GP was the guaranteed employment on completion of the residency (54.6%) while a 56.6% of total respondents were positive to the introduction of GP/FM as a curriculum course during University studies. Conclusion Despite the great needs, GP specialty is currently not a career option among undergraduate students of the greater Medical University in Greece and is still held in low esteem. A university department responsible for undergraduate teaching, promotion and research in GP (where not available) is essential; the status of undergraduate training in general practice/family medicine seems to be one of the most important factors that influence physician career choices regarding primary care specialties. PMID:17543106

Gut Feelings as a Third Track in General Practitioners’ Diagnostic Reasoning

PubMed Central

Van de Wiel, Margje; Van Royen, Paul; Van Bokhoven, Marloes; Van der Weijden, Trudy; Dinant, Geert Jan

2010-01-01

Background General practitioners (GPs) are often faced with complicated, vague problems in situations of uncertainty that they have to solve at short notice. In such situations, gut feelings seem to play a substantial role in their diagnostic process. Qualitative research distinguished a sense of alarm and a sense of reassurance. However, not every GP trusted their gut feelings, since a scientific explanation is lacking. Objective This paper explains how gut feelings arise and function in GPs’ diagnostic reasoning. Approach The paper reviews literature from medical, psychological and neuroscientific perspectives. Conclusions Gut feelings in general practice are based on the interaction between patient information and a GP’s knowledge and experience. This is visualized in a knowledge-based model of GPs’ diagnostic reasoning emphasizing that this complex task combines analytical and non-analytical cognitive processes. The model integrates the two well-known diagnostic reasoning tracks of medical decision-making and medical problem-solving, and adds gut feelings as a third track. Analytical and non-analytical diagnostic reasoning interacts continuously, and GPs use elements of all three tracks, depending on the task and the situation. In this dual process theory, gut feelings emerge as a consequence of non-analytical processing of the available information and knowledge, either reassuring GPs or alerting them that something is wrong and action is required. The role of affect as a heuristic within the physician’s knowledge network explains how gut feelings may help GPs to navigate in a mostly efficient way in the often complex and uncertain diagnostic situations of general practice. Emotion research and neuroscientific data support the unmistakable role of affect in the process of making decisions and explain the bodily sensation of gut feelings.The implications for health care practice and medical education are discussed. PMID:20967509

Cardiovascular Risk Factor Burden in Africa and the Middle East: The Africa Middle East Cardiovascular Epidemiological (ACE) Study

PubMed Central

Alsheikh-Ali, Alawi A.; Omar, Mohamed I.; Raal, Frederick J.; Rashed, Wafa; Hamoui, Omar; Kane, Abdoul; Alami, Mohamed; Abreu, Paula; Mashhoud, Walid M.

2014-01-01

Background Increased urbanization in the developing world parallels a rising burden of chronic diseases. Developing countries account for ∼80% of global cardiovascular (CV) deaths, but contribute a paucity of systematic epidemiological data on CV risk factors. Objective To estimate the prevalence of CV risk factors in rural and urban cohorts attending general practice clinics in the Africa and Middle East (AfME) region. Methods In a cross-sectional epidemiological study, the presence of CV risk factors (hypertension, diabetes mellitus (diabetes), dyslipidemia, obesity, smoking and abdominal obesity) were evaluated in stable adult outpatients attending general practice primary care clinics. A rural population was defined as isolated (>50 km or lack of easy access to commuter transportation) from urban centers. Results 4,378 outpatients were systematically recruited from 94 clinics across 14 AfME countries. Mean age was 46±14 years and 52% of outpatients were female. A high prevalence of dyslipidemia (70%) and abdominal obesity (68%) were observed, followed by hypertension (43%) and diabetes (25%). The vast majority of outpatients (92%) had at least one modifiable CV risk factor, many (74%) had more than one, and half (53%) had 3 or more. These findings were observed in both genders and across urban and rural centers. Among outpatients with pre-existing hypertension or dyslipidemia, many were not at their target blood pressure or LDL-cholesterol goals. Conclusion Cardiovascular risk factors are highly prevalent among relatively young, stable outpatients attending general practice clinics across AfME. The findings support opportunistic screening for CV risk factors whenever outpatients visit a general practitioner and provide an opportunity for early identification and management of CV risk factors, including lifestyle interventions. PMID:25090638

A cluster randomised pragmatic trial applying Self-determination theory to type 2 diabetes care in general practice

PubMed Central

2011-01-01

Background Treatment recommendations for prevention of type 2 diabetes complications often require radical and life-long health behaviour changes. Observational studies based on Self-determination theory (SDT) propose substantial factors for the maintenance of behaviour changes and concomitant well-being, but experimental research is needed to develop and evaluate SDT-based interventions. The aims of this paper were to describe 1) the design of a trial assessing the effectiveness of a training course for practice-nurses in autonomy support on patient-perceived motivation, HbA1, cholesterol, and well-being among a diabetes population, 2) the actual intervention to a level of detail that allows its replication, and 3) the connection between SDT recommendations for health care-provider behaviour and the content of the training course. Methods/Design The study is a cluster-randomised pragmatic trial including 40 Danish general practices with nurse-led diabetes consultations, and the associated diabetes population. The diabetes population was identified by registers (n = 4034). The intervention was a 16-hour course with interactive training for practice nurses. The course was delivered over 4 afternoons at Aarhus University and one 1/2 hour visit to the practice by one of the course-teachers over a period of 10 months (0, 2, 5, 10 mths.). The intervention is depicted by a PaT Plot showing the timeline and the characteristics of the intervention components. Effectiveness of the intervention will be assessed on the diabetes populations with regard to well-being (PAID, SF-12), HbA1c- and cholesterol-levels, perceived autonomy support (HCCQ), type of motivation (TSRQ), and perceived competence for diabetes care (PCD) 15-21 months after the core course; the completion of the second course afternoon. Data will be retrieved from registers and by questionnaires. Discussion Challenges and advantages of the pragmatic design are discussed. In a real-world setting, this study will determine the impact on motivation, HbA1c, cholesterol, and well-being for people with diabetes by offering a training course in autonomy support to practice-nurses from general practices with nurse-led consultations. Trial registration ClinicalTrials.gov: NCT01187069 PMID:22111524

The scope and practice of behaviour change communication to improve infant and young child feeding in low- and middle-income countries: results of a practitioner study in international development organizations.

PubMed

Pelto, Gretel H; Martin, Stephanie L; Van Liere, Marti; Fabrizio, Cecilia S

2016-04-01

We describe features of the landscape of behaviour change communication (BCC) practice devoted to infant and young child feeding (IYCF) in low- and middle-income countries by practitioners in international development organizations. We used an iterative, snowball sampling procedure to identify participants, and the self-administered questionnaire contained pre-coded questions and open-ended questions, relying primarily on content analysis to derive generalizations. Highlights of findings include (i) IYCF-specific BCC is usually delivered within the context of other public health messages and programmes; (ii) technical assistance with programme development and implementation are primary activities, and evaluation-related work is also common; and (iii) formative research and evaluation is universal, but process evaluation is not. With respect to scaling up nutrition: (i) use of mass media and digital technology generally play only a minor role in BCC activities and are not currently an integral part of BCC programming strategies and (ii) only 58% of the participants report activities related to communication with policy makers. The individuals who comprise the community of BCC leaders in the area of IYCF are a diverse group from the perspective of academic backgrounds and nationalities. In addition to nutrition, public health, agriculture and adult learning are common disciplinary backgrounds. In our view, this diversity is a source of strength. It facilitates continuing growth and maturation in the field by assuring inputs of different perspectives, theoretical orientations and experiences. © 2015 John Wiley & Sons Ltd.

Toxoplasmosis-Related Knowledge and Practices Among Pregnant Women in the United States

PubMed Central

Ogunmodede, Folashade; Scheftel, Joni; Kirkland, Elizabeth; Lopez, Adriana; Schulkin, Jay; Lynfield, Ruth

2003-01-01

Background: Infection with Toxoplasma gondii during pregnancy can lead to severe illness in the fetus. Many T. gondii infections are preventable by simple hygienic measures. Methods: We surveyed pregnant women in the US to determine their knowledge about toxoplasmosis and their practices to prevent infection. Volunteer obstetricians selected to be demographically representative of the American College of Obstetricians and Gynecologists recruited the participants. Results: Of 403 women responding to the survey, 48% indicated that they had heard or seen information about toxoplasmosis; however, only 7% were aware of being tested for the disease. Forty percent of responding women knew that toxoplasmosis is caused by an infection, but 21% thought that a poison causes it. The highest level of knowledge was about cats and T. gondii ; 61% responded that the organism is shed in the feces of infected cats and 60% responded that people could acquire toxoplasmosis by changing cat litter. There was a low level of knowledge about other risk factors; only 30% of the women were aware that T. gondii may be found in raw or undercooked meat. Nevertheless, a high percentage of women indicated that they do not eat undercooked meat during pregnancy and that they practice good hygienic measures such as washing their hands after handling raw meat, gardening or changing cat litter. Conclusion: Except for the risk of transmission from cats, knowledge among pregnant women about toxoplasmosis is low. However, toxoplasmosis-preventive practices are generally good, suggesting that providers should continue to offer education about practices that help prevent foodborne diseases in general as well as information about preventing toxoplasmosis specifically. PMID:15022874

Application of the Human Activity Assistive Technology model for occupational therapy research.

PubMed

Giesbrecht, Ed

2013-08-01

Theoretical models provide a framework for describing practice and integrating evidence into systematic research. There are few models that relate specifically to the provision of assistive technology in occupational therapy practice. The Human Activity Assistive Technology model is an enduring example that has continued to develop by integrating a social model of disability, concepts from occupational therapy theory and principles of assistive technology adoption and abandonment. This study first describes the core concepts of the Human Activity Assistive Technology model and reviews its development over three successive published versions. A review of the research literature reflects application of the model to clinical practice, study design, outcome measure selection and interpretation of results, particularly among occupational therapists. An evaluative framework is used to critique the adequacy of the Human Activity Assistive Technology model for practice and research, exploring attributes of clarity, simplicity, generality, accessibility and importance. Finally, recommendations are proposed for continued development of the model and research applications. Most of the existing research literature employs the Human Activity Assistive Technology model for background and study design; there is emerging evidence to support the core concepts as predictive factors. Although the concepts are generally simple, clear and applicable to occupational therapy practice and research, evolving terminology and outcomes become more complex with the conflation of integrated theories. The development of the Human Activity Assistive Technology model offers enhanced access and application for occupational therapists, but poses challenges to clarity among concepts. Suggestions are made for further development and applications of the model. © 2013 Occupational Therapy Australia.

A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

PubMed Central

Woodman, Jenny; Allister, Janice; Rafi, Imran; de Lusignan, Simon; Belsey, Jonathan; Petersen, Irene; Gilbert, Ruth

2012-01-01

Background Information is lacking on how concerns about child maltreatment are recorded in primary care records. Aim To determine how the recording of child maltreatment concerns can be improved. Design and setting Development of a quality improvement intervention involving: clinical audit, a descriptive survey, telephone interviews, a workshop, database analyses, and consensus development in UK general practice. Method Descriptive analyses and incidence estimates were carried out based on 11 study practices and 442 practices in The Health Improvement Network (THIN). Telephone interviews, a workshop, and a consensus development meeting were conducted with lead GPs from 11 study practices. Results The rate of children with at least one maltreatment-related code was 8.4/1000 child years (11 study practices, 2009–2010), and 8.0/1000 child years (THIN, 2009–2010). Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, but all had relevant free text, scanned documents, or codes. When stating their reasons for undercoding maltreatment concerns, GPs cited damage to the patient relationship, uncertainty about which codes to use, and having concerns about recording information on other family members in the child’s records. Consensus recommendations are to record the code ‘child is cause for concern’ as a red flag whenever maltreatment is considered, and to use a list of codes arranged around four clinical concepts, with an option for a templated short data entry form. Conclusion GPs under-record maltreatment-related concerns in children’s electronic medical records. As failure to use codes makes it impossible to search or audit these cases, an approach designed to be simple and feasible to implement in UK general practice was recommended. PMID:22781996

Reforming primary health care: is New Zealand's primary health care strategy achieving its early goals?

PubMed Central

Cumming, Jacqueline; Mays, Nicholas; Gribben, Barry

2008-01-01

Background In 2001, the New Zealand government introduced its Primary Health Care Strategy (PHCS), aimed at strengthening the role of primary health care, in order to improve health and to reduce inequalities in health. As part of the Strategy, new funding was provided to reduce the fees that patients pay when they use primary health care services in New Zealand, to improve access to services and to increase service use. In this article, we estimate the impact of the new funding on general practitioner and practice nurse visit fees paid by patients and on consultation rates. The analyses involved before-and-after monitoring of fees and consultation rates in a random sample of 99 general practices and covered the period from June 2001 (pre-Strategy) to mid-2005. Results Fees fell particularly in Access (higher need, higher per capita funded) practices over time for doctor and nurse visits. Fees increased over time for many in Interim (lower need, lower per capita funded) practices, but they fell for patients aged 65 years and over as new funding was provided for this age group. There were increases in consultation rates across almost all age, funding model (Access or Interim), socio-demographic and ethnic groups. Increases were particularly high in Access practices. Conclusion The Strategy has resulted in lower fees for primary health care for many New Zealanders, and consultation rates have also increased over the past few years. However, fees have not fallen by as much as expected in government policy given the amount of extra public money spent since there are limited requirements for practices to reduce patients' fees in line with increases in public funding for primary care. PMID:18990236

Evaluation of Advanced Access in the National Primary Care Collaborative

PubMed Central

Pickin, Mark; O'Cathain, Alicia; Sampson, Fiona C; Dixon, Simon

2004-01-01

Background: An aim of the National Primary Care Collaborative is to improve quality and access for patients in primary care using principles of Advanced Access. Aims: To determine whether Advanced Access led to improved availability of appointments with general practitioners (GPs) and to examine GPs' views of the process. Design: Observational study. Setting: Four hundred and sixty-two general practices in England participating in four waves of the collaborative during 2000 and 2001. Method: Regression analysis of the collaborative's monthly data on the availability of GP appointments for the 352 practices in waves 1–3, and a postal survey of lead GPs in all four waves. The main outcome measures were the change in mean time to the third available appointment with GPs, and the proportion of GPs thinking it worthwhile participating in the collaborative. Results: The time to the third available appointment improved from a mean of 3.6 to 1.9 days, difference = 1.7 days, 95% confidence interval (CI) = 1.4 to 2.0 days. It improved in two-thirds of practices (66% [219/331]), remained the same in 16% (53/331), and worsened in 18% (59/331). The majority of GPs in all four waves, 83% (308/371, 95% CI = 79 to 87), felt that it was worthwhile participating in the collaborative, although one in 12 practices would not recommend it. One-fifth of GPs cited a lack of resources as a constraint, and some expressed concerns about the trade-off between immediate access and continuity of care. Conclusion: Advanced Access helped practices to improve availability of GP appointments, and was well received by the majority of practices. PMID:15113514

Dental care resistance prevention and antibiotic prescribing modification—the cluster-randomised controlled DREAM trial

PubMed Central

2014-01-01

Background Bacterial resistance development is one of the most urgent problems in healthcare worldwide. In Europe, dentistry accounts for a comparatively high amount of antibiotic prescriptions. In light of increasing levels of bacterial resistance, this development is alarming. So far, very few interventional studies have been performed, and further research is urgently needed. By means of a complex educational intervention, the DREAM trial aims at optimising antibiotic prescribing behaviour of general dentists in Germany. Method This is a cluster-randomised controlled trial, where each cluster consists of one dental practice and all of its patients in a defined period. Participants are general dentists practicing in the German region of Mecklenburg-Western Pomerania. Randomisation takes place after baseline data collection (6 months) and will be stratified by the antibiotic prescribing rates of the participating dental practices. Dentists randomised into the intervention group will participate in a complex small group educational seminar that aims at: increasing knowledge on bacterial resistance, pharmacology, and prophylaxis of infectious endocarditis; increasing awareness of dentist-patient communication using video-taped vignettes of dentist-patient communication on antibiotic treatment; improving collaboration between general dentists, general practitioners, and practice-based cardiologists on the necessity of antibiotic prophylaxis; enhancing awareness of the dentists’ own prescribing habits by providing antibiotic prescribing feedback; and increasing patient knowledge on antibiotic treatment by providing patient-centred information material on antibiotic prophylaxis of endocarditis. The dentists randomised into the control group will not receive any educational programme and provide care as usual. Primary outcome is the overall antibiotic prescribing rate measured at T1 (period of six months after intervention). In a subgroup of adult patients affected by odontogenic infections, microbiological analyses for antibiotic resistance of oral streptococci are performed. Discussion Major aim of the study is to improve the process of decision making with regard to antibiotic prescribing. The approach is simple to implement and might be used rapidly in graduate and post-graduate medical education. We expect the results of this trial to have a major impact on antibiotic prescription strategies and practices in Germany. Trial registration Current Controlled Trials ISRCTN09576376 PMID:24559212

Costs and difficulties of recruiting patients to provide e-health support: pilot study in one primary care trust

PubMed Central

2012-01-01

Background Better use of e-health services by patients could improve outcomes and reduce costs but there are concerns about inequalities of access. Previous research in outpatients suggested that anonymous personal email support may help patients with long term conditions to use e-health, but recruiting earlier in their 'journey' may benefit patients more. This pilot study explored the feasibility and cost of recruiting patients for an e-health intervention in one primary care trust. Methods The sample comprised 46 practices with total patient population of 250,000. We approached all practices using various methods, seeking collaboration to recruit patients via methods agreed with each practice. A detailed research diary was kept of time spent recruiting practices and patients. Researcher time was used to estimate costs. Patients who consented to participate were offered email support for their use of the Internet for health. Results Eighteen practices agreed to take part; we recruited 27 patients, most (23/27) from five practices. Practices agreed to recruit patients for an e-health intervention via waiting room leaflets (16), posters (16), practice nurses (15), doctors giving patients leaflets (5), a study website link (7), inclusion in planned mailshots (2), and a special mailshot to patients selected from practice computers (1). After low recruitment response we also recruited directly in five practices through research assistants giving leaflets to patients in waiting rooms. Ten practices recruited no patients. Those practices that were more difficult to recruit were less likely to recruit patients. Leaving leaflets for practice staff to distribute and placing posters in the practice were not effective in recruiting patients. Leaflets handed out by practice nurses and website links were more successful. The practice with lowest costs per patient recruited (£70) used a special mailshot to selected patients. Conclusion Recruitment via general practice was not successful and was therefore expensive. Direct to consumer methods and recruitment of patients in outpatients to offer email support may be more cost effective. If recruitment in general practice is required, contacting practices by letter and email, not following up non-responding practices, and recruiting patients with selected conditions by special mailshot may be the most cost-effective approach. PMID:22458706

Training transfer: scientific background and insights for practical application.

PubMed

Issurin, Vladimir B

2013-08-01

Training transfer as an enduring, multilateral, and practically important problem encompasses a large body of research findings and experience, which characterize the process by which improving performance in certain exercises/tasks can affect the performance in alternative exercises or motor tasks. This problem is of paramount importance for the theory of training and for all aspects of its application in practice. Ultimately, training transfer determines how useful or useless each given exercise is for the targeted athletic performance. The methodological background of training transfer encompasses basic concepts related to transfer modality, i.e., positive, neutral, and negative; the generalization of training responses and their persistence over time; factors affecting training transfer such as personality, motivation, social environment, etc. Training transfer in sport is clearly differentiated with regard to the enhancement of motor skills and the development of motor abilities. The studies of bilateral skill transfer have shown cross-transfer effects following one-limb training associated with neural adaptations at cortical, subcortical, spinal, and segmental levels. Implementation of advanced sport technologies such as motor imagery, biofeedback, and exercising in artificial environments can facilitate and reinforce training transfer from appropriate motor tasks to targeted athletic performance. Training transfer of motor abilities has been studied with regard to contralateral effects following one limb training, cross-transfer induced by arm or leg training, the impact of strength/power training on the preparedness of endurance athletes, and the impact of endurance workloads on strength/power performance. The extensive research findings characterizing the interactions of these workloads have shown positive transfer, or its absence, depending on whether the combinations conform to sport-specific demands and physiological adaptations. Finally, cross-training as a form of concurrent exercising in different athletic disciplines has been examined in reference to the enhancement of general fitness, the preparation of recreational athletes, and the preparation of athletes for multi-sport activities such as triathlon, duathlon, etc.

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

PubMed Central

Poulton, B C

1996-01-01

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied. PMID:8745848

Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice.

PubMed

Eliassen, Knut Eirik; Hjetland, Reidar; Reiso, Harald; Lindbæk, Morten; Tschudi-Madsen, Hedda

2017-03-01

Promptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment. Prospective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts. Norwegian general practice. A total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study. Individual symptoms, symptom load and general function. Mild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM. The symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function. Monitoring patients' symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB. Key points Erythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment. This increase does not affect general function. The levels of subjective health complaints in patients treated for erythema migrans are comparable to the background population.

Career influences among final year dental students who plan to enter private practice

PubMed Central

2014-01-01

Background Existing research about the influence of educational debt on students’ decision to enter general practice immediately after graduation is conflicting. Other potential factors that could affect this decision include the influence of a spouse or other family member, the importance of a mentoring dentist, and how students perceive the burden of their debt. The goal of this study was to examine the importance of debt on career decision-making while also considering the role of other influences. Methods Responses to a self-completed questionnaire of all final (fourth) year students at the University of Iowa College of Dentistry from 2007 through 2010 were analyzed to identify the importance of educational debt and the influence of spouses, other family members, and mentoring dentists in the decision to enter private general practice immediately after graduation. Statistical analysis included bivariate tests (t-tests and Chi-square tests) and multivariable logistic regression. Results 58.9% of respondents (N = 156) planned to immediately enter private practice after dental school. Bivariate analyses revealed women to be more likely to enter private practice than their male counterparts (69.0% vs. 51.8%, p = .006). Students planning to enter practice immediately did not differ significantly from those with other career plans on the basis of marital status or having a family member in dentistry. Anticipated educational debt of at least $100,000 was positively associated with plans to enter private practice immediately after graduation. Self-reported importance of educational debt was not associated with career plans. However, the influence of a spouse, other family members, and family dentists were also positively associated with the decision to enter private practice. These factors all maintained significance in the final multivariable model (p < 0.05); however, educational debt of at least $100,000 was the strongest predictor of plans to enter private practice (OR = 2.34; p = 0.023). Conclusions Since the 1970s, increasing numbers of dentists in the U.S. have pursued specialty training after dental school. However, rising educational debts may counter this trend as increasing numbers of dentists choose to immediately pursue general dentistry at graduation. This project has demonstrated the significant influence of educational debt, beyond other external influences. PMID:24606674

Evaluating an audit and feedback intervention for reducing antibiotic prescribing behaviour in general dental practice (the RAPiD trial): a partial factorial cluster randomised trial protocol

PubMed Central

2014-01-01

Background Antibiotic prescribing in dentistry accounts for 9% of total antibiotic prescriptions in Scottish primary care. The Scottish Dental Clinical Effectiveness Programme (SDCEP) published guidance in April 2008 (2nd edition, August 2011) for Drug Prescribing in Dentistry, which aims to assist dentists to make evidence-based antibiotic prescribing decisions. However, wide variation in prescribing persists and the overall use of antibiotics is increasing. Methods RAPiD is a 12-month partial factorial cluster randomised trial conducted in NHS General Dental Practices across Scotland. Its aim is to compare the effectiveness of individualised audit and feedback (A&F) strategies for the translation into practice of SDCEP recommendations on antibiotic prescribing. The trial uses routinely collected electronic healthcare data in five aspects of its design in order to: identify the study population; apply eligibility criteria; carry out stratified randomisation; generate the trial intervention; analyse trial outcomes. Eligibility was determined on contract status and a minimum level of recent NHS treatment provision. All eligible dental practices in Scotland were simultaneously randomised at baseline either to current audit practice or to an intervention group. Randomisation was stratified by single-handed/multi-handed practices. General dental practitioners (GDPs) working at intervention practices will receive individualised graphical representations of their antibiotic prescribing rate from the previous 14 months at baseline and an update at six months. GDPs could not be blinded to their practice allocation. Intervention practices were further randomised using a factorial design to receive feedback with or without: a health board comparator; a supplementary text-based intervention; additional feedback at nine months. The primary outcome is the total antibiotic prescribing rate per 100 courses of treatment over the year following delivery of the baseline intervention. A concurrent qualitative process evaluation will apply theory-based approaches using the Consolidated Framework for Implementation Research to explore the acceptability of the interventions and the Theoretical Domains Framework to identify barriers and enablers to evidence-based antibiotic prescribing behaviour by GDPs. Discussion RAPiD will provide a robust evaluation of A&F in dentistry in Scotland. It also demonstrates that linked administrative datasets have the potential to be used efficiently and effectively across all stages of an randomised controlled trial. Trial registration Current Controlled Trials ISRCTN49204710 PMID:24758164

Figures in clinical trial reports: current practice & scope for improvement

PubMed Central

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-01-01

Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used. PMID:18021449

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012

PubMed Central

Van Tuong, Phan; Phuong, Tran Thi Minh; Anh, Bui Thi My; Nguyen, Trang Huyen Thi

2017-01-01

Background: Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the “Safe injection” program throughout the country, including Hanoi. Methods: This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results: The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who were younger age group (OR=3.1; p<0.05) and fewer number of years working as a nurse (OR=2.8; p<0.05). Conclusions: While nurses have high level of knowledge about safe injections but a small proportion actually practiced. Experience may not always guarantee safe practices.  Injection safety training should be regularly imparted upon all categories of nurses. PMID:29188014

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012.

PubMed

Van Tuong, Phan; Phuong, Tran Thi Minh; Anh, Bui Thi My; Nguyen, Trang Huyen Thi

2017-01-01

Background : Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the "Safe injection" program throughout the country, including Hanoi. Methods : This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results : The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who were younger age group (OR=3.1; p<0.05) and fewer number of years working as a nurse (OR=2.8; p<0.05). Conclusions : While nurses have high level of knowledge about safe injections but a small proportion actually practiced. Experience may not always guarantee safe practices.  Injection safety training should be regularly imparted upon all categories of nurses.

Judgements about fellow professionals and the management of patients receiving palliative care in primary care: a qualitative study

PubMed Central

Walshe, Catherine; Todd, Chris; Caress, Ann-Louise; Chew-Graham, Carolyn

2008-01-01

Background Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. Aim To explore the influences on referrals within general and specialist community palliative care services. Design of study Qualitative, multiple-case study. Setting Three primary care trusts in the north-west of England. Method Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. Results Judgements — positive and negative — about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional ‘game playing’ to achieve professionals' desired outcomes. Conclusion Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care. PMID:18494176

[Digital Information on Rehabilitation and Retirement for Physicians - A Practical Test].

PubMed

Deck, Ruth; Waschkau, Alexander; Götz, Katja; Schwill, Simon; Flum, Elisabeth; Steinhäuser, Jost

2018-06-14

About 1.6 million rehabilitation applications are submitted to the German pension insurance annually. Physicians working in ambulatory care play an important role in the application process. Studies show that there is too little knowledge about medical rehabilitation in these groups of physicians, the detection of rehabilitation needs and the process of application for rehabilitation. Against this background, a website Information for Doctors on Rehabilitation & Retirement was developed which addresses especially these needs. The aim of the study was to evaluate the website within a practical test. The practical test was performed with a mixed Methods Approach: 1) Quantitative survey with respect to increased knowledge after using the homepage, 2) assessment of cases with regard to rehabilitation indication and 3) evaluation of the user friendliness of the homepage by participating doctors by means of think-aloud technique. A total of 79 postgraduate General Practice trainees participated. They had high information needs regarding different aspects of rehabilitation, which were partly satisfied by the use of the homepage. The correct assessment of rehabilitation cases improved with the aid of the website for general practitioners with experience with application for rehabilitation only. The homepage was evaluated as clear and helpful, but the texts were judged as too extensive. The homepage can support physicians working in ambulatory care with respect to rehabilitation. Some impulses for optimization of the content have been identified and can help to further increase the usefulness of the website. © Georg Thieme Verlag KG Stuttgart · New York.

Prenatal screening for congenital anomalies: exploring midwives' perceptions of counseling clients with religious backgrounds.

PubMed

Gitsels-van der Wal, Janneke T; Manniën, Judith; Gitsels, Lisanne A; Reinders, Hans S; Verhoeven, Pieternel S; Ghaly, Mohammed M; Klomp, Trudy; Hutton, Eileen K

2014-07-19

In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives' perceptions and practices regarding taking client's religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives' knowledge of whether pregnancy termination is allowed in Islam. This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in The Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study. Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client's religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives' own religious backgrounds were independent of whether they paid attention to the clients' religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups. While many midwives took client's religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.

Reducing lighting energy use in retail display windows

NASA Astrophysics Data System (ADS)

Freyssinier, Jean Paul; Frering, Daniel; Taylor, Jennifer; Narendran, Nadarajah; Rizzo, Patricia

2006-08-01

A field study was conducted at three clothing stores to validate previous laboratory findings indicating that colored LEDs used as background display lighting could: 1) lower the power demand of accent lighting by up to 50 percent; and 2) provide greater attention capture and visual appeal than current lighting practice. Blue LEDs provided a colored background for window mannequins by illuminating white backdrops. Eliminating fluorescent general lighting and reducing the number and wattage of halogen accent lamps in the display windows reduced the lighting power demand by up to 50 percent. During an eight-week period, more than 700 shoppers rated the attractiveness, eye-catching ability, comfort, and visibility of four different lighting conditions. The results of this field study showed that by introducing color contrast between the displayed objects and the background, the power demand of the accent lighting could be reduced by up to 50 percent without sacrificing visual appeal, visibility, ability to capture the attention of shoppers, and the ability to see the colors of the objects on display. Furthermore, the sales of the products on display were not affected by the 50 percent reduction in lighting.

Crack Damage Detection Method via Multiple Visual Features and Efficient Multi-Task Learning Model.

PubMed

Wang, Baoxian; Zhao, Weigang; Gao, Po; Zhang, Yufeng; Wang, Zhe

2018-06-02

This paper proposes an effective and efficient model for concrete crack detection. The presented work consists of two modules: multi-view image feature extraction and multi-task crack region detection. Specifically, multiple visual features (such as texture, edge, etc.) of image regions are calculated, which can suppress various background noises (such as illumination, pockmark, stripe, blurring, etc.). With the computed multiple visual features, a novel crack region detector is advocated using a multi-task learning framework, which involves restraining the variability for different crack region features and emphasizing the separability between crack region features and complex background ones. Furthermore, the extreme learning machine is utilized to construct this multi-task learning model, thereby leading to high computing efficiency and good generalization. Experimental results of the practical concrete images demonstrate that the developed algorithm can achieve favorable crack detection performance compared with traditional crack detectors.

Contextualizing immigrants' lived experience: story of Taiwanese immigrants in the United States.

PubMed

Tsai, Jenny Hsin-Chun

2003-01-01

Immigration involves extensive changes in living environments. Nonetheless, the predominant approach in the health science literature has been to utilize individual characteristics (including ethnic background) to explain and predict immigrants' lived experiences and health outcomes. Contexts, particularly the larger societal contexts by which immigrants are constituted, are generally ignored. Data from a critical ethnography regarding immigrants' experiences with language, occupation, and economic survival in the United States are utilized to illustrate that immigrants' lives are inseparable from the larger societal contexts, such as immigration policy, Western imperialism, and structural discrimination. The implications for practice, education, and research are discussed.

Ki aikido: a solution to stress.

PubMed

Wiles, L

1990-03-10

It is common knowledge that the life of the general dental practitioner is extremely stressful. Different dentists resort to various ways of unwinding--perhaps a game of golf, a sailing trip, or mending the odd clock as occupational therapy. These are all ways of getting away from the stress of day-to-day work--but perhaps the time has come to look for a more fundamental solution. How many dentists have considered taking up a martial art to alleviate the problem of stress? Here, we outline the background of ki aikido and its practical applications in daily life.

Sick notes, general practitioners, emergency departments and fracture clinics

PubMed Central

Walker, C A; Gregori, A; O'Connor, P; Jaques, K; Joseph, R

2007-01-01

Background General practitioner waiting times are increasing. The two national surveys regarding general practice showed that the number of patients waiting for ⩾2 days for an appointment rose from 63% to 72% between 1998 and 2002, with 25% waiting for ⩾4 days. The Department of Health recognised that many patients discharged from hospitals and outpatient clinics required to visit their general practitioner for the sole purpose of obtaining a sick note. The report entitled Making a difference: reducing general practitioner paperwork estimated that 518 000 appointments (and 42 000 GP h) could be saved by ensuring that these patients were issued with a sick note directly from hospital rather than being referred to their general practitioner. This practice was to be adopted from July 2001 and included patients discharged from wards as well as those seen in outpatient departments. Method 50 emergency departments and fracture clinics in Scotland and England were contacted to assess whether these guidelines had been adopted. Only hospitals with both accident and emergency and fracture clinics were included; nurse‐led and paediatric departments were excluded. Results Of the 25 Scottish emergency hospitals contacted, 4 (16%) accident and emergency departments and 8 (32%) fracture clinics issued sick notes. This was compared with 5 of 25 (20%) accident and emergency departments and 12 of 25 (48%) fracture clinics in England. Four Scottish and five English accident and emergency departments stated that it was policy to give sick notes, three Scottish and four English departments said that it was policy not to give them and the rest (72% in Scotland and 64% in England) stated that they had no clear policy but “just don't give them”. Conclusion The 2001 guidance from the joint Cabinet Office/Department of Health has not been fully incorporated into standard practice in Scotland and England. If all emergency departments and fracture clinics were to issue sick notes to patients requiring >7 days absence from work, this could reduce general practitioner consultations and improve waiting times. PMID:17183039

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

16 CFR 1406.2 - Background.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Background. 1406.2 Section 1406.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS COAL AND WOOD BURNING... Consumer Product Safety Commission disclose a number of incidents involving coal and wood burning...

The application of foraging theory to the information searching behaviour of general practitioners.

PubMed

Dwairy, Mai; Dowell, Anthony C; Stahl, Jean-Claude

2011-08-23

General Practitioners (GPs) employ strategies to identify and retrieve medical evidence for clinical decision making which take workload and time constraints into account. Optimal Foraging Theory (OFT) initially developed to study animal foraging for food is used to explore the information searching behaviour of General Practitioners. This study is the first to apply foraging theory within this context.Study objectives were: 1. To identify the sequence and steps deployed in identifiying and retrieving evidence for clinical decision making. 2. To utilise Optimal Foraging Theory to assess the effectiveness and efficiency of General Practitioner information searching. GPs from the Wellington region of New Zealand were asked to document in a pre-formatted logbook the steps and outcomes of an information search linked to their clinical decision making, and fill in a questionnaire about their personal, practice and information-searching backgrounds. A total of 115/155 eligible GPs returned a background questionnaire, and 71 completed their information search logbook. GPs spent an average of 17.7 minutes addressing their search for clinical information. Their preferred information sources were discussions with colleagues (38% of sources) and books (22%). These were the two most profitable information foraging sources (15.9 min and 9.5 min search time per answer, compared to 34.3 minutes in databases). GPs nearly always accessed another source when unsuccessful (95% after 1st source), and frequently when successful (43% after 2nd source). Use of multiple sources accounted for 41% of searches, and increased search success from 70% to 89%. By consulting in foraging terms the most 'profitable' sources of information (colleagues, books), rapidly switching sources when unsuccessful, and frequently double checking, GPs achieve an efficient trade-off between maximizing search success and information reliability, and minimizing searching time. As predicted by foraging theory, GPs trade time-consuming evidence-based (electronic) information sources for sources with a higher information reward per unit time searched. Evidence-based practice must accommodate these 'real world' foraging pressures, and Internet resources should evolve to deliver information as effectively as traditional methods of information gathering.

Quality of tuberculosis care in India: a systematic review

PubMed Central

Satyanarayana, S.; Subbaraman, R.; Shete, P.; Gore, G.; Das, J.; Cattamanchi, A.; Mayer, K.; Menzies, D.; Harries, A. D.; Hopewell, P.; Pai, M.

2015-01-01

SUMMARY BACKGROUND While Indian studies have assessed care providers’ knowledge and practices, there is no systematic review on the quality of tuberculosis (TB) care. METHODS We searched multiple sources to identify studies (2000–2014) on providers’ knowledge and practices. We used the International Standards for TB Care to benchmark quality of care. RESULTS Of the 47 studies included, 35 were questionnaire surveys and 12 used chart abstraction. None assessed actual practice using standardised patients. Heterogeneity in the findings precluded meta-analysis. Of 22 studies evaluating provider knowledge about using sputum smears for diagnosis, 10 found that less than half of providers had correct knowledge; 3 of 4 studies assessing self-reported practices by providers found that less than a quarter reported ordering smears for patients with chest symptoms. In 11 of 14 studies that assessed treatment, less than one third of providers knew the standard regimen for drug-susceptible TB. Adherence to standards in practice was generally lower than correct knowledge of those standards. Eleven studies with both public and private providers found higher levels of appropriate knowledge/practice in the public sector. CONCLUSIONS Available evidence suggests suboptimal quality of TB care, particularly in the private sector. Improvement of quality of care should be a priority for India. PMID:26056098

Perceived future career prospects in general practice: quantitative results from questionnaire surveys of UK doctors

PubMed Central

Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

2016-01-01

Background There are more studies of current job satisfaction among GPs than of their views about their future career prospects, although both are relevant to commitment to careers in general practice. Aim To report on the views of GPs compared with clinicians in other specialties about their future career prospects. Design and setting Questionnaire surveys were sent to UK medical doctors who graduated in selected years between 1974 and 2008. Method Questionnaires were sent to the doctors at different times after graduation, ranging from 3 to 24 years. Results Based on the latest survey of each graduation year of the 20 940 responders, 66.2% of GPs and 74.2% of hospital doctors were positive about their prospects and 9.7% and 8.3%, respectively, were negative. However, with increasing time since graduation and increasing levels of seniority, GPs became less positive about their prospects; by contrast, over time, surgeons became more positive. Three to 5 years after graduation, 86.3% of those training in general practice were positive about their prospects compared with 52.9% of surgical trainees: in surveys conducted 12–24 years after graduation, 60.2% of GPs and 76.6% of surgeons were positive about their prospects. Conclusion GPs held broadly positive views of their career prospects, as did other doctors. However, there was an increase in negativity with increasing time since graduation that was not seen in hospital doctors. Research into the causes of this negativity and policy measures to ameliorate it would contribute to the continued commitment of GPs and may help to reduce attrition. PMID:27578813

Primary care contact prior to suicide in individuals with mental illness

PubMed Central

Pearson, Anna; Saini, Pooja; Da Cruz, Damian; Miles, Caroline; While, David; Swinson, Nicola; Williams, Alyson; Shaw, Jenny; Appleby, Louis; Kapur, Navneet

2009-01-01

Background Previous studies have reported differing rates of consultation with GPs prior to suicide. Patients with a psychiatric history have higher rates of consultation and consult closer to the time of their death. Aim To investigate the frequency and nature of general practice consultations in the year before suicide for patients in current, or recent, contact with secondary mental health services. Design of study Retrospective case-note study and semi-structured interviews. Setting General practices in the northwest of England. Method General practice data were obtained by a retrospective review of medical records (n = 247) and semi-structured interviews with GPs (n = 159). Results GP records were reviewed in 247 of the 286 cases (86%). Overall, 91% of individuals (n = 224) consulted their GP on at least one occasion in the year before death. The median number of consultations was 7 (interquartile range = 3–10). Interviews were carried out with GPs with regard to 159 patients. GPs reported concerns about their patient's safety in 43 (27%) cases, but only 16% of them thought that the suicide could have been prevented. Agreement between GPs and mental health teams regarding risk of suicide was poor. Both sets of clinicians rated moderate to high levels of risk in only 3% of cases for whom information was available (n = 139) (overall κ = 0.024). Conclusion Consultation prior to suicide is common but suicide prevention in primary care is challenging. Possible strategies might include examining the potential benefits of risk assessment and collaborative working between primary and secondary care. PMID:19861027

How does comorbidity affect cost of health care in patients with irritable bowel syndrome? A cohort study in general practice

PubMed Central

2010-01-01

Background Irritable bowel syndrome (IBS) is associated with other disorders (comorbidity), reduced quality of life and increased use of health resources. We aimed to explore the impact of comorbidity on cost of health care in patients with IBS in general practice. Methods In this cohort study 208 consecutive patients with IBS (Rome II) were recruited. Sociodemographic data, IBS symptoms, and comorbidity (somatic symptoms, organic diseases and psychiatric disorders) were assessed at baseline. Based on a follow up interview after 6-9 months and use of medical records, IBS and non-IBS related health resource use were measured as consultations, hospitalisations, use of medications and alternative health care products and sick leave days. Costs were calculated by national tariffs and reported in Norwegian Kroner (NOK, 1 EURO equals 8 NOK). Multivariate analyses were performed to identify predictors of costs. Results A total of 164 patients (mean age 52 years, 69% female, median duration of IBS 17 years) were available at follow up, 143 patients (88%) had consulted their GP of whom 31 (19%) had consulted for IBS. Mean number of sick- leave days for IBS and comorbidity were 1.7 and 16.3 respectively (p < 0.01), costs related to IBS and comorbidity were 954 NOK and 14854 NOK respectively (p < 0.001). Age, organic diseases and somatic symptoms, but not IBS severity, were significant predictors for total costs. Conclusion Costs for health resource use among patients with IBS in general practice were largely explained by comorbidity, which generated ten times the costs for IBS. PMID:20233451

Knowledge transfer for the management of dementia: a cluster-randomised trial of blended learning in general practice

PubMed Central

2010-01-01

Background The implementation of new medical knowledge into general practice is a complex process. Blended learning may offer an effective and efficient educational intervention to reduce the knowledge-to-practice gap. The aim of this study was to compare knowledge acquisition about dementia management between a blended learning approach using online modules in addition to quality circles (QCs) and QCs alone. Methods In this cluster-randomised trial with QCs as clusters and general practitioners (GPs) as participants, 389 GPs from 26 QCs in the western part of Germany were invited to participate. Data on the GPs' knowledge were obtained at three points in time by means of a questionnaire survey. Primary outcome was the knowledge gain before and after the interventions. A subgroup analysis of the users of the online modules was performed. Results 166 GPs were available for analysis and filled out a knowledge test at least two times. A significant increase of knowledge was found in both groups that indicated positive learning effects of both approaches. However, there was no significant difference between the groups. A subgroup analysis of the GPs who self-reported that they had actually used the online modules showed that they had a significant increase in their knowledge scores. Conclusion A blended learning approach was not superior to a QCs approach for improving knowledge about dementia management. However, a subgroup of GPs who were motivated to actually use the online modules had a gain in knowledge. Trial registration Current Controlled Trials ISRCTN36550981. PMID:20047652

Identification of an updated set of prescribing-safety indicators for GPs

PubMed Central

Spencer, Rachel; Bell, Brian; Avery, Anthony J; Gookey, Gill; Campbell, Stephen M

2014-01-01

Background Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. Aim To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. Design and setting RAND/UCLA consensus development of indicators in UK general practice. Method Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. Results Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7–9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug–drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. Conclusion This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety. PMID:24686882

Noise characteristics of CT perfusion imaging: how does noise propagate from source images to final perfusion maps?

NASA Astrophysics Data System (ADS)

Li, Ke; Chen, Guang-Hong

2016-03-01

Cerebral CT perfusion (CTP) imaging is playing an important role in the diagnosis and treatment of acute ischemic strokes. Meanwhile, the reliability of CTP-based ischemic lesion detection has been challenged due to the noisy appearance and low signal-to-noise ratio of CTP maps. To reduce noise and improve image quality, a rigorous study on the noise transfer properties of CTP systems is highly desirable to provide the needed scientific guidance. This paper concerns how noise in the CTP source images propagates to the final CTP maps. Both theoretical deviations and subsequent validation experiments demonstrated that, the noise level of background frames plays a dominant role in the noise of the cerebral blood volume (CBV) maps. This is in direct contradiction with the general belief that noise of non-background image frames is of greater importance in CTP imaging. The study found that when radiation doses delivered to the background frames and to all non-background frames are equal, lowest noise variance is achieved in the final CBV maps. This novel equality condition provides a practical means to optimize radiation dose delivery in CTP data acquisition: radiation exposures should be modulated between background frames and non-background frames so that the above equality condition is satisïnAed. For several typical CTP acquisition protocols, numerical simulations and in vivo canine experiment demonstrated that noise of CBV can be effectively reduced using the proposed exposure modulation method.

Optical Design Considerations for Efficient Light Collection from Liquid Scintillation Counters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bernacki, Bruce E.; Douglas, Matthew; Erchinger, Jennifer L.

2015-01-01

Liquid scintillation counters measure charged particle-emitting radioactive isotopes and are used for environmental studies, nuclear chemistry, and life science. Alpha and beta emissions arising from the material under study interact with the scintillation cocktail to produce light. The prototypical liquid scintillation counter employs low-level photon-counting detectors to measure the arrival of the scintillation light produced as a result of the dissolved material under study interacting with the scintillation cocktail. For reliable operation the counting instrument must convey the scintillation light to the detectors efficiently and predictably. Current best practices employ the use of two or more detectors for coincidence processingmore » to discriminate true scintillation events from background events due to instrumental effects such as photomultiplier tube dark rates, tube flashing, or other light emission not generated in the scintillation cocktail vial. In low background liquid scintillation counters additional attention is paid to shielding the scintillation cocktail from naturally occurring radioactive material (NORM) present in the laboratory and within the instruments construction materials. Low background design is generally at odds with optimal light collection. This study presents the evolution of a light collection design for liquid scintillation counting in a low background shield. The basic approach to achieve both good light collection and a low background measurement is described. The baseline signals arising from the scintillation vial are modeled and methods to efficiently collect scintillation light are presented as part of the development of a customized low-background, high sensitivity liquid scintillation counting system.« less

Preventing disease through opportunistic, rapid engagement by primary care teams using behaviour change counselling (PRE-EMPT): protocol for a general practice-based cluster randomised trial

PubMed Central

2010-01-01

Background Smoking, excessive alcohol consumption, lack of exercise and an unhealthy diet are the key modifiable factors contributing to premature morbidity and mortality in the developed world. Brief interventions in health care consultations can be effective in changing single health behaviours. General Practice holds considerable potential for primary prevention through modifying patients' multiple risk behaviours, but feasible, acceptable and effective interventions are poorly developed, and uptake by practitioners is low. Through a process of theoretical development, modeling and exploratory trials, we have developed an intervention called Behaviour Change Counselling (BCC) derived from Motivational Interviewing (MI). This paper describes the protocol for an evaluation of a training intervention (the Talking Lifestyles Programme) which will enable practitioners to routinely use BCC during consultations for the above four risk behaviours. Methods/Design This cluster randomised controlled efficacy trial (RCT) will evaluate the outcomes and costs of this training intervention for General Practitioners (GPs) and nurses. Training methods will include: a practice-based seminar, online self-directed learning, and reflecting on video recorded and simulated consultations. The intervention will be evaluated in 29 practices in Wales, UK; two clinicians will take part (one GP and one nurse) from each practice. In intervention practices both clinicians will receive training. The aim is to recruit 2000 patients into the study with an expected 30% drop out. The primary outcome will be the proportion of patients making changes in one or more of the four behaviours at three months. Results will be compared for patients seeing clinicians trained in BCC with patients seeing non-BCC trained clinicians. Economic and process evaluations will also be conducted. Discussion Opportunistic engagement by health professionals potentially represents a cost effective medical intervention. This study integrates an existing, innovative intervention method with an innovative training model to enable clinicians to routinely use BCC, providing them with new tools to encourage and support people to make healthier choices. This trial will evaluate effectiveness in primary care and determine costs of the intervention. Trial Registration ISRCTN22495456 PMID:20858273

GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network.

PubMed

Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian

2012-01-01

This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.

Health Beliefs and Practices Related to Dengue Fever: A Focus Group Study

PubMed Central

Wong, Li Ping; AbuBakar, Sazaly

2013-01-01

Background This qualitative study aimed to provide an in-depth understanding of the meaning of dengue fever (DF) amongst people living in a dengue endemic region, dengue prevention and treatment-seeking behaviours. The Health Belief Model was used as a framework to explore and understand dengue prevention behaviours. Methods A total of 14 focus group discussions were conducted with 84 Malaysian citizens of different socio-demographic backgrounds between 16th December, 2011 and 12th May, 2012. Results The study revealed that awareness about DF and prevention measures were high. The pathophysiology of dengue especially dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) were rarely known; as a result, it was seen as deadly by some but was also perceived as easily curable by others without a basis of understanding. Young adults and elderly participants had a low perception of susceptibility to DF. In general, the low perceived susceptibility emerged as two themes, namely a perceived natural ability to withstand infection and a low risk of being in contact with the dengue virus vector, Aedes spp. mosquitoes. The barriers to sustained self-prevention against dengue prevention that emerged in focus groups were: i) lack of self-efficacy, ii) lack of perceived benefit, iii) low perceived susceptibility, and iv) unsure perceived susceptibility. Low perceived benefit of continued dengue prevention practices was a result of lack of concerted action against dengue in their neighborhood. Traditional medical practices and home remedies were widely perceived and experienced as efficacious in treating DF. Conclusion Behavioural change towards attaining sustainability in dengue preventive practices may be enhanced by fostering comprehensive knowledge of dengue and a change in health beliefs. Wide use of unconventional therapy for DF warrants the need to enlighten the public to limit their reliance on unproven alternative treatments. PMID:23875045

[Establishment of the background color to make discrimination of domestic ethical tablets sharper and more feasible based on the analysis of their color distribution].

PubMed

Ishizaki, Makiko; Maeda, Hatsuo; Okamoto, Ikuko

2012-01-01

In Japan, pharmacists as well as patients often have problems distinguishing one ethical tablet from another because they can be very similar in color. In an attempt to solve this problem, we hypothesized using a background sheet of dark gray identified by N3.5 on the Munsell color system (Munsell CS). The colors of 369 and 656 ethical tablets in Japan and the USA, respectively, were measured. On the Munsell CS, the Japanese tablets were localized mostly in the range of hues between 10R∼10Y with values ≧ 8 and chroma ≦ 4, while the colors of the American tablets were scattered over the hue spectrum with a variety of values and chroma. Based on these findings, we examined the effects of background colors on discrimination between 5 tablets classified into yellow, yellow red, red, or mixed groups that represented typical domestic Japanese tablets. Background colors of light, medium, and dark gray, purple, blue, and blue green were selected based on a general concept on color discrimination. The influence of white 10 mm-ruled squares on background sheets was examined as well. Under JIS Z8723 conditions, 42 volunteers used a 4-point scale to evaluate how clearly they could discriminate between each set of tablets on each of the background sheets. Variance analysis of the obtained data with SPSS demonstrated that with healthy vision, use of a dark gray background sheet with or without ruled squares enabled the sharpest and most feasible discrimination between all sets of tablets. A similar test with dark gray and white clearly demonstrated that the former works as a practical background color for discrimination among different domestic Japanese tablets.

A survey on knowledge and self-reported formula handling practices of parents and child care workers in Palermo, Italy

PubMed Central

2009-01-01

Background Powdered infant formula (PIF) is not a sterile product, but this information appears to be poorly diffused among child caregivers. Parents and child care workers may behave in an unsafe manner when handling PIF. Methods This study involved parents and child care workers in the 24 municipal child care centres of Palermo. Knowledge and self-reported practices about PIF handling were investigated by a structured questionnaire. A Likert scale was used to measure the strength of the respondent's feelings. Association of knowledge and self-reported practices with demographic variables was also evaluated. Results 42.4% of parents and 71.0% of child care workers filled in the questionnaire. Significant differences were found between parents and child care workers for age and education. 73.2% of parents and 84.4% of child care workers were confident in sterility of PIF. Generally, adherence to safe procedures when reconstituting and handling PIF was more frequently reported by child care workers who, according to the existing legislation, are regularly subjected to a periodic training on food safety principles and practices. Age and education significantly influenced the answers to the questionnaire of both parents and child care workers. Conclusion The results of the study reveal that parents and child care workers are generally unaware that powdered formulas may contain viable microorganisms. However, child care workers consistently chose safer options than parents when answering the questions about adherence to hygienic practices. At present it seems unfeasible to produce sterile PIF, but the risk of growth of hazardous organisms in formula at the time of administration should be minimized by promoting safer behaviours among caregivers to infants in both institutional settings and home. PMID:20003304

Exercise-based treatments for substance use disorders: evidence, theory, and practicality

PubMed Central

Linke, Sarah E.; Ussher, Michael

2016-01-01

Background Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery. Objectives The aims of this paper were to: (i) summarize the research examining the effects of exercise-based treatments for SUDs; (ii) discuss the theoretical mechanisms and practical reasons for investigating this topic; (iii) identify the outstanding relevant research questions that warrant further inquiry; and (iv) describe potential implications for practice. Methods The following databases were searched for peer-reviewed original and review papers on the topic of substance use and exercise: PubMed Central, MEDLINE, EMBASE, PsycINFO, and CINAHL Plus. Reference lists of these publications were subsequently searched for any missed but relevant manuscripts. Identified papers were reviewed and summarized by both authors. Results The limited research conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical reasons supporting the investigation of this topic has been published. Conclusions Definitive conclusions are difficult to draw due to diverse study protocols and low adherence to exercise programs, among other problems. Despite the currently limited and inconsistent evidence, numerous theoretical and practical reasons support exercise-based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects. PMID:25397661

Counsellors in primary care in Southampton: a questionnaire survey of their qualifications, working arrangements, and casemix.

PubMed Central

Clark, A; Hook, J; Stein, K

1997-01-01

BACKGROUND: There has been an upsurge of interest in counselling in primary care over the past five years. This has been stimulated by a growing demand for non-drug treatment of emotional disorders and by the extension of reimbursement for the costs of counsellors. Continued calls for careful evaluation have been largely unheeded in the face of heady growth. AIM: To establish the prevalence of counselling services in the 67 general practices in the Southampton and South West Hampshire Health District, and to describe in detail their qualifications, working arrangements, and casemix. METHOD: A questionnaire enquiring about counselling services was sent to all the general practices in the district. A second questionnaire was then posted to all the counsellors identified as working in these practices. RESULTS: Twenty-six (39%) practices employed one or more counsellors. Fundholding practices were four times more likely than non-fundholders to employ a counsellor. Most of the counselling work was short term (4-20 sessions). The most common presenting complaints were relationship problems, depression, anxiety, and bereavement. CONCLUSION: This descriptive study highlights the wide variation in the qualifications and training of counsellors. Until the issue of effectiveness is resolved through further research, the best safeguard of quality is to ensure that counsellors meet the appropriate training standards laid down by the British Association of Counsellors. Monitoring standards is a legitimate task for those commissioning health care who are increasingly responsible for reimbursement of a counsellor's salary. Counsellors who meet appropriate training criteria should be encouraged to pursue accreditation with the British Association of Counsellors. Those who do not meet these criteria should be encouraged to undergo additional training. PMID:9474822

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

PubMed Central

Mitchell, Caroline; Dwyer, Rachel; Hagan, Teresa; Mathers, Nigel

2011-01-01

Background The National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and ‘stepped care’ for depression. Aim To explore primary care practitioner perspectives on the clinical utility of the NICE guideline and the impact of the QOF on diagnosis and management of depression in routine practice. Design and setting Qualitative study using focus groups from four multidisciplinary practice teams with diverse populations in south Yorkshire. Method Four focus groups were conducted, using a topic guide and audiotaping. There were 38 participants: GPs, nurses, doctors in training, mental health workers, and a manager. Data analysis was iterative and thematic. Results The NICE guideline, with its embedded principles of holism and evidence-based practice, was viewed positively but its impact was compromised by resource and practitioner barriers to implementation. The perceived imposition of the screening questions and severity assessments (PHQ-9) with no responsive training had required practitioners to work hard to minimise negative impacts on their work, for example: constantly adapting consultations to tick boxes; avoiding triggering open displays of distress without the time to offer appropriate care; positively managing how their patients were labelled. Further confusion was experienced around the evolving content of psychological interventions for depression. Conclusion Organisational barriers to the implementation of the NICE guideline and the limited scope of the QOF highlight the need for policy makers to work more effectively with the complex realities of general practice in order to systematically improve the quality and delivery of ‘managed’ care for depression. PMID:21619752

Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care

PubMed Central

2011-01-01

Background Primary care can play an important role in providing cardiovascular risk management in patients with established Cardiovascular Diseases (CVD), patients with a known high risk of developing CVD, and potentially for individuals with a low risk of developing CVD, but who have unhealthy lifestyles. To describe and compare cardiovascular risk management, internationally valid quality indicators and standardized measures are needed. As part of a large project in 9 European countries (EPA-Cardio), we have developed and tested a set of standardized measures, linked to previously developed quality indicators. Methods A structured stepwise procedure was followed to develop measures. First, the research team allocated 106 validated quality indicators to one of the three target populations (established CVD, at high risk, at low risk) and to different data-collection methods (data abstraction from the medical records, a patient survey, an interview with lead practice GP/a practice survey). Secondly, we selected a number of other validated measures to enrich the assessment. A pilot study was performed to test the feasibility. Finally, we revised the measures based on the findings. Results The EPA-Cardio measures consisted of abstraction forms from the medical-records data of established Coronary Heart Disease (CHD)-patients - and high-risk groups, a patient questionnaire for each of the 3 groups, an interview questionnaire for the lead GP and a questionnaire for practice teams. The measures were feasible and accepted by general practices from different countries. Conclusions An internationally standardized measure of cardiovascular risk management, linked to validated quality indicators and tested for feasibility in general practice, is now available. Careful development and pilot testing of the measures are crucial in international studies of quality of healthcare. PMID:21473758

Test of cure, retesting and extragenital testing practices for Chlamydia trachomatis and Neisseria gonorrhoeae among general practitioners in different socioeconomic status areas: A retrospective cohort study, 2011-2016

PubMed Central

van Liere, Geneviève A. F. S.; Cals, Jochen W. L.; Dukers-Muijrers, Nicole H. T. M.

2018-01-01

Background For Chlamydia trachomatis (CT), a test of cure (TOC) within 3–5 weeks is not recommended. International guidelines differ in advising a Neisseria gonorrhoeae (NG) TOC. Retesting CT and NG positives within 3–12 months is recommended in international guidelines. We assessed TOC and retesting practices including extragenital testing in general practitioner (GP) practices located in different socioeconomic status (SES) areas to inform and optimize local test practices. Methods Laboratory data of 48 Dutch GP practices between January 2011 and July 2016 were used. Based on a patient’s first positive CT or NG test, the proportion of TOC (<3 months) and retests (3–12 months) were calculated. Patient- and GP-related factors were assessed using multivariate logistic regression analyses. Results For CT (n = 622), 20% had a TOC and 24% had a retest at the GP practice. GP practices in low SES areas were more likely to perform a CT TOC (OR:1.8;95%CI:1.1–3.1). Younger patients (<25 years) were more likely to have a CT TOC (OR:1.6;95%CI:1.0–2.4). For CT (n = 622), 2.4% had a TOC and 6.1% had a retest at another STI care provider. For NG (n = 73), 25% had a TOC and 15% had a retest at the GP practice. For NG (n = 73), 2.7% had a TOC and 12.3% had a retest at another STI care provider. In only 0.3% of the consultations patients were tested on extragenital sites. Conclusion Almost 20% of the patients returned for a CT TOC, especially at GP practices in low SES areas. For NG, 1 out of 4 patients returned for a TOC. Retesting rates were low for both CT (24%) and NG (15%), (re)infections including extragenital infections may be missed. Efforts are required to focus TOC and increase retesting practices of GPs in order to improve CT/NG control. PMID:29538469

Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study.

PubMed

Spooner, Catherine; Jayasinghe, Upali W; Faruqi, Nighat; Stocks, Nigel; Harris, Mark F

2018-05-21

Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m 2 . The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to < 40; OR 4.47 (95% CI 1.03 to 19.40)) and obesity category 3 (BMI = ≥ 40; OR 27.06 (95% CI 4.85 to 150.95)), not being employed (OR 7.70 (95% CI 2.17 to 27.25)), non-English speaking backgrounds (OR 5.74 (95% CI 1.35 to 24.45)) and negatively associated with the HLQ domain: ability to actively engage with healthcare providers (OR 0.12 (95% CI 0.05 to 0.28)). There was no association between weight stigma and gender, age, education or the other HLQ domains examined. Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .

Global Diversity and Academic Success of Foreign-Trained Academic Neurosurgeons in the United States.

PubMed

Mistry, Akshitkumar M; Ganesh Kumar, Nishant; Reynolds, Rebecca A; Hale, Andrew T; Wellons, John C; Naftel, Robert P

2017-08-01

To quantify the proportion of academic neurosurgeons practicing in the United States who acquired residency training outside of the United States and compare their training backgrounds and academic success with those who received their residency training in the United States. We identified 1338 clinically active academic neurosurgeons from 104 programs that participated in the neurosurgery residency match in the United States in January-February 2015. Their training backgrounds, current academic positions, and history of National Institutes of Health (NIH) grant awards between 2005 and 2014 were retrieved from publicly accessible sources. Eighty-four U.S. academic neurosurgeons (6.3%) received their residency training in 20 different countries outside of the United States/Puerto Rico, representing all major regions of the world. The majority trained in Canada (n = 48). We found no major differences between the foreign-trained and U.S.-trained neurosurgeons in male:female ratio, year of starting residency, proportion with positions in medical schools ranked in the top 15 by the U.S. News and World Report, general distribution of academic positions, and proportion with an NIH grant. Compared with U.S.-trained academic neurosurgeons, foreign-trained academic neurosurgeons had a significantly higher proportion of Ph.D. degrees (32.1% vs. 12.3%; P < 0.0001) and held more associate professorships (34.5% vs. 23.1%; P = 0.02). The academic practices of the foreign-trained neurosurgeons were widely distributed throughout the United States. A small group of U.S. academic neurosurgeons (6.3%) have acquired residency training outside of the United States, representing all major regions of the world. Their general demographic data and academic accomplishments are comparable to those of U.S.-trained neurosurgeons. Copyright © 2017 Elsevier Inc. All rights reserved.

Communication pitfalls of traditional history and physical write-up documentation

PubMed Central

Brown, Jeffrey L

2017-01-01

Background An unofficial standardized “write-up” outline is commonly used for documenting history and physical examinations, giving oral presentations, and teaching clinical skills. Despite general acceptance, there is an apparent discrepancy between the way clinical encounters are conducted and how they are documented. Methods Fifteen medical school websites were randomly selected from search-engine generated lists. One example of a history and physical write-up from each of six sites, one teaching outline from each of nine additional sites, and recommendations for documentation made in two commonly used textbooks were compared for similarities and differences. Results Except for minor variations in documenting background information, all sampled materials utilized the same standardized format. When the examiners’ early perceptions of the patients’ degree of illness or level of distress were described, they were categorized as “general appearance” within the physical findings. Contrary to clinical practice, none of the examples or recommendations documented these early perceptions before chief concerns and history were presented. Discussion An examiner’s initial perceptions of a patient’s affect, degree of illness, and level of distress can influence the content of the history, triage decisions, and prioritization of likely diagnoses. When chief concerns and history are shared without benefit of this information, erroneous assumptions and miscommunications can result. Conclusion This survey confirms common use of a standardized outline for documenting, communicating, and teaching history-taking and physical examination protocol. The present outline shares early observations out of clinical sequence and may provide inadequate context for accurate interpretation of chief concerns and history. Corrective actions include modifying the documentation sequence to conform to clinical practice and teaching contextual methodology for sharing patient information. PMID:28096709

Social Anxiety Scale for Adolescents: factorial invariance across gender and age in Hispanic American adolescents.

PubMed

La Greca, Annette M; Ingles, Candido J; Lai, Betty S; Marzo, Juan C

2015-04-01

Social anxiety is a common psychological disorder that often emerges during adolescence and is associated with significant impairment. Efforts to prevent social anxiety disorder require sound assessment measures for identifying anxious youth, especially those from minority backgrounds. We examined the factorial invariance and latent mean differences of the Social Anxiety Scale for Adolescents (SAS-A) across gender and age groups in Hispanic American adolescents (N = 1,191; 56% girls; 15-18 years) using multigroup confirmatory factor analyses. Results indicated that the factorial configuration of the correlated three-factor model of the SAS-A was invariant across gender and age. Analyses of latent mean differences revealed that boys exhibited higher structured means than girls on the Social Avoidance and Distress-General (SAD-General) subscale. On all SAS-A subscales, Fear of Negative Evaluation, Social Avoidance and Distress-New, and SAD-General, estimates of the structured means decreased with adolescent age. Implications for further research and clinical practice are discussed. © The Author(s) 2014.

44 CFR 10.1 - Background and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Background and purpose. 10.1 Section 10.1 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL ENVIRONMENTAL CONSIDERATIONS General § 10.1 Background and purpose. (a) This part...

Help-seeking for mental health problems in young refugees: a review of the literature with implications for policy, practice, and research.

PubMed

de Anstiss, Helena; Ziaian, Tahereh; Procter, Nicholas; Warland, Jane; Baghurst, Peter

2009-12-01

The large and diverse bodies of literature on refugee child and adolescent mental health have not been matched by a commensurate interest in help-seeking. Most help-seeking research has centred on Western and, to a lesser extent, non-refugee ethnic minority adult populations. An emerging child and adolescent help-seeking literature consistently reports widespread underutilization of mental health services by children in the general population. Current research and opinion suggest a similar trend for refugee and other ethnic minority children. While service underutilization appears to be an issue for all children, those from refugee backgrounds may be at increased risk of mental health problems and have greater difficulty accessing mental health care. From a policy and practice perspective, the most important explanation for low uptake of services by refugee families concerns an overall failure of Western mental health systems to accommodate the needs of ethnically diverse populations in general and refugees in particular. In order to effectively plan for the mental health needs of refugee children and adolescents, Western host country governments need a clear understanding of help-seeking behaviour.

Tracing organizing principles: learning from the history of systems biology.

PubMed

Green, Sara; Wolkenhauer, Olaf

2013-01-01

With the emergence of systems biology, the identification of organizing principles is being highlighted as a key research aim. Researchers attempt to "reverse engineer" the functional organization of biological systems using methodologies from mathematics, engineering and computer science while taking advantage of data produced by new experimental techniques. While systems biology is a relatively new approach, the quest for general principles of biological organization dates back to systems theoretic approaches in early and mid-twentieth century. The aim of this paper is to draw on this historical background in order to increase the understanding of the motivation behind the search for general principles and to clarify different epistemic aims within systems biology. We pinpoint key aspects of earlier approaches that also underlie the current practice. These are i) the focus on relational and system-level properties, ii) the inherent critique of reductionism and fragmentation of knowledge resulting from overspecialization, and iii) the insight that the ideal of formulating abstract organizing principles is complementary to, rather than conflicting with, the aim of formulating detailed explanations of biological mechanisms. We argue that looking back not only helps us understand the current practice but also points to possible future directions for systems biology.

Accelerating language acquisition.

PubMed

Fowler, W; Ogston, K; Roberts-Fiati, G; Swenson, A

1993-01-01

How much can the development of language and other skills be accelerated in the general population? High correlations between early verbal and mental competencies and parent and teacher language socialization practices suggest enormous potential for widespread improvement. Here we report follow-up research in progress in studies of late adolescent children from diverse ethnic and educational backgrounds who participated in a language enrichment programme during infancy in the home or day-care. In 39 of 44 home-stimulated children located to date (nearly all from college-educated families) 62-93% were: in gifted or advanced programmes, obtaining high grades, avid readers and skilled in writing (over half read before school and wrote creative material independently) and generally highly skilled in verbal, mathematical and other academic domains. They also excelled socially and in sports, and showed intellectual independence. Additional subjects and data (on competence, later experiences and Scholastic Aptitude Test [SAT] scores) are currently being collected. Preliminary data analyses suggest that although early language enrichment can in the short term easily increase competence in all groups well beyond norms generated by current socialization practices, long-term outcomes are a complex function of developmental dynamics between the early, complex, foundation of high skills and motivation for learning, and the interaction with facilitative parental resources.

Negotiations of distress between East Timorese and Vietnamese refugees and their family doctors in Melbourne.

PubMed

Kokanovic, Renata; May, Carl; Dowrick, Christopher; Furler, John; Newton, Danielle; Gunn, Jane

2010-05-01

Recent critiques of depression have contested its coherence as a concept and highlighted its performance in medicalising distress. Studies of depression in a cross-cultural context have focused on language and belief systems as technical barriers to practice that need to be overcome in enacting depression work. This paper seeks to locate culture within the broader socio-structural context of depression care in general practice. The paper draws on interviews with five general practitioners (GPs), and 24 patients from Vietnamese and East Timorese backgrounds who predominantly have left their home as refugees. Each had been diagnosed with depression or prescribed antidepressants. These patients gave accounts of distress deeply embedded within, and inseparable from, lives fraught with frightening pre-migration experiences, traumatic escape and profound dislocation and alienation in their new 'home'. Fragmented lives were contrasted with the nourishing social fabric of homes left behind. GP participants were involved in a process of engaging with a profoundly communal and structural account of emotional distress while defending and drawing on an individualised notion of depression in performing their work and accounting for the pain presented to them.

Primary care and public health a natural alliance? The introduction of the guidelines for obesity and undernutrition of the Dutch College of General Practitioners.

PubMed

van Avendonk, Mariëlle J P; Mensink, Paul A J S; Drenthen, A J M Ton; van Binsbergen, Jaap J

2012-04-01

The prevalence of obesity and overweight is increasing globally and forms a huge public health problem. On the other hand, the prevalence of malnutrition or undernutrition is substantial, especially in nursing homes or in the elderly at home. Primary care and public health are separate disciplines. But in the field of nutrition and other lifestyle-related interventions, there are many direct and indirect interfaces for over- as well as undernutrition. The Dutch College of General Practitioners (NHG) published the Practice Guideline Obesity in adults and children to lead GPs in this process and to bridge the gap with public health. The same applies for the recently published National Primary Care Cooperation Agreement Undernutrition on the collaboration of primary care workers to enhance awareness and early intervention in case of nutritional impairment. This article goes into the background as well as the content of these two NHG products and the implications for daily practice. An attempt is made to connect primary care and public health in this matter. Particularly in the case of obesity, a close relationship with public health is of vital importance.

Does Council Tax Valuation Band (CTVB) correlate with Under-Privileged Area 8 (UPA8) score and could it be a better 'Jarman Index'?

PubMed Central

Beale, Norman; Taylor, Gordon; Straker-Cook, Dawn

2001-01-01

Background Widespread scepticism persists on the use of the Under-Privileged Area (UPA8) score of Jarman in distributing supplementary resources to so-attributed 'deprived' UK general practices. The search for better 'needs' markers continues. Having already shown that Council Tax Valuation Band (CTVB) is a predictor of UK GP workload, we compare, here, CTVB of residence of a random sample of patients with their respective 'Jarman' scores. Methods Correlation coefficient is calculated between (i) the CTVB of residence of a randomised sample of patients from an English general practice and (ii) the UPA8 scores of the relevant enumeration districts in which they live. Results There is a highly significant correlation between the two measures despite modest study size of 478 patients (85% response). Conclusions The proposal that CTVB is a marker of deprivation and of clinical demand should be examined in more detail: it correlates with 'Jarman', which is already used in NHS resource allocation. But unlike 'Jarman', CTVB is simple, objective, and free of the problems of Census data. CTVB, being household-based, can be aggregated at will. PMID:11716793

Gonorrhoea and Syphilis Epidemiology in Flemish General Practice 2009–2013: Results from a Registry-based Retrospective Cohort Study Compared with Mandatory Notification

PubMed Central

Schweikardt, Christoph; Goderis, Geert; Elli, Steven; Coppieters, Yves

2016-01-01

Background The number of newly diagnosed gonorrhoea and syphilis cases has increased in Flanders in recent years. Our aim was to investigate, to which extent these diagnoses were registered by general practitioners (GPs), and to examine opportunities and limits of the Intego database in this regard. Methods Data from a retrospective cohort study based on the Flemish Intego general practice database was analyzed for the years 2009–2013. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from figures of mandatory notification. Results A total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI) 9.6; 14.7) per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5), respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4) and 7.0 (CI: 6.7, 7.3), respectively. Conclusion In spite of limitations such as small numbers and different case definitions, comparison with mandatory notification suggests that the GP was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the GP. PMID:29546196

Methods to recognize work-related cancer in workplaces, the general population, and by experts in the clinic, a Norwegian experience

PubMed Central

2011-01-01

Background In most countries, the numbers of work-related cancer identified are much lower than are the estimated total burden of cancer caused by exposure at work. Therefore, there is a great need to use all available practical as well as epidemiological methods for identification as well as to develop new methods of recognizing cases of work-related cancers. Methods Primarily based on practical experiences from Norway, methods to identify cases of possible work-related cancers in the general population and at workplaces as well as methods to recognize more specific cases after referral to specialized clinics are reviewed in this publication. Results Countries applying a number of the available methods to detect work-related cancer reach a reporting rate of 60 such cases per million, while other countries that do not employ such methods hardly identify any cases. As most subjects previously exposed to cancer causing agents and substances at work are gradually recruited out of work, methods should be versatile for identification of cases in the general population, as well as at work. Conclusions Even in countries using a number of the available methods for identification, only a limited fraction of the real number of work-related cancer are notified to the labour inspectorate. Clinicians should be familiar with the methods and do the best to identify work-related cancer to serve prevention. PMID:21899752

A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds.

PubMed Central

Appleton, K; House, A; Dowell, A

1998-01-01

BACKGROUND: The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD: Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes. PMID:9624747

A STUDY ON A COOPERATIVE RELATIONSHIP TO THE IMPROVEMENT OF THE REGIONAL FIRE FIGHTING VALIDITY -Case Study in Bangkok, Thailand-

NASA Astrophysics Data System (ADS)

Sripramai, Keerati; Oikawa, Yasushi; Watanabe, Hiroshi; Katada, Toshitaka

Generally, in order to improve some regional fire fighting validity, indispensable strategies are not only a reinforcement of the governmental fire fighting ability, but also a strengthening of the cooperative relationship between governmental and non-governmental fire fighting ability. However, for practical purposes, the effective strategy should be different depending on the actual situationin the subject area. So, in this study, we grasp the actual state and background of the problems that need to be solved for the improvement of the regional fire fighting validity in Bangkok as a case study, and examine the appropriate solution focusing on the relationship between official and voluntary fire fighting. Through some practicable activities such as interviews, investigati ons, and making the regional fire fighting validity map, it became clear that the problems of uncooperative relationship and the lack of trust between stakeholders should be solved first and foremost.

An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge

PubMed Central

2014-01-01

Background There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. Results A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. Conclusions The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups. PMID:24667040

Differential receipt of sentinel lymph node biopsy within practice-based research networks

PubMed Central

Meyer, Anne-Marie; Reeder-Hayes, Katherine E.; Liu, Huan; Wheeler, Stephanie B.; Penn, Dolly; Weiner, Bryan J.; Carpenter, William R.

2013-01-01

Background Provider-based research networks (PBRNs) are promising for accelerating not only research, but also dissemination of research-based evidence into broader community practice. Sentinel lymph node biopsy (SLNB) is an innovation in breast cancer care associated with equivalent survival and lower morbidity, as compared to standard axillary lymph node dissection. We examined the diffusion of SLNB into practice and whether affiliation with the Community Clinical Oncology Program (CCOP), a cancer-focused PBRN, was associated with more rapid uptake of SLNB. Research Design Surveillance Epidemiology and End Results(SEER)-Medicare data were used to study women diagnosed with stage I or II breast cancer in the years 2000 to 2005 and undergoing breast conserving surgery with axillary staging (n=6,226). The primary outcome was undergoing SLNB. CCOP affiliation of the surgical physician was ascertained from NCI records. Multivariable generalized linear modeling with generalized estimating equations was used to measure association between CCOP exposure and undergoing SLNB, controlling for potential confounders. Results Women treated by a CCOP physician had significantly higher odds of receiving SLNB compared to women treated by a non-CCOP physician (OR 2.68; 95% CI 1.35, 5.34). The magnitude of this association was larger than that observed among patients treated by physicians operating in medical school-affiliated hospitals (OR 1.76; 95% CI 1.30–2.39). Conclusion Women treated by CCOP-affiliated physicians were more likely to undergo SLNB irrespective of the hospital’s medical school affiliation, suggesting that the CCOP PBRN may play a role in the rapid adoption of research-based innovation in community practice. PMID:23942221

Collaboration between general practitioners (GPs) and mental healthcare professionals within the context of reforms in Quebec

PubMed Central

2012-01-01

Background In the context of the high prevalence and impact of mental disorders worldwide, and less than optimal utilisation of services and adequacy of care, strengthening primary mental healthcare should be a leading priority. This article assesses the state of collaboration among general practitioners (GPs), psychiatrists and psychosocial mental healthcare professionals, factors that enable and hinder shared care, and GPs’ perceptions of best practices in the management of mental disorders. A collaboration model is also developed. Methods The study employs a mixed-method approach, with emphasis on qualitative investigation. Drawing from a previous survey representative of the Quebec GP population, 60 GPs were selected for further investigation. Results Globally, GPs managed mental healthcare patients in solo practice in parallel or sequential follow-up with mental healthcare professionals. GPs cited psychologists and psychiatrists as their main partners. Numerous hindering factors associated with shared care were found: lack of resources (either professionals or services); long waiting times; lack of training, time and incentives for collaboration; and inappropriate GP payment modes. The ideal practice model includes GPs working in multidisciplinary group practice in their own settings. GPs recommended expanding psychosocial services and shared care to increase overall access and quality of care for these patients. Conclusion As increasing attention is devoted worldwide to the development of optimal integrated primary care, this article contributes to the discussion on mental healthcare service planning. A culture of collaboration has to be encouraged as comprehensive services and continuity of care are key recovery factors of patients with mental disorders. PMID:23730332

Extending the authority for sickness certification beyond the medical profession: the importance of ‘boundary work’

PubMed Central

2014-01-01

Background The study aimed to explore the views of general practitioners (GPs), nurses and physiotherapists towards extending the role of sickness certification beyond the medical profession in primary care. Methods Fifteen GPs, seven nurses and six physiotherapists were selected to achieve varied respondent characteristics including sex, geographical location, service duration and post-graduate specialist training. Constant-comparative qualitative analysis of data from 28 semi-structured telephone interviews was undertaken. Results The majority of respondents supported the extended role concept; however members of each professional group also rejected the notion. Respondents employed four different legitimacy claims to justify their views and define their occupational boundaries in relation to sickness certification practice. Condition-specific legitimacy, the ability to adopt a holistic approach to sickness certification, system efficiency and control-related arguments were used to different degrees by each occupation. Practical suggestions for the extension of the sickness certification role beyond the medical profession are underpinned by the sociological theory of professional identity. Conclusions Extending the authority to certify sickness absence beyond the medical profession is not simply a matter of addressing practical and organisational obstacles. There is also a need to consider the impact on, and preferences of, the specific occupations and their respective boundary claims. This paper explores the implications of extending the sick certification role beyond general practice. We conclude that the main policy challenge of such a move is to a) persuade GPs to relinquish this role (or to share it with other professions), and b) to understand the ‘boundary work’ involved. PMID:24884678

Fearful or functional - a cross-sectional survey of the concepts of childhood fever among German and Turkish mothers in Germany

PubMed Central

2011-01-01

Background Fever is one of the most common presenting complaints in paediatrics and general practice. In the majority of cases nothing harmful is diagnosed. However, the subjective meaning of fever often varies between doctors and parents. Knowledge of the parents' concept of fever may help tailor counselling to their needs. In this study we determine 1) the influence of socio-economic status and cultural background on two concepts of fever which we labelled "functional" and "fearful", each representing typical experiences of mothers, and 2) the actions taken by the mothers related to these concepts. Methods A standardized interview study was conducted among German and Turkish mothers in Germany in 2009. The questionnaire consisted of 36 questions and 205 items. Interviews were conducted in 16 private practices of paediatricians and 2 paediatric emergency departments in an urban region of Germany. The two fever concepts were represented in 6 statements that could be rated with a six-point Likert scale. The association of the socio-economic status and the cultural background with one of the fever concepts was determined by a multiple logistic regression. Results A total of 338 mothers (49% with a Turkish background) completed the interview (response rate 92%). The average age of mothers with a German background was higher (34.1 years vs. 32.0 years, p = 0.0001). Mothers with a Turkish background were more likely to relate to the concept "fearful" [adjusted Odds Ratio (AOR) 1.99; confidence interval (CI) 1.16-3.44]. Mothers with a middle or high socio-economic status were more likely to respond to the concept "functional" [middle: AOR, 0.53; CI, 0.30-0.92; high: AOR, 0.44; CI, 0.21-0.95]. Mothers adhering to the concept "fearful" more often gave acetaminophen before the recommended interval of 6 hours (46.8% vs. 31.3%, p = 0.005) and visited out-of-hours services more frequently in the preceding 9 months than the other group (0.7 vs. 0.4, p = 0.001). Conclusions A Turkish migrant background and a low socio-economic status are associated with the fever concept "fearful". Mothers with these attributes seem to require specific and reassuring counselling as they use antipyretic drugs extensively and out-of-hours services frequently. PMID:21605413

Validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale for children aged 11–17 years

PubMed

Yalın Sapmaz, Şermin; Özek Erkuran, Handan; Ergin, Dilek; Öztürk, Masum; Şen Celasin, Nesrin; Karaarslan, Duygu; Aydemir, Ömer

2018-02-23

Background/aim: This study aimed to assess the validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Materials and methods: The study sample consisted of 32 patients treated in a child psychiatry unit and diagnosed with generalized anxiety disorder and 98 healthy volunteers who were attending middle or high school during the study period. For the assessment, the Screen for Child Anxiety and Related Emotional Disorders (SCARED) was also used along with the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Results: Regarding reliability analyses, the Cronbach alpha internal consistency coefficient was calculated as 0.932. The test-retest correlation coefficient was calculated as r = 0.707. As for construct validity, one factor that could explain 62.6% of the variance was obtained and this was consistent with the original construct of the scale. As for concurrent validity, the scale showed a high correlation with SCARED. Conclusion: It was concluded that Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

A method for modelling GP practice level deprivation scores using GIS

PubMed Central

Strong, Mark; Maheswaran, Ravi; Pearson, Tim; Fryers, Paul

2007-01-01

Background A measure of general practice level socioeconomic deprivation can be used to explore the association between deprivation and other practice characteristics. An area-based categorisation is commonly chosen as the basis for such a deprivation measure. Ideally a practice population-weighted area-based deprivation score would be calculated using individual level spatially referenced data. However, these data are often unavailable. One approach is to link the practice postcode to an area-based deprivation score, but this method has limitations. This study aimed to develop a Geographical Information Systems (GIS) based model that could better predict a practice population-weighted deprivation score in the absence of patient level data than simple practice postcode linkage. Results We calculated predicted practice level Index of Multiple Deprivation (IMD) 2004 deprivation scores using two methods that did not require patient level data. Firstly we linked the practice postcode to an IMD 2004 score, and secondly we used a GIS model derived using data from Rotherham, UK. We compared our two sets of predicted scores to "gold standard" practice population-weighted scores for practices in Doncaster, Havering and Warrington. Overall, the practice postcode linkage method overestimated "gold standard" IMD scores by 2.54 points (95% CI 0.94, 4.14), whereas our modelling method showed no such bias (mean difference 0.36, 95% CI -0.30, 1.02). The postcode-linked method systematically underestimated the gold standard score in less deprived areas, and overestimated it in more deprived areas. Our modelling method showed a small underestimation in scores at higher levels of deprivation in Havering, but showed no bias in Doncaster or Warrington. The postcode-linked method showed more variability when predicting scores than did the GIS modelling method. Conclusion A GIS based model can be used to predict a practice population-weighted area-based deprivation measure in the absence of patient level data. Our modelled measure generally had better agreement with the population-weighted measure than did a postcode-linked measure. Our model may also avoid an underestimation of IMD scores in less deprived areas, and overestimation of scores in more deprived areas, seen when using postcode linked scores. The proposed method may be of use to researchers who do not have access to patient level spatially referenced data. PMID:17822545

Community-based dental education and the importance of faculty development.

PubMed

McAndrew, Maureen

2010-09-01

Community-based dental education offers a variety of positive learning experiences for students while providing needed dental services for the underserved. More dental students are being instructed by a growing body of largely volunteer community-based faculty who practice in a wide range of community settings including community hospitals and clinics, nursing homes, and private practices. These geographically dispersed instructors may have little experience as educators. Their practice styles and their motivation to improve teaching effectiveness are likely to differ from the styles and motivation of school-based faculty members. Moreover, many dental schools have begun to emphasize practices that may be unfamiliar to community-based faculty such as evidence-based practice. Providing faculty development for them is challenging, yet crucial to the success of these programs and dental education in general. Fundamental elements that must be considered for effective community faculty development programming include fostering a culture of respect between school-based and community faculty members, basing programs on the actual needs of these educators, integrating principles of adult learning theory, and establishing ongoing institutional support. This article provides background on this movement, reviews the literature for faculty development programs geared specifically to community-based educators, makes recommendations for development programs for these dental educators, and includes suggestions for future research.

Exploring nursing students’ experience of peer learning in clinical practice

PubMed Central

Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

2015-01-01

Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

General practitioners' management of mental disorders: A rewarding practice with considerable obstacles

PubMed Central

2012-01-01

Background Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs) are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs), even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. Methods This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS) and qualitative (NVivo) analyses were performed. Results At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks), and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy) favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one-problem-per-visit rule; longer time slots). GPs found MD practice rewarding as patients were seen as grateful and more complying with medical recommendations compared to other patients, generally leading to positive outcomes. Conclusions To improve MD management, this study highlights the importance of extending multidisciplinary GP practice settings with salary or hourly fee payment; access to psychotherapeutic and psychiatric expertise; and case-discussion training involving local networks of GPs and MD specialists that encourage both knowledge transfer and shared care. PMID:22423592

General Music Teachers' Backgrounds and Multicultural Repertoire Selection

ERIC Educational Resources Information Center

Lee, Soojin

2018-01-01

The purpose of this qualitative study was to examine how teachers' backgrounds could contribute to their decisions to include music from diverse cultures. Analysis of interviews with three general music teachers indicated that their music training and experiences, ethnic backgrounds, and years of teaching experience may have influenced their…

Evidence from household surveys for measuring coverage of newborn care practices

PubMed Central

Sitrin, Deborah; Perin, Jamie; Vaz, Lara ME; Carvajal–Aguirre, Liliana; Khan, Shane M; Fishel, Joy; Amouzou, Agbessi

2017-01-01

Background Aside from breastfeeding, there are little data on use of essential newborn care practices, such as thermal protection and hygienic cord care, in high mortality countries. These practices have not typically been measured in national household surveys, often the main source for coverage data in these settings. The Every Newborn Action Plan proposed early breastfeeding as a tracer for essential newborn care due to data availability and evidence for the benefits of breastfeeding. In the past decade, a few national surveys have added questions on other practices, presenting an opportunity to assess the performance of early breastfeeding initiation as a tracer indicator. Methods We identified twelve national surveys between 2005–2014 that included at least one indicator for immediate newborn care in addition to breastfeeding. Because question wording and reference populations varied, we standardized data to the extent possible to estimate coverage of newborn care practices, accounting for strata and multistage survey design. We assessed early breastfeeding as a tracer by: 1) examining associations with other indicators using Pearson correlations; and 2) stratifying by early breastfeeding to determine differences in coverage of other practices for initiators vs non–initiators in each survey, then pooling across surveys for a meta–analysis, using the inverse standard error as the weight for each observation. Findings Associations between pairs of coverage indicators are generally weak, including those with breastfeeding. The exception is drying and wrapping, which have the strongest association of any two interventions in all five surveys where measured; estimated correlations for this range from 0.47 in Bangladesh’s 2007 DHS to 0.83 in Nepal’s 2006 DHS. The contrast in coverage for other practices by early breastfeeding is generally small; the greatest absolute difference was 6.7%, between coverage of immediate drying for newborns breastfed early compared to those who were not. Conclusions Early initiation of breastfeeding is not a high performing tracer indicator for essential newborn care practices measured in previous national surveys. To have informative data on whether newborns are getting life–saving services, standardized questions about specific practices, in addition to breastfeeding initiation, need to be added to surveys. PMID:29423180

Newly identified psychiatric illness in one general practice: 12-month outcome and the influence of patients' personality.

PubMed Central

Wright, A F; Anderson, A J

1995-01-01

BACKGROUND. Relatively little is known about the natural history and outcome of psychological problems in patients who present to general practitioners. Only a small proportion of such patients are seen by specialists. Clinical experience suggests that patient personality is one of the factors influencing outcome in patients diagnosed as having psychiatric illness. AIM. This study set out to examine prospectively the progress and 12-month outcome of patients with newly identified psychiatric illness, and the association of patients' personality with outcome. METHOD. One hundred and seventy one patients with clinically significant psychiatric illness attending one practice in a Scottish new town were followed up prospectively (96 presented with psychological symptoms and 75 with somatic symptoms), and were compared with a group of 127 patients with chronic physical illness. Patients were assessed in terms of psychiatric state, social problems and personality using both computer-based and pencil and paper tests in addition to clinical assessments at each consultation during the follow-up year and structured interview one year after recruitment. RESULTS. Most of the improvement in psychiatric state scores on the 28-item general health questionnaire occurred in the first six months of the illness. Of the 171 patients with psychiatric illness 34% improved quickly and remained well, 54% had an intermittent course but had improved at 12-month follow up while 12% pursued a chronic course without improvement. The mean number of consultations in the follow-up year was 8.4 for patients presenting with psychological symptoms, 7.2 for those presenting with somatic symptoms and 6.6 for patients with chronic physical illness. The Eysenck N score proved a strong predictor of the outcome of new psychiatric illness. CONCLUSION. Only one in three patients with newly identified psychiatric illness improved quickly and and remained well, reflecting the importance of continuing care of patients with psychological problems. This study has confirmed the feasibility of simple personality testing in everyday practice and shown a link between Eysenck N score and the outcome of new psychiatric illness. The predictive value of the Eysenck N score in general practice requires further research. PMID:7702888

Incidence and reinfection rates of genital chlamydial infection among women aged 16–24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group

PubMed Central

LaMontagne, D Scott; Baster, Kathleen; Emmett, Lynsey; Nichols, Tom; Randall, Sarah; McLean, Louise; Meredith, Paula; Harindra, Veerakathy; Tobin, Jean M; Underhill, Gillian S; Hewitt, W Graham; Hopwood, Jennifer; Gleave, Toni; Ghosh, Ajit K; Mallinson, Harry; Davies, Alisha R; Hughes, Gwenda; Fenton, Kevin A

2007-01-01

Background In England, screening for genital chlamydial infection has begun; however, screening frequency for women is not yet determined. Aim To measure chlamydia incidence and reinfection rates among young women to suggest screening intervals. Methods An 18‐month prospective cohort study of women aged 16–24 years recruited from general practices, family planning clinics and genitourinary medicine (GUM) clinics: baseline‐negative women followed for incidence and baseline‐positive women for reinfection; urine tested every 6 months via nucleic acid amplification; and behavioural data collected. Extra test and questionnaire completed 3 months after initial positive test. Factors associated with infection and reinfection investigated using Cox regression stratified by healthcare setting of recruitment. Results Chlamydia incidence was mean (95% CI) 4.9 (2.7 to 8.8) per 100 person‐years (py) among women recruited from general practices, 6.4 (4.2 to 9.8) from family planning clinics and 10.6 (7.4 to 15.2) from GUM clinics. Incidence was associated with young age, history of chlamydial infection and acquisition of new sexual partners. If recently acquiring new partners, condom use at last sexual intercourse was independently associated with lower incidence. Chlamydia reinfection was mean (95% CI) 29.9 (19.7 to 45.4) per 100/person‐year from general practices, 22.3 (15.6 to 31.8) from family planning clinics and 21.1 (14.3 to 30.9) from GUM clinics. Factors independently associated with higher reinfection rates were acquisition of new partners and failure to treat all partners. Conclusions Sexual behaviours determined incidence and reinfection, regardless of healthcare setting. Our results suggest annual screening of women aged 16–24 years who are chlamydia negative, or sooner if partner change occurs. Rescreening chlamydia‐positive women within 6 months of baseline infection may be sensible, especially if partner change occurs or all partners are not treated. PMID:17050567

Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia

PubMed Central

2012-01-01

Background In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. Methods A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions) on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender) were recruited through an online panel provider (participation rate: 10%) in 2010. Results Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen) had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Conclusions Medication-taking decisions are the subject of rational choices, influenced by the attributes of treatments and potentially amenable to intervention through education, strategic pricing and the altering of dosing characteristics. Understanding individual treatment preferences is thus an important step to improving adherence support provision in practice. Re-framing future interventions and policies to support rational and informed individual patient choices, is the way forward to realising the full potential health and economic benefits from the efficacious use of medications. PMID:22715853

[The image of general practitioners from the perspective of patients with and without a Turkish migration background - a qualitative study].

PubMed

Uslu, S; Natanzon, I; Joos, S

2014-06-01

In order to improve the medical care of people with migration background, the existing specialties in medical understanding must be taken into account. The aim of this study was to explore the image of general practitioners from the viewpoint of patients and to evaluate possible differences in the perception of patients with and without a Turkish migration background. 5 focus groups with participants with and without migration background were assessed in German language. In addition to a predefined interview guideline, the collage technique was used in order to explore the image of the practitioners through pictures. The content analysis was conducted according to Mayring using the software program ATLAS.ti. The patients revealed a highly positive image about the general practitioners. By means of the collage technique some negative aspects could be identified which were not discussed in the focus groups. Only minimal differences in the opinions of participants with and without Turkish migration background could be observed. These were a strongly negative attribution to the general practitioners with regard to financial aspects by the participants without migration background on the one hand and a rather paternalistic viewpoint by the participants with Turkish migration background on the other hand. Asked about an image change of general practitioners, the overall opinion has changed over the years from doctors being considered to be "powerful" and "unapproachable" to a "normal" level. Major reasons for this image change were attributed to the fact that patients are becoming increasingly informed about medical issues through the internet and the high work pressure of general practitioners. The image of general practitioners in Turkey was perceived more negative as compared to Germany. The image of general practitioners from the perspective of patients is predominantly positive. Altogether, only minor differences in the perception of German speaking patients with and without Turkish migration background could be identified. Therefore, specific ways of proceeding or qualification measures for general practitioners do not seem necessary in this context. © Georg Thieme Verlag KG Stuttgart · New York.

A spatial analysis of the expanding roles of nurses in general practice.

PubMed

Pearce, Christopher; Hall, Sally; Phillips, Christine; Dwan, Kathryn; Yates, Rachael; Sibbald, Bonnie

2012-08-07

Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. This study used a mixed methods, 'rapid appraisal' approach involving observation, photographs, and interviews. Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

ASSET (Age/Sex Standardised Estimates of Treatment): A Research Model to Improve the Governance of Prescribing Funds in Italy

PubMed Central

Favato, Giampiero; Mariani, Paolo; Mills, Roger W.; Capone, Alessandro; Pelagatti, Matteo; Pieri, Vasco; Marcobelli, Alberico; Trotta, Maria G.; Zucchi, Alberto; Catapano, Alberico L.

2007-01-01

Background The primary objective of this study was to make the first step in the modelling of pharmaceutical demand in Italy, by deriving a weighted capitation model to account for demographic differences among general practices. The experimental model was called ASSET (Age/Sex Standardised Estimates of Treatment). Methods and Major Findings Individual prescription costs and demographic data referred to 3,175,691 Italian subjects and were collected directly from three Regional Health Authorities over the 12-month period between October 2004 and September 2005. The mean annual prescription cost per individual was similar for males (196.13 euro) and females (195.12 euro). After 65 years of age, the mean prescribing costs for males were significantly higher than females. On average, costs for a 75-year-old subject would be 12 times the costs for a 25–34 year-old subject if male, 8 times if female. Subjects over 65 years of age (22% of total population) accounted for 56% of total prescribing costs. The weightings explained approximately 90% of the evolution of total prescribing costs, in spite of the pricing and reimbursement turbulences affecting Italy in the 2000–2005 period. The ASSET weightings were able to explain only about 25% of the variation in prescribing costs among individuals. Conclusions If mainly idiosyncratic prescribing by general practitioners causes the unexplained variations, the introduction of capitation-based budgets would gradually move practices with high prescribing costs towards the national average. It is also possible, though, that the unexplained individual variation in prescribing costs is the result of differences in the clinical characteristics or socio-economic conditions of practice populations. If this is the case, capitation-based budgets may lead to unfair distribution of resources. The ASSET age/sex weightings should be used as a guide, not as the ultimate determinant, for an equitable allocation of prescribing resources to regional authorities and general practices. PMID:17611624

Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act

PubMed Central

van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L

2010-01-01

Background The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. Aim To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Design of study Retrospective dynamic cohort study comparing 5 years before (1998–2002) and 5 years after (2003–2007) implementation of the Act. Method Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. Results The mean annual incidence of requests before implementation amounted to 3.1/10 000 and thereafter to 2.8/10 000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10 000 to 2.6/10 000 (P = 0.008); the requests by females increased non-significantly from 2.6/10 000 to 3.1/10 000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). Conclusion There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females. PMID:20353671

Nursing care of children in general practice settings: roles and responsibilities.

PubMed

Walsh, Anne; Barnes, Margaret; Mitchell, Amy E

2015-11-01

To examine roles and responsibilities of Practice Nurses in the area of child health and development and in advising parents about child health issues. As the focus of Australia's health care system shifts further towards the primary health care sector, governmental initiatives require that Practice Nurses are knowledgeable, confident and competent in providing care in the area of child health and development. Little is known about roles and responsibilities of Practice Nurses in this area. Cross-sectional survey design. Practice Nurses completed a national online survey examining the roles and responsibilities in child health and development, professional development needs and role satisfaction. Data were collected from June 2010-April 2011. Respondents (N = 159) reported having a significant role in well and sick child care and were interested in extending their role. Frequent activities included immunization, phone triage/advice, child health/development advice, wound care and Healthy Kids Checks. However, few had paediatric/child nursing backgrounds or postgraduate qualifications in paediatric nursing and they reported limited preparation for the role. Practice Nurses reported difficulties with keeping up-to-date with child health information and advising parents confidently. Satisfaction was relatively low regarding opportunities and encouragement to undertake professional development and expand scope of practice. Practice Nurses are largely unprepared to meet the demands of their child health role and need support to develop and maintain the skills and knowledge base necessary for high-quality, evidence-based practice. Both financial and time support is needed to enable Practice Nurses to access child health professional development. © 2015 John Wiley & Sons Ltd.

Empathy Variation in General Practice: A Survey among General Practitioners in Denmark

PubMed Central

Ahnfeldt-Mollerup, Peder; Søndergaard, Jens

2018-01-01

Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informed approach to improve empathy among GPs. Objective: Our objective is to measure and analyze variation in physician empathy and its association with GP demographic, professional, and job satisfaction characteristics. Methods: 464 Danish GPs responded to a survey containing the Danish version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP) and questions related to their demographic, professional and job satisfaction characteristics. Descriptive statistics and a quantile plot of the ordered empathy scores were used to describe empathy variation. In addition, random-effect logistic regression analysis was performed to explore the association between empathy levels and the included GP characteristics. Results: Empathy scores were negatively skewed with a mean score of 117.9 and a standard deviation of 10.1 within a range from 99 (p5) to 135 (p95). GPs aged 45–54 years and GPs who are not employed outside of their practice were less likely to have high empathy scores (≥120). Neither gender, nor length of time since specialization, length of time in current practice, practice type, practice location, or job satisfaction was associated with odds of having high physician empathy. However, odds of having a high empathy score were higher for GPs who stated that the physician-patient relationship and interaction with colleagues has a high contribution to job satisfaction compared to the reference groups (low and medium contribution of these factors). This was also the trend for GPs who stated a high contribution to job satisfaction from intellectual stimulation. In contrast, high contribution of economic profit and prestige did not contribute to increased odds of having a high empathy score. Conclusions: Albeit generally high, we observed substantial variation in physician empathy levels among this population of Danish GPs. This variation is positively associated with values of interpersonal relationships and interaction with colleagues, and negatively associated with middle age (45–54 years) and lack of outside employment. There is room to increase GP physician empathy via educational and organizational interventions, and consequently, to improve healthcare quality and outcomes. PMID:29498682

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

PubMed Central

2014-01-01

Background Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries. PMID:24533792

Nurse-led motivational interviewing to change the lifestyle of patients with type 2 diabetes (MILD-project): protocol for a cluster, randomized, controlled trial on implementing lifestyle recommendations

PubMed Central

Jansink, Renate; Braspenning, Jozé; van der Weijden, Trudy; Niessen, Louis; Elwyn, Glyn; Grol, Richard

2009-01-01

Background The diabetes of many patients is managed in general practice; healthcare providers aim to promote healthful behaviors, such as healthful diet, adequate physical activity, and smoking cessation. These measures may decrease insulin resistance, improve glycemic control, lipid abnormalities, and hypertension. They may also prevent cardiovascular disease and complications of diabetes. However, professionals do not adhere optimally to guidelines for lifestyle counseling. Motivational interviewing to change the lifestyle of patients with type 2 diabetes is intended to improve diabetes care in accordance with the national guidelines for lifestyle counseling. Primary care nurses will be trained in motivational interviewing embedded in structured care in general practice. The aim of this paper is to describe the design and methods of a study evaluating the effects of the nurses' training on patient outcomes. Methods/Design A cluster, randomized, controlled trial involving 70 general practices (35 practices in the intervention arm and 35 in the control arm) starting in March 2007. A total of 700 patients with type 2 diabetes will be recruited. The patients in the intervention arm will receive care from the primary care nurse, who will receive training in an implementation strategy with motivational interviewing as the core component. Other components of this strategy will be adaptation of the diabetes protocol to local circumstances, introduction of a social map for lifestyle support, and educational and supportive tools for sustaining motivational interviewing. The control arm will be encouraged to maintain usual care. The effect measures will be the care process, metabolic parameters (glycosylated hemoglobin, blood pressure and lipids), lifestyle (diet, physical activity, smoking, and alcohol), health-related quality of life, and patients' willingness to change behaviors. The measurements will take place at baseline and after 14 months. Discussion Applying motivational interviewing for patients with diabetes in primary care has been studied, but to our knowledge, no other study has yet evaluated the implementation and sustainability of motivating and involving patients in day-to-day diabetes care in general practice. If this intervention proves to be effective and cost-effective, large-scale implementation of this nurse-oriented intervention will be considered and anticipated. Trial registration Current Controlled Trials ISRCTN68707773. PMID:19183462

GPs’ perceptions of workload in England: a qualitative interview study

PubMed Central

Croxson, Caroline HD; Ashdown, Helen F; Hobbs, FD Richard

2017-01-01

Background GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable. Aim To gather an in-depth understanding of GPs’ perceptions and attitudes towards workload. Design and setting All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached. Method Semi-structured, qualitative interviews were conducted. Data were analysed thematically. Results In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload. Conclusion This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. PMID:28093422

Utility of routinely acquired primary care data for paediatric disease epidemiology and pharmacoepidemiology

PubMed Central

Helms, Peter J; Daukes, Suzie Ekins; Taylor, Michael W; Simpson, Colin R; McLay, James S

2005-01-01

Background The majority of medicines prescribed for children are prescribed in primary care for common acute and chronic conditions. This is in contrast to prescribing in secondary care where the population of children admitted is small but where a large number of different medicines are prescribed to treat more serious and less common conditions. Methods Data on prescribing was extracted from the General Practice Administration System for Scotland (GPASS) for the year November 1999 to October 2000 and prescribing patterns for children aged 0–16 years expressed as percentages. A comparison of age specific consultations for asthma, as an example of a common paediatric condition, was also made between two separate general practice data sets, the General Practice Research Database (GRPD) and the continuous morbidity recording (CMR) subset of GPASS. Results Of 214 medicines investigated for unlicensed and off-label prescribing no unlicensed prescribing was identified. Off-label prescribing due to age was most common among younger and older children. The most common reasons for off-label prescriptions were, in order of frequency, lower than recommended dose, higher than recommended dose, below the recommended age, and unlicensed formulation. Age and gender specific consultations for asthma were similar in the two representative databases, GPRD and CMR, both showing disappearance of the male predominance in the teenage years. Conclusions Large primary care data sets available within a unified health care system such as the UK National Health Service (NHS) are likely to be broadly compatible and produce similar results. The prescribing of off-label medicines to children is common in primary care, most commonly due to prescribing out with the recommended dosage regimen. PMID:15948933

Comparison of video-recorded consultations with those in which patients' consent is withheld.

PubMed Central

Coleman, T; Manku-Scott, T

1998-01-01

BACKGROUND: Video-recorded consultations are widely used for research in general practice. Recently, video recordings have begun to be used for the purposes of general practitioner (GP) registrar assessment. It is unknown, however, whether consultations in which patients withhold consent for recording differ from those that are recorded. AIM: To compare clinical problems and demographic characteristics of adult patients who consent to the video recording of consultations with those who withhold consent. METHOD: This was prospective study of 538 adult patients consulting 42 GPs, based in practices throughout Leicestershire. Each patient attended a surgery session with one of the 42 GPs between April 1995 and March 1996. Clinical presentations and demographic characteristics of patients consenting and withholding consent to the video recording of their consultations were compared. GPs' perceptions of whether patients in these two groups were distressed/upset or embarrassed were also compared. RESULTS: A total of 85.9% (462/538) of adults consented to video recording, and 14.1% (76/538) withheld consent. Multiple logistic regression revealed that patients who presented with a mental health problem were more likely to withhold consent to recording (odds ratio 2.5, 95% confidence interval 1.4-4.6). Younger patients were also more likely to withhold consent to video recording. Additionally, where patients' consent was withheld, GPs perceived patients to be more distressed or embarrassed. CONCLUSION: Younger patients and those suffering from mental health problems are more likely than others to withhold consent to being video recorded for research purposes in general practice. The implications of this study for the assessment of registrar GPs using video-recorded consultations are discussed. PMID:9624767

Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs

PubMed Central

Campbell, Stephen M; Fuat, Ahmet; Summerton, Nick; Lancaster, Neil; Hobbs, FD Richard

2011-01-01

Background Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice. Aim To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice. Design and setting An appropriateness ratings evaluation in UK general practice. Method Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method. Results Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other. Conclusion NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography. PMID:21722451

Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom

PubMed Central

Mohammed, Mohammed A.; Marshall, Tom; Nirantharakumar, Krishnarajah; Stevens, Andrew; Fitzmaurice, David

2013-01-01

Background Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence (NICE, UK) guidelines whilst seeking to identify subgroups of AF patients to inform efforts to optimise warfarin use. Methodology A retrospective database analysis to determine warfarin prescribing using tree models based on 50361 patients with AF (classified as low, moderate and high risk of stroke using CHADS2) from 430 general practices in the UK. Results Over one-third (37.0%, 4573/12351) of low risk AF patients were on warfarin, compared with 47.1% (8349/17709) moderate risk AF patients and 54.9% (11142/20301) high risk AF patients. Clinical subgroups (n = 15 low risk subgroups, n = 15 medium risk subgroups, n = 22 high risk subgroups) were identified. Several factors not supported by current guidelines (age, BMI, dementia, gender) were associated with the use of warfarin. Gender and BMI were associated with warfarin use in low and medium risk AF patients but not in high risk AF patients. Conclusion Whilst NICE guidelines suggest that all high risk AF patients should be on warfarin, half of those at moderate risk should be on warfarin and none of those at low risk should be on warfarin, we found evidence of over and under use of warfarin. Interventions to optimise warfarin therapy tailored to and targeting specific subgroups of AF patients identified by the tree models are required. PMID:23658703

Patient–doctor continuity and diagnosis of cancer: electronic medical records study in general practice

PubMed Central

Ridd, Matthew J; Ferreira, Diana L Santos; Montgomery, Alan A; Salisbury, Chris; Hamilton, William

2015-01-01

Background Continuity of care may affect the diagnostic process in cancer but there is little research. Aim To estimate associations between patient–doctor continuity and time to diagnosis and referral of three common cancers. Design and setting Retrospective cohort study in general practices in England. Method This study used data from the General Practice Research Database for patients aged ≥40 years with a diagnosis of breast, colorectal, or lung cancer. Relevant cancer symptoms or signs were identified up to 12 months before diagnosis. Patient–doctor continuity (fraction-of-care index adjusted for number of consultations) was calculated up to 24 months before diagnosis. Time ratios (TRs) were estimated using accelerated failure time regression models. Results Patient–doctor continuity in the 24 months before diagnosis was associated with a slightly later diagnosis of colorectal (time ratio [TR] 1.01, 95% confidence interval [CI] =1.01 to 1.02) but not breast (TR = 1.00, 0.99 to 1.01) or lung cancer (TR = 1.00, 0.99 to 1.00). Secondary analyses suggested that for colorectal and lung cancer, continuity of doctor before the index consultation was associated with a later diagnosis but continuity after the index consultation was associated with an earlier diagnosis, with no such effects for breast cancer. For all three cancers, most of the delay to diagnosis occurred after referral. Conclusion Any effect for patient–doctor continuity appears to be small. Future studies should compare investigations, referrals, and diagnoses in patients with and without cancer who present with possible cancer symptoms or signs; and focus on ‘difficult to diagnose’ types of cancer. PMID:25918335

Under the radar: a cross-sectional study of the challenge of identifying at-risk alcohol consumption in the general practice setting

PubMed Central

2014-01-01

Background Primary care providers are an important source of information regarding appropriate alcohol consumption. As early presentation to a provider for alcohol-related concerns is unlikely, it is important that providers are able to identify at-risk patients in order to provide appropriate advice. This study aimed to report the sensitivity, specificity, positive predictive value and negative predictive value of General Practitioner (GP) assessment of alcohol consumption compared to patient self-report, and explore characteristics associated with GP non-detection of at-risk status. Method GP practices were selected from metropolitan and regional locations in Australia. Eligible patients were adults presenting for general practice care who were able to understand English and provide informed consent. Patients completed a modified AUDIT-C by touchscreen computer as part of an omnibus health survey while waiting for their appointment. GPs completed a checklist for each patient, including whether the patient met current Australian guidelines for at-risk alcohol consumption. Patient self-report and GP assessments were compared for each patient. Results GPs completed the checklist for 1720 patients, yielding 1565 comparisons regarding alcohol consumption. The sensitivity of GPs’ detection of at-risk alcohol consumption was 26.5%, with specificity of 96.1%. Higher patient education was associated with GP non-detection of at-risk status. Conclusions GP awareness of which patients might benefit from advice regarding at-risk alcohol consumption appears low. Given the complexities associated with establishing whether alcohol consumption is ‘at-risk’, computer-based approaches to routine screening of patients are worthy of exploration as a method for prompting the provision of advice in primary care. PMID:24766913

Artificial neural networks in biology and chemistry: the evolution of a new analytical tool.

PubMed

Cartwright, Hugh M

2008-01-01

Once regarded as an eccentric and unpromising algorithm for the analysis of scientific data, the neural network has been developed in the last decade into a powerful computational tool. Its use now spans all areas of science, from the physical sciences and engineering to the life sciences and allied subjects. Applications range from the assessment of epidemiological data or the deconvolution of spectra to highly practical applications, such as the electronic nose. This introductory chapter considers briefly the growth in the use of neural networks and provides some general background in preparation for the more detailed chapters that follow.

National Athletic Trainers' Association Position Statement: Skin Diseases

PubMed Central

Zinder, Steven M.; Basler, Rodney S. W.; Foley, Jack; Scarlata, Chris; Vasily, David B.

2010-01-01

Abstract Objective: To present recommendations for the prevention, education, and management of skin infections in athletes. Background: Trauma, environmental factors, and infectious agents act together to continually attack the integrity of the skin. Close quarters combined with general poor hygiene practices make athletes particularly vulnerable to contracting skin diseases. An understanding of basic prophylactic measures, clinical features, and swift management of common skin diseases is essential for certified athletic trainers to aid in preventing the spread of infectious agents. Recommendations: These guidelines are intended to provide relevant information on skin infections and to give specific recommendations for certified athletic trainers and others participating in athletic health care. PMID:20617918

An alternative to unstructured grids for computing gas dynamic flows around arbitrarily complex two-dimensional bodies

NASA Technical Reports Server (NTRS)

Quirk, James J.

1992-01-01

In this paper we describe an approach for dealing with arbitrary complex, two dimensional geometries, the so-called cartesian boundary method. Conceptually, the cartesian boundary method is quite simple. Solid bodies blank out areas of a background, cartesian mesh, and the resultant cut cells are singled out for special attention. However, there are several obstacles that must be overcome in order to achieve a practical scheme. We present a general strategy that overcomes these obstacles, together with some details of our successful conversion of an adaptive mesh algorithm from a body-fitted code to a cartesian boundary code.

Background monitoring and its role in global estimation and forecast of the state of the biosphere.

PubMed

Izrael, Y A

1982-12-01

(1) Scientific grounds and the concept of monitoring as the system for observations, assessment and prediction of man-induced changes in the state of natural environment, the program and aims of the background monitoring were developed by the author in 1972-1980. These questions were discussed in detail at the International Symposium on Global Integrated Monitoring (Riga, U.S.S.R., December, 1978). It should be stressed that along with significant anthropogenic loading on large cities and industrial areas, natural ecosystems covering most of the Earth's territory are also exposed to quite extended, though insignificant anthropogenic effects. This paper proposes to consider the ways of the background information use for the biosphere state assessment and prediction. (2) Classification of objects for monitoring from the point of view of the consequences of the man-made impact, pollution in the first hand, is as follows: - population (public health); - ecosystem elements employed by man whose production is used by population (soil, water bodies, forest, etc.); - biotic elements of ecosystems (without the immediate consumed production); - abiotic constituents of natural ecosystems, considerable components of the biosphere, climatic system. (3) Historically, monitoring in all countries involves the first two spheres. The background monitoring also extends on the next two spheres. It should differentially take into account physical, chemical and biological factors of impacts. Indentification of biological effects is most complex and vital. Human impact at the background level proceeds indirectly through a general (global or regional) deterioration of the state of the biosphere. (4) Gradually the background monitoring is being practiced on a larger and larger scale. It is shown that the long-range atmospheric transport of pollutants in various regions leads to a gradual general increase of all the natural media pollution and to perceptible biological effects (soil and water acidification and resulting disturbances in the composition of soil and water organisms). The levels of the background impact differ. Thus, the background concentrations of a number of anthropogenic pollutants in Central Europe is 10-20 times higher than in Central Asia. (5) The area of priority in the background monitoring of the biosphere pollution has become evident: compounds of sulphur, mercury and their derivatives, organochloride pesticides, some radioactive substances (e.g., krypton-85 in the atmosphere). (6) The World Ocean is practically all contaminated on a global scale. Biological effects of the World Ocean pollution cause special concern. Particularly important consequences, including climate impact, may be caused by disturbances in energy and matter transfer between environmental media (water-air, water-bottom, etc.). The priority of the impact factors can be allocated here as well: oil products, metals, organochloride compounds, polycyclic aromatic hydrocarbons. (7) One of the most effective possibilities of environmental quality control is standardization which consists in elaboration of permissible ecological loadings upon ecosystems and natural media. The approach to ecological standardization differs from that of hygienic control in principle. The objective of ecological standardization is to ensure the integrity of the given ecosystem and natural environment on the whole. (8) Ecological standardization in its turn requires knowledge related to the damage from this or another impact because in such a case there is a possibility to compare ecological standards for the same ecosystem in the case when impacts are of different origin (e.g., different pollutants).

Composition and leaching of construction and demolition waste: inorganic elements and organic compounds.

PubMed

Butera, Stefania; Christensen, Thomas H; Astrup, Thomas F

2014-07-15

Thirty-three samples of construction and demolition waste collected at 11 recycling facilities in Denmark were characterised in terms of total content and leaching of inorganic elements and presence of the persistent organic pollutants PCBs and PAHs. Samples included (i) "clean" (i.e. unmixed) concrete waste, (ii) mixed masonry and concrete, (iii) asphalt and (iv) freshly cast concrete cores; both old and newly generated construction and demolition waste was included. PCBs and PAHs were detected in all samples, generally in non-critical concentrations. Overall, PAHs were comparable to background levels in urban environments. "Old" and "new" concrete samples indicated different PCB congener profiles and the presence of PCB even in new concrete suggested that background levels in raw materials may be an issue. Significant variability in total content of trace elements, even more pronounced for leaching, was observed indicating that the number of analysed samples may be critical in relation to decisions regarding management and utilisation of the materials. Higher leaching of chromium, sulphate and chloride were observed for masonry-containing and partly carbonated samples, indicating that source segregation and management practices may be important. Generally, leaching was in compliance with available leaching limits, except for selenium, and in some cases chromium, sulphate and antimony. Copyright © 2014 Elsevier B.V. All rights reserved.

The LUCK study: Laxative Usage in patients with GP-diagnosed Constipation in the UK, within the general population and in pregnancy. An epidemiological study using the General Practice Research Database (GPRD)

PubMed Central

Shafe, Anna C. E.; Lee, Sally; Dalrymple, Jamie S. O.; Whorwell, Peter J.

2011-01-01

Background: Despite the high prevalence of constipation and its related public health implications, there is relatively little research available on the condition from large epidemiological studies. The aim of this study was to investigate the epidemiology of general practitioner (GP)-diagnosed constipation and the prescribing trends for laxatives in the UK, within the general population and during pregnancy. Methods: A cohort study for the period from 2005 to 2009 was performed using the UK primary care database (General Practice Research Database), which contains information on over 3 million individuals. Results: The prevalence of GP-diagnosed constipation ranged from 12 per 1000 persons in 2005 (0.012 per person year) to 12.8 per 1000 in 2009 (0.013 per person year). The prevalence was almost twice as high in women as in men, and was higher in older patients. In 2005 the most commonly prescribed laxatives were lactulose (37%), senna (26%), macrogol (19%), ispaghula (6%), docusate sodium (5%), bisacodyl (4%) and glycerol suppositories (2%). By 2009, this pattern had changed: macrogol (31%), lactulose (29%), senna (22%), ispaghula (5%), docusate sodium (6%), bisacodyl (3%) and glycerol suppositories (3%). In pregnancy, lactulose accounted for 81% of laxative use in 2005, falling to 64% by 2009. In contrast, macrogol use in pregnancy rose from 13% in 2005 to 32% in 2009. Conclusions: GP-diagnosed constipation is common, accounting for a large number of consultations. Laxative prescribing trends have changed over the 5-year study period, prescriptions for macrogol becoming increasingly common and prescriptions for lactulose and senna less common. Macrogol also appears to have been replacing lactulose for treating constipation in pregnant women. PMID:22043228

Neuromyths in Education: Prevalence and Predictors of Misconceptions among Teachers

PubMed Central

Dekker, Sanne; Lee, Nikki C.; Howard-Jones, Paul; Jolles, Jelle

2012-01-01

The OECD’s Brain and Learning project (2002) emphasized that many misconceptions about the brain exist among professionals in the field of education. Though these so-called “neuromyths” are loosely based on scientific facts, they may have adverse effects on educational practice. The present study investigated the prevalence and predictors of neuromyths among teachers in selected regions in the United Kingdom and the Netherlands. A large observational survey design was used to assess general knowledge of the brain and neuromyths. The sample comprised 242 primary and secondary school teachers who were interested in the neuroscience of learning. It would be of concern if neuromyths were found in this sample, as these teachers may want to use these incorrect interpretations of neuroscience findings in their teaching practice. Participants completed an online survey containing 32 statements about the brain and its influence on learning, of which 15 were neuromyths. Additional data was collected regarding background variables (e.g., age, sex, school type). Results showed that on average, teachers believed 49% of the neuromyths, particularly myths related to commercialized educational programs. Around 70% of the general knowledge statements were answered correctly. Teachers who read popular science magazines achieved higher scores on general knowledge questions. More general knowledge also predicted an increased belief in neuromyths. These findings suggest that teachers who are enthusiastic about the possible application of neuroscience findings in the classroom find it difficult to distinguish pseudoscience from scientific facts. Possessing greater general knowledge about the brain does not appear to protect teachers from believing in neuromyths. This demonstrates the need for enhanced interdisciplinary communication to reduce such misunderstandings in the future and establish a successful collaboration between neuroscience and education. PMID:23087664

Neuromyths in Education: Prevalence and Predictors of Misconceptions among Teachers.

PubMed

Dekker, Sanne; Lee, Nikki C; Howard-Jones, Paul; Jolles, Jelle

2012-01-01

The OECD's Brain and Learning project (2002) emphasized that many misconceptions about the brain exist among professionals in the field of education. Though these so-called "neuromyths" are loosely based on scientific facts, they may have adverse effects on educational practice. The present study investigated the prevalence and predictors of neuromyths among teachers in selected regions in the United Kingdom and the Netherlands. A large observational survey design was used to assess general knowledge of the brain and neuromyths. The sample comprised 242 primary and secondary school teachers who were interested in the neuroscience of learning. It would be of concern if neuromyths were found in this sample, as these teachers may want to use these incorrect interpretations of neuroscience findings in their teaching practice. Participants completed an online survey containing 32 statements about the brain and its influence on learning, of which 15 were neuromyths. Additional data was collected regarding background variables (e.g., age, sex, school type). Results showed that on average, teachers believed 49% of the neuromyths, particularly myths related to commercialized educational programs. Around 70% of the general knowledge statements were answered correctly. Teachers who read popular science magazines achieved higher scores on general knowledge questions. More general knowledge also predicted an increased belief in neuromyths. These findings suggest that teachers who are enthusiastic about the possible application of neuroscience findings in the classroom find it difficult to distinguish pseudoscience from scientific facts. Possessing greater general knowledge about the brain does not appear to protect teachers from believing in neuromyths. This demonstrates the need for enhanced interdisciplinary communication to reduce such misunderstandings in the future and establish a successful collaboration between neuroscience and education.

Predictors of Final Specialty Choice by Internal Medicine Residents

PubMed Central

Diehl, Andrew K; Kumar, Vineeta; Gateley, Ann; Appleby, Jane L; O'Keefe, Mary E

2006-01-01

BACKGROUND Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE To identify factors that predict the clinical practice of residents following their training. DESIGN Prospective cohort study. PARTICIPANTS Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P<.001). Residents with higher loan indebtedness more often became generalists (P = .001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05

Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety

PubMed Central

2014-01-01

Background Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety. Methods Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes. Results Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes. Conclusions Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation. PMID:25030651

Attitudes and beliefs toward the use of a dental diagnostic terminology A survey of dental providers in a dental practice

PubMed Central

Ramoni, Rachel B.; Walji, Muhammad F.; Kim, Soyun; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Skourtes, Eugene; Yansane, Alfa; White, Joel M.; Kalenderian, Elsbeth

2015-01-01

Background Attitudes and views are critical to the adoption of innovation. While there have been broadening calls for a standardized dental diagnostic terminology, little is known about the views of private practice dental team members towards the adoption of such a terminology. Methods A survey was developed using validated questions identified through literature review. Domain experts’ input allowed for further modifications. The final survey was administered electronically to 814 team members at a multi-office practice based in the Pacific Northwest. Results Response proportion was 92%. The survey had excellent reliability (Cronbach alpha coefficient = 0.87). Results suggested that participants showed, in general, positive attitudes and beliefs towards using a standardized diagnostic terminology in their practices. Additional written comments by participants highlighted the potential for improved communication with use of the terminology. Conclusions Dental providers and staff in one multi-office practice showed positive attitudes towards the use of a diagnostic terminology, specifically they believed it would improve communication between the dentist and patient as well as among providers, while expressing some concerns if using standardized dental diagnostic terms helps clinicians to deliver better dental care. Practical Implications As the dental profession is advancing towards the use of standardized diagnostic terminologies, successful implementation will require that dental team leaders prepare their dental teams by gauging their attitude toward the use of such a terminology. PMID:26025826

Stakeholder experiences with general practice pharmacist services: a qualitative study.

PubMed

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of general practice pharmacist roles.

Diversification of U.S. medical schools via affirmative action implementation

PubMed Central

Lakhan, Shaheen Emmanuel

2003-01-01

Background The diversification of medical school student and faculty bodies via race-conscious affirmative action policy is a societal and legal option for the U.S. Supreme Court has recently ruled its use constitutional. This paper investigates the implications of affirmative action, particularly race-conscious compared to race-blind admissions policy; explains how alternative programs are generally impractical; and provides a brief review of the history and legality of affirmative action in the United States. Discussion Selection based solely on academic qualifications such as GPA and MCAT scores does not achieve racial and ethnic diversity in medical school, nor does it adequately predict success as practicing physicians. However, race-conscious preference yields greater practice in underserved and often minority populations, furthers our biomedical research progression, augments health care for minority patients, and fosters an exceptional medical school environment where students are better able to serve an increasingly multicultural society. Summary The implementation of race-conscious affirmative action results in diversity in medicine. Such diversity has shown increased medical practice in underserved areas, thereby providing better health care for the American people. PMID:13678423

Near patient testing in general practice: a review.

PubMed Central

Hilton, S

1990-01-01

Until recently, technological advances in general practice have generally been thought of as the applications of microcomputers in practice organization and record keeping. Advances in miniaturization and versatility of diagnostic technology will have a similarly large impact on the way general practitioners practice medicine in the next decade. This article reviews some of the newer tests that are already available to general practitioners, particularly in diagnostic biochemistry and microbiology. Preliminary evaluative work and research studies in general practice are also described. PMID:2107838

The co-use of conventional drugs and herbs among patients in Norwegian general practice: a cross-sectional study

PubMed Central

2013-01-01

Background Different patient groups are known to use herbal remedies and conventional drugs concomitantly (co-use). This poses a potential risk of herb-drug interaction through altering the drug’s pharmacokinetics or pharmacodynamics. Little is known about co-use among patients in general practice. The primary aim of this study was to compare patients in general practice that co-use herbal remedies and conventional drugs with those who do not. The secondary aim was to register the herb-drug combinations with potential clinical relevant interactions among the co-users. Method A questionnaire based cross-sectional study conducted in the autumn 2011 in a general practice office with four general practitioners (GPs) and one intern in Western Norway. Adults >18 years who came for an office visit were invited. The questionnaire asked about demographics, herbal use, conventional drug use and communication about herbal use. Multivariable logistic regression was used to compare co-users to the other patients. Results Of the 381 patients who completed the questionnaire, the prevalence of herbal use was 44%, with bilberry (41%), green tea (31%), garlic (27%), Aloe vera (26%) and echinacea (18%) as the most frequently used. Among those using conventional drugs regularly, 108 (45%) co-used herbs. Close to 40% of patients on anticoagulants co-used herbs, with garlic and bilberry as the most frequent herbs. Compared to all other patients, co-users had significantly (p < 0.05) increased odds to be female (adjOR 2.0), age above 70 years (adjOR 3.3), use herbs to treat an illness (adjOR 4.2), use two or more herbs (polyherbacy, adjOR 12.1) and having experienced adverse effects of herbal use (adjOR 37.5). Co-use was also associated with use of analgesics or dermatological drugs (adjOR 5.1 and 7.9 respectively). Three out of four patients did not discuss herbal use with any health care professional. Conclusion A sizable proportion of the GP patients co-used herbs with conventional drugs, also combinations with reported interaction potential or additive effects like anticoagulants and garlic. The low disclosure of herbal use to their GP, polyherbacy and the risk of interactions in vulnerable groups like elderly and chronically ill patients, warrant increased awareness among GPs. PMID:24171723

Patient and professional views of open access hysterosalpingography for the initial management of infertility in primary care

PubMed Central

Wilkes, Scott; Rubin, Greg; Crosland, Ann; Hall, Nicola; Murdoch, Alison

2009-01-01

Background Hysterosalpingography (HSG) is recommended as a first-line investigation for tubal assessment of infertile women. This investigation is not routinely available to GPs. Aim To explore the perceptions and attitudes of patients and health professionals to open access HSG for the initial management of infertile couples in general practice. Design of study A nested qualitative study using in-depth interviews with GPs, fertility specialists, and infertile couples. Setting Northumberland, Newcastle upon Tyne, North Tyneside, South Tyneside, and Gateshead. Method Participants were 39 interviewees: 12 GPs, five fertility specialists, and 13 infertile couples (nine interviewed with their partner). Results Four themes emerged: personal factors; will it benefit patients, GPs, and fertility specialists?; professional factors; does it fit the role of a GP?; local context; do the skills exist in general practice?; and wider context; will it benefit the NHS? GPs who had used open access HSG, felt it was appropriate for general practice and would continue to use the service. All GPs, fertility specialists, and infertile couples who had experienced open access HSG wished the service to remain in place. The main barriers to its uptake were: infrequency with which infertility presents; lack of clarity on perceived responsibilities; difficulty keeping up to date, including assimilating guidelines; low clinical priority; and lack of support in authoritative guidance. Conclusion Providing GPs with open access to HSG would allow a full initial assessment of the infertile couple and refer women with blocked tubes directly to tertiary care. While there is general support for the provision of such a facility, the majority of GPs perceive its use as being by a limited number of GPs who have a special interest in infertility. The study findings can inform future development of infertility services at the interface between primary and secondary/tertiary care. PMID:19401016

General practice fundholding: progress to date.

PubMed Central

Smith, R D; Wilton, P

1998-01-01

BACKGROUND: The cornerstone of the National Health Service (NHS) reforms was the establishment of an internal market, which separated purchasing and providing roles. As purchasers of care, general practice fundholders were seen as a pivotal part of the 'new patient-led NHS', which was intended to lead to improved cost-containment and cost-effectiveness, quality of care, and patient choice and empowerment. AIM: To review published evidence of the extent to which these objectives may have been achieved over the past six years. METHOD: Keyword search of on-line databases (MEDLINE and Econ-lit) from 1990 to 1996, plus manual search of references within those articles identified. RESULTS: In the absence of any formal evaluation of fundholding, it is difficult to assess the overall success of this reform. However, in terms of cost-containment and cost-effectiveness, there is mixed evidence. In some areas, such as prescribing, the evidence suggests cost-savings, although the evidence is less clear on reductions or changes in referrals. There is also evidence that suggests that improvements in prescribing may have been achieved at substantial additional administration and transaction costs. With respect to quality of care, the evidence suggests that, although quality in the procedural aspects of health provision has improved, there is little evidence about how health outcomes may have been affected. In terms of patient choice and empowerment, the evidence suggests that, whilst general practitioner choice of secondary providers has improved, little progress has been made with regard to increased consumer choice. CONCLUSION: Evidence concerning the success or otherwise of general practice fundholding over the past six years is incomplete and mixed. The major deficiency concerns any effect on health outcomes that may be the result of fundholding. Until such research is conducted, the jury will have to remain out on whether fundholding has secured improved efficiency in the delivery of health care. PMID:9692288

‘Can he have the test for bipolar, doctor? His dad's got it’: exploring the potential of general practitioners to work with children and young people presenting in primary care with common mental health problems – a clinical initiative

PubMed Central

2012-01-01

Background General practitioners (GPs) play a key role in assessing and managing adult mental health problems, but this input is not seen in their management of child and adolescent mental health. Mental health problems in 5–19-year-olds are common, yet detection rates in primary care are low. The symptoms of most adult diagnoses of mental health problems are present by mid-adolescence, yet the typical time from onset to diagnosis is 5–15 years. The role of general practice in this area has been underexplored. Aim This pilot study explores the potential of GPs to respond to common mental health problems in children and adolescents. Design Children and young people who would have ordinarily been referred to Child and Adolescent Mental Health Services (CAMHS) were seen in a GP setting. In a UK general practice surgery serving a disadvantaged population. Method Children and young people were seen for an initial biopsychosocial assessment and formulation of the presenting concerns. GP-based interventions were offered as appropriate or referred to CAMHS. Results Data from the first 50 children (2–19 years) are presented. Twenty younger children (10 years and under) and 30 older children (11 years and above) were seen. Eighteen referrals were made to CAMHS. GP interventions included watchful waiting, brief behavioural interventions, non-directive counselling, brief cognitive– behavioural therapy (CBT) and liaison with colleagues in education, CAMHS and the voluntary sector. Conclusion This clinical pilot demonstrates that with adequate time, access to supervision and practice support, children and young people experiencing emotional and behavioural problems associated with common mental health issues can be helped in primary care. PMID:23730336

Academic Impact of a Public Electronic Health Database: Bibliometric Analysis of Studies Using the General Practice Research Database

PubMed Central

Chen, Yu-Chun; Wu, Jau-Ching; Haschler, Ingo; Majeed, Azeem; Chen, Tzeng-Ji; Wetter, Thomas

2011-01-01

Background Studies that use electronic health databases as research material are getting popular but the influence of a single electronic health database had not been well investigated yet. The United Kingdom's General Practice Research Database (GPRD) is one of the few electronic health databases publicly available to academic researchers. This study analyzed studies that used GPRD to demonstrate the scientific production and academic impact by a single public health database. Methodology and Findings A total of 749 studies published between 1995 and 2009 with ‘General Practice Research Database’ as their topics, defined as GPRD studies, were extracted from Web of Science. By the end of 2009, the GPRD had attracted 1251 authors from 22 countries and been used extensively in 749 studies published in 193 journals across 58 study fields. Each GPRD study was cited 2.7 times by successive studies. Moreover, the total number of GPRD studies increased rapidly, and it is expected to reach 1500 by 2015, twice the number accumulated till the end of 2009. Since 17 of the most prolific authors (1.4% of all authors) contributed nearly half (47.9%) of GPRD studies, success in conducting GPRD studies may accumulate. The GPRD was used mainly in, but not limited to, the three study fields of “Pharmacology and Pharmacy”, “General and Internal Medicine”, and “Public, Environmental and Occupational Health”. The UK and United States were the two most active regions of GPRD studies. One-third of GRPD studies were internationally co-authored. Conclusions A public electronic health database such as the GPRD will promote scientific production in many ways. Data owners of electronic health databases at a national level should consider how to reduce access barriers and to make data more available for research. PMID:21731733

A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars

PubMed Central

2013-01-01

Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP) registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL) scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%). Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia and overseas. Resilience was also lower than might be expected of a satisfied and professionally successful cohort. PMID:23294479

How common is multiple general practice attendance in Australia?

PubMed

Wright, Michael; Hall, Jane; van Gool, Kees; Haas, Marion

2018-05-01

Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

PubMed Central

Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-01-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013–2014 (n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014. PMID:29096580

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey.

PubMed

Cowling, Thomas E; Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-11-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013-2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government ('General Medical Services' 54.6%; 4337/7949). Few practices were limited companies with locally negotiated 'Alternative Provider Medical Services' contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference -3.04, 95% CI -4.15 to -1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (-12.78, 95% CI -15.17 to -10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013-2014.

The effect of feedback to general practitioners on quality of care for people with type 2 diabetes. A systematic review of the literature

PubMed Central

Guldberg, Trine Lignell; Lauritzen, Torsten; Kristensen, Jette Kolding; Vedsted, Peter

2009-01-01

Background There have been numerous efforts to improve and assure the quality of treatment and follow-up of people with Type 2 diabetes (PT2D) in general practice. Facilitated by the increasing usability and validity of guidelines, indicators and databases, feedback on diabetes care is a promising tool in this aspect. Our goal was to assess the effect of feedback to general practitioners (GPs) on the quality of care for PT2D based on the available literature. Methods Systematic review searches were conducted using October 2008 updates of Medline (Pubmed), Cochrane library and Embase databases. Additional searches in reference lists and related articles were conducted. Papers were included if published in English, performed as randomized controlled trials, studying diabetes, having general practice as setting and using feedback to GPs on diabetes care. The papers were assessed according to predefined criteria. Results Ten studies complied with the inclusion criteria. Feedback improved the care for PT2D, particularly process outcomes such as foot exams, eye exams and Hba1c measurements. Clinical outcomes like lowering of blood pressure, Hba1c and cholesterol levels were seen in few studies. Many process and outcome measures did not improve, while none deteriorated. Meta analysis was unfeasible due to heterogeneity of the studies included. Two studies used electronic feedback. Conclusion Based on this review, feedback seems a promising tool for quality improvement in diabetes care, but more research is needed, especially of electronic feedback. PMID:19419548

Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia

PubMed Central

2017-01-01

Background: Patients’ behaviour in making decisions regarding health is currently changing from passive recipients to recipients who play an active role in taking action to control their health and taking self-care initiatives. Objectives: This study was conducted to evaluate the health seeking behaviour among general public and its associated factors; and to evaluate the medicine taking behaviour in public and the practice of self-medication. Methods: A cross-sectional study was undertaken among general public in Penang Island, Malaysia. A convenience sampling of 888 participants successfully completed the survey. Self-administered questionnaires were distributed among the residents in the north east of Penang Island. Results: This study showed that most of the participants chose to consult the physician when they experience any health problems (66.7%), followed by self-medication (20.9%). The first action for consulting the physician was significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI 1.04-8.89). The prevalence of self-medication was 54%. The practice of self-medication was significantly associated with Chinese participants, educated people, people with alone living status and people with more self-care orientation. Conclusion: Increasing the awareness of the public about the rational choice of getting medical assistance is a very important issue to control their health. A health education program is needed to increase the awareness about the use of medicines among the general public and to enable them to make the right decisions relating to health problems. PMID:28943981

Who wants to be a surgeon? A study of 300 first year medical students

PubMed Central

Fysh, Thomas HS; Thomas, Geraint; Ellis, Harold

2007-01-01

Background While medicine in general is becoming more female-dominated, women are still under-represented in surgery. Opinion is divided as to whether this is due to lifestyle considerations, disinterest or perceived discrimination. It is not clear at what stage these careers decisions are made. Methods 300 first year medical students at Guy's King's and St Thomas' School of Medicine (GKT) were asked their view on possible career choices at this stage. Results While men represented only 38% of the student population, they represented over two-thirds of the students wishing to pursue a career in surgery. Women still opt for general practice and paediatrics. Conclusion Surgery is a disproportionately unpopular career choice of the female first-year medical students of GKT compared to the male students. It appears that the choice is freely made and, at this stage at least, does not represent concerns about compatibility with lifestyle. PMID:17239248

[Computerised monitoring of integrated cervical screening. Indicators of diagnostic performance].

PubMed

Bucchi, L; Pierri, C; Amadori, A; Folicaldi, S; Ghidoni, D; Nannini, R; Bondi, A

2003-12-01

In a previous issue of this journal, we presented the background, rationale, general methods, and indicators of participation of a computerised system for the monitoring of integrated cervical screening, i.e. the integration of spontaneous Pap smear practice into organised screening. We also reported the results of the application of those indicators in the general database of the Pathology Department of Imola Health District in northern Italy. In the current paper, we present the rationale and definitions of indicators of diagnostic performance (total Pap smears and rate of unsatisfactory Pap smears, distribution by cytology class reported, rate of patients without timely follow-up, detection rate, positive predictive value, distribution of cytology classes reported by histology diagnosis, and distribution of cases of CIN and carcinoma registered by detection modality) as well as the results of their application in the same database as above.

The literature of medical ethics: Bernard Häring

PubMed Central

Soane, Brendan

1977-01-01

To the general reader and watcher of television programmes medical ethics may appear to be something new. This is not so, for hundreds of articles and many books have appeared over the last 10 years or so to discuss and analyse the problems arising from the practice of medicine. In this study of two larger works - Medical Ethics and Manipulation - both by Bernard Häring, a Roman Catholic theologian - Father Brendan Soane analyses these in some detail and sets their ideas in the context of what has already been written on the major issues of medical ethics and what is likely to be foremost in discussion in the near future. Many readers of this Journal already have the particular background of knowledge to see the problems in medicine which are in fact ethical but the general reader may require help and enlightenment and this is now provided for a special field within the field. PMID:874983

The collaboration of general practitioners and nurses in primary care: a comparative analysis of concepts and practices in Slovenia and Spain.

PubMed

Hämel, Kerstin; Vössing, Carina

2017-09-01

Aim A comparative analysis of concepts and practices of GP-nurse collaborations in primary health centres in Slovenia and Spain. Cross-professional collaboration is considered a key element for providing high-quality comprehensive care by combining the expertise of various professions. In many countries, nurses are also being given new and more extensive responsibilities. Implemented concepts of collaborative care need to be analysed within the context of care concepts, organisational structures, and effective collaboration. Background review of primary care concepts (literature analysis, expert interviews), and evaluation of collaboration in 'best practice' health centres in certain regions of Slovenia and Spain. Qualitative content analysis of expert interviews, presentations, observations, and group discussions with professionals and health centre managers. Findings In Slovenian health centres, the collaboration between GPs and nurses has been strongly shaped by their organisation in separate care units and predominantly case-oriented functions. Conventional power structures between professions hinder effective collaboration. The introduction of a new cross-professional primary care concept has integrated advanced practice nurses into general practice. Conventional hierarchies still exist, but a shared vision of preventive care is gradually strengthening attitudes towards team-oriented care. Formal regulations or incentives for teamwork have yet to be implemented. In Spain, health centres were established along with a team-based care concept that encompasses close physician-nurse collaboration and an autonomous role for nurses in the care process. Nurses collaborate with GPs on more equal terms with conflicts centring on professional disagreements. Team development structures and financial incentives for team achievements have been implemented, encouraging teams to generate their own strategies to improve teamwork. Clearly defined structures, shared visions of care and team development are important for implementing and maintaining a good collaboration. Central prerequisites are advanced nursing education and greater acceptance of advanced nursing practice.

Outcomes of endodontic therapy in general practice

PubMed Central

Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

2014-01-01

Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis. PMID:22547719

Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses

PubMed Central

Ringwalt, Chris; Gugelmann, Hallam; Garrettson, Mariana; Dasgupta, Nabarun; Chung, Arlene E; Proescholdbell, Scott K; Skinner, Asheley Cockrell

2014-01-01

BACKGROUND: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians’ opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown. OBJECTIVE: To examine the relationships between physicians’ and other providers’ primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP). METHODS: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ2 statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients’ pain diagnoses and demographic characteristics. RESULTS: Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner/family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races/ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8). CONCLUSIONS: Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP. PMID:24809067

General practice research: attitudes and involvement of Queensland general practitioners.

PubMed

Askew, Deborah A; Clavarino, Alexandra M; Glasziou, Paul P; Del Mar, Christopher B

2002-07-15

To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. Postal survey and semi-structured interviews conducted from May to September 2001. 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

The development of professional practice standards for Australian general practice nurses.

PubMed

Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

2017-08-01

The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.

Orthographic Competence among Multilingual School Children: Writing Moroccan Arabic in France

ERIC Educational Resources Information Center

Weth, Constanze

2015-01-01

This paper presents children's writing in their vernacular family language, Moroccan Arabic. It first provides some background to the family and school literacies of nine-year-old children of Moroccan Arabic (MA) background growing up in France with French literacy practices at school and Written Arabic literacy practices in the home. The paper…

Predicting Rural Practice Using Different Definitions to Classify Medical School Applicants as Having a Rural Upbringing

ERIC Educational Resources Information Center

Owen, John A.; Conaway, Mark R.; Bailey, Beth A.; Hayden, Gregory F.

2007-01-01

Purpose: This study determines the relationship between a medical school applicant's rural background and the likelihood of rural practice using different definitions of rural background. Methods: Cohort study of 599 physicians who entered the University of Virginia School of Medicine in 1990-1995 and graduated in 1994-1999. The…

Exclusionary Discipline Practices across Students' Racial/Ethnic Backgrounds and Disability Status: Findings from the Pacific Northwest

ERIC Educational Resources Information Center

Vincent, Claudia G.; Sprague, Jeffrey R.; Tobin, Tary J.

2012-01-01

We examined 2009-2010 data on exclusionary discipline practices from one state in the Pacific Northwest of the United States across students' racial/ethnic backgrounds and disability status. Our focus was on proportionate representation in exclusionary discipline actions and in the duration of those disciplinary actions. Descriptive outcomes…

Training our Future Endocrine Surgeons: A Look at the Endocrine Surgery Operative Experience of U.S. Surgical Residents

PubMed Central

Zarebczan, Barbara; Rajamanickam, Victoria; Leverson, Glen; Chen, Herbert; Sippel, Rebecca S

2010-01-01

Background Over the last 10 years the number of endocrine procedures performed in the US has increased significantly. We sought to determine if this has translated into an increase in operative volume for general surgery and otolaryngology residents. Method We evaluated records from the Resident Statistic Summaries of the RRC for US general surgery and otolaryngology residents for the years 2004-2008, specifically examining data on thyroidectomies and parathyroidectomies. Results Between 2004 and 2008, the average endocrine case volume of US general surgery and otolaryngology residents increased by approximately 15%, but otolaryngology residents performed over twice as many operations as US general surgery residents. The growth in case volume was mostly due to increases in the number of thyroidectomies performed by US general surgery and otolaryngology residents (17.9 to 21.8, p=0.007 and 46.5 to 54.4, p=0.04). Overall, otolaryngology residents also performed more parathyroidectomies than their general surgery counterparts (11.6 vs. 8.8, p=0.007). Conclusion Although there has been an increase in the number of endocrine cases performed by graduating US general surgery residents, this is significantly smaller than that of otolaryngology residents. In order to remain competitive, general surgery residents wishing to practice endocrine surgery may need to pursue additional fellowship training. PMID:21134536

Assessing the cost-effectiveness of a routine versus an extensive laboratory work-up in the diagnosis of anaemia in Dutch general practice.

PubMed

Kip, Michelle Ma; Schop, Annemarie; Stouten, Karlijn; Dekker, Soraya; Dinant, Geert-Jan; Koffijberg, Hendrik; Bindels, Patrick Je; IJzerman, Maarten J; Levin, Mark-David; Kusters, Ron

2018-01-01

Background Establishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up. Methods A decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up. Results The probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: -0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €-35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed. Conclusions The extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.

Barriers among Danish women and general practitioners to raising the issue of intimate partner violence in general practice: a qualitative study

PubMed Central

2014-01-01

Background Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women’s views and attitudes are regarding being asked about IPV. Methods Data were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. Results This study provides important knowledge regarding the barriers and attitudes towards inquiry about IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV. Conclusions It is acceptable to inquire about IPV with women in Denmark in a non-judgemental and respectful way. Informing about IPV prevalence is important prior to the inquiry. However, general practitioners require more awareness and training before a favourable environment for this change in procedure can be created. Further large-scale research is needed to support the evidence generated by this small study. PMID:24893567

Does an activity based remuneration system attract young doctors to general practice?

PubMed Central

2012-01-01

Background The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of current GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the potential entrants to general practice have for activity based vs. salary based payment systems. Methods In November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis. Results A total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice more attractive, while 17% considered it to make general practice less attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work pace. Conclusions Given a concern about low recruitment to general practice in Norway, and the fact that an increasing share of medical students is women, we were interested in the extent to which the current Norwegian remuneration system correspond with the preferences of potential GPs. This study suggests that an existing remuneration mechanism has a selection effect on who would like to become a GP. Those most attracted are income motivated men. Those deterred are risk averse, and less happy with a high work pace. More research is needed on the extent to which experienced GPs differ along the questions we asked potential GPs, as well as studying the relative importance of other attributes than payment schemes. PMID:22433750

Accessing primary care: a simulated patient study

PubMed Central

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-01-01

Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

Clinical Practices and Outcomes in Elderly Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

PubMed Central

Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L.; Bommer, Juergen; Port, Friedrich K.

2011-01-01

Summary Background and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Design, setting, participants, & measurements Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Conclusions Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice. PMID:21734085

Validation of the diagnosis of autism in general practitioner records

PubMed Central

Fombonne, Eric; Heavey, Lisa; Smeeth, Liam; Rodrigues, Laura C; Cook, Claire; Smith, Peter G; Meng, Linyan; Hall, Andrew J

2004-01-01

Background We report on the validity of the computerized diagnoses of autism in a large case-control study investigating the possible association between autism and the measles, mumps and rubella vaccine in the UK using the General Practitioner Research Database (GPRD). We examined anonymized copies of all relevant available clinical reports, including general practitioners' (GP) notes, consultant, speech therapy and educational psychologists reports, on 318 subjects born between 1973 and 1997 with a diagnosis of autism or a related disorder recorded in their electronic general practice record. Methods Data were abstracted to a case validation form allowing for the identification of developmental symptoms relevant to the diagnosis of pervasive developmental disorders (PDDs). Information on other background clinical and familial features was also abstracted. A subset of 50 notes was coded independently by 2 raters to derive reliability estimates for key clinical characteristics. Results For 294 subjects (92.5%) the diagnosis of PDD was confirmed after review of the records. Of these, 180 subjects (61.2%) fulfilled criteria for autistic disorder. The mean age at first recording of a PDD diagnosis in the GPRD database was 6.3 years (SD = 4.6). Consistent with previous estimates, the proportion of subjects experiencing regression in the course of their development was 19%. Inter-rater reliability for the presence of a PDD diagnosis was good (kappa = .73), and agreement on clinical features such as regression, age of parental recognition of first symptoms, language delay and presence of epilepsy was also good (kappas ranging from .56 to 1.0). Conclusions This study provides evidence that the positive predictive value of a diagnosis of autism recorded in the GPRD is high. PMID:15113435

Effect of an Education Programme for South Asians with Asthma and Their Clinicians: A Cluster Randomised Controlled Trial (OEDIPUS)

PubMed Central

Griffiths, Chris; Bremner, Stephen; Islam, Kamrul; Sohanpal, Ratna; Vidal, Debi-Lee; Dawson, Carolyn; Foster, Gillian; Ramsay, Jean; Feder, Gene; Taylor, Stephanie; Barnes, Neil; Choudhury, Aklak; Packe, Geoff; Bayliss, Elizabeth; Trathen, Duncan; Moss, Philip; Cook, Viv; Livingstone, Anna Eleri; Eldridge, Sandra

2016-01-01

Background People with asthma from ethnic minority groups experience significant morbidity. Culturally-specific interventions to reduce asthma morbidity are rare. We tested the hypothesis that a culturally-specific education programme, adapted from promising theory-based interventions developed in the USA, would reduce unscheduled care for South Asians with asthma in the UK. Methods A cluster randomised controlled trial, set in two east London boroughs. 105 of 107 eligible general practices were randomised to usual care or the education programme. Participants were south Asians with asthma aged 3 years and older with recent unscheduled care. The programme had two components: the Physician Asthma Care Education (PACE) programme and the Chronic Disease Self Management Programme (CDSMP), targeted at clinicians and patients with asthma respectively. Both were culturally adapted for south Asians with asthma. Specialist nurses, and primary care teams from intervention practices were trained using the PACE programme. South Asian participants attended an outpatient appointment; those registered with intervention practices received self-management training from PACE-trained specialist nurses, a follow-up appointment with PACE-trained primary care practices, and an invitation to attend the CDSMP. Patients from control practices received usual care. Primary outcome was unscheduled care. Findings 375 south Asians with asthma from 84 general practices took part, 183 registered with intervention practices and 192 with control practices. Primary outcome data were available for 358/375 (95.5%) of participants. The intervention had no effect on time to first unscheduled attendance for asthma (Adjusted Hazard Ratio AHR = 1.19 95% CI 0.92 to 1.53). Time to first review in primary care was reduced (AHR = 2.22, (1.67 to 2.95). Asthma-related quality of life and self-efficacy were improved at 3 months (adjusted mean difference -2.56, (-3.89 to -1.24); 0.44, (0.05 to 0.82) respectively. Conclusions A multi-component education programme adapted for south Asians with asthma did not reduce unscheduled care but did improve follow-up in primary care, self-efficacy and quality of life. More effective interventions are needed for south Asians with asthma. PMID:28030569

The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care

PubMed Central

de Lusignan, Simon; Gallagher, Hugh; Chan, Tom; Thomas, Nicki; van Vlymen, Jeremy; Nation, Michael; Jain, Neerja; Tahir, Aumran; du Bois, Elizabeth; Crinson, Iain; Hague, Nigel; Reid, Fiona; Harris, Kevin

2009-01-01

Background Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT) Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. Clinical Trials Registration ISRCTN56023731. ClinicalTrials.gov identifier. PMID:19602233

A theoretical and practical clarification on the calculation of reflection loss for microwave absorbing materials

NASA Astrophysics Data System (ADS)

Liu, Ying; Zhao, Kun; Drew, Michael G. B.; Liu, Yue

2018-01-01

Reflection loss is usually calculated and reported as a function of the thickness of microwave absorption material. However, misleading results are often obtained since the principles imbedded in the popular methods contradict the fundamental facts that electromagnetic waves cannot be reflected in a uniform material except when there is an interface and that there are important differences between the concepts of characteristic impedance and input impedance. In this paper, these inconsistencies have been analyzed theoretically and corrections provided. The problems with the calculations indicate a gap between the background knowledge of material scientists and microwave engineers and for that reason a concise review of transmission line theory is provided along with the mathematical background needed for a deeper understanding of the theory of reflection loss. The expressions of gradient, divergence, Laplacian, and curl operators in a general orthogonal coordinate system have been presented including the concept of reciprocal vectors. Gauss's and Stokes's theorems have been related to Green's theorem in a novel way.

Supernatural impotence: historical review with anthropological and clinical implications.

PubMed

Margolin, J; Witztum, E

1989-12-01

The historical and cultural background of the belief in supernatural impotence is presented, emphasizing its possible implications for clinical practice. A brief historical survey of the concept in Judaism and Christianity is followed by a short anthropological survey of supernatural impotence in different ethnic subcultures in Israel. A case demonstration exemplifies the connection between understanding the patient's cultural background and beliefs and the clinical competence of the therapist. The relationship between the clinical-therapeutic process in psychiatric practice and knowledge of the patient's cultural background and beliefs is stressed.

Patient initiated aggression - prevalence and impact for general practice staff.

PubMed

Herath, Pushpani; Forrest, Laura; McRae, Ian; Parker, Rhian

2011-06-01

Patient initiated aggression toward general practice staff can cause distress among staff, however, it is unknown how frequently practice staff experience patient aggression in the workplace. The aim of this study is to determine the national prevalence of patient aggression toward general practice staff. A clustered cross sectional survey involving general practice staff working in Australia. A questionnaire was posted to 1109 general practices nationally and 217 questionnaires were completed and returned (19.6% response rate). It was found that verbal aggression is commonly experienced by practice staff, particularly receptionists, whereas physical aggression is infrequent. Staff working in larger practices experience more verbal aggression and property damage or theft and it was reported that verbal aggression has a greater impact on staff wellbeing than physical aggression. This study provides some national evidence of the prevalence of patient aggression toward general practice staff. This may inform the development of policy and procedures.

The proposed general practice descriptors--will they influence preventive medicine?

PubMed

Moorhead, R G

1989-01-01

The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.

Influences on final year medical students' attitudes to general practice as a career.

PubMed

Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

2014-03-01

General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed Central

2013-01-01

Background Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. Methods An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. Results The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score ‘Preventive Services’ (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). Conclusions There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology. PMID:23510482

Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series.

PubMed

Fuchs, Cara; Lee, Jonathan K; Roemer, Lizabeth; Orsillo, Susan M

2013-02-01

A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g=.38, 95% CI=.11 - .64) to large (Hedges' g=1.32, 95% CI=.61 - 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.

The economic benefit for family/general medicine practices employing physician assistants.

PubMed

Grzybicki, Dana M; Sullivan, Paul J; Oppy, J Miller; Bethke, Anne-Marie; Raab, Stephen S

2002-07-01

To measure the economic benefit of a family/general medicine physician assistant (PA) practice. Qualitative description of a model PA practice in a family/general medicine practice office setting, and comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice. The study site was a family/general medicine practice office in southwestern Pennsylvania. The description of PA practice was obtained through direct observation and semistructured interviews during site visits in 1998. Comparison of site practice characteristics with published national statistics was performed to confirm the site's usefulness as a model practice. Data used for PA productivity analyses were obtained from site visits, interviews, office billing records, office appointment logs, and national organizations. The PA in the model practice had a same-task substitution ratio of 0.86 compared with the supervising physician. The PA was economically beneficial for the practice, with a compensation-to-production ratio of 0.36. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA was $52,592. Sensitivity analyses illustrated the economic benefit of a PA practice in a variety of theoretical family/general medicine practice office settings. Family/general medicine PAs are of significant economic benefit to practices that employ them.

General Aviation in Nebraska: Nebraska SATS Project Background Paper No. 1

NASA Technical Reports Server (NTRS)

Smith, Russell; Wachal, Jocelyn

2000-01-01

The Nebraska SATS project is a state-level component of NASA's Small Aircraft Transportation System (SATS). During the next several years the project will examine several different factors affecting SATS implementation in Nebraska. These include economic and taxation issues, public policy issues, airport planning processes, information dissemination strategies, and systemic change factors. This background paper profiles the general aviation system in Nebraska. It is written to provide information about the "context" within which SATS will be pursued. The primary focus is thus on describing and providing background information about the current situation. A secondary focus is on drawing general conclusions about the ability of the current system to incorporate the types of changes implied by SATS. First, some brief information on the U.S. aviation system is provided. The next two sections profile the current general aviation aircraft and pilot base. Nebraska's system of general aviation airports is then described. Within this section of the paper, information is provided on the different types of general aviation airports in Nebraska, airport activity levels and current infrastructure. The fourth major section of the background paper looks at Nebraska's local airport authorities. These special purpose local governments oversee the majority of the general aviation airports in the state. Among the items examined are total expenditures, capital expenditures and planning activities. Next, the paper provides background information on the Nebraska Department of Aeronautics (NDA) and recent Federal funding for general aviation in Nebraska. The final section presents summary conclusions.

To what extent do clinical notes by general practitioners reflect actual medical performance? A study using simulated patients.

PubMed Central

Rethans, J J; Martin, E; Metsemakers, J

1994-01-01

BACKGROUND. Review of clinical notes is used extensively as an indirect method of assessing doctors' performance. However, to be acceptable it must be valid. AIM. This study set out to examine the extent to which clinical notes in medical records of general practice consultations reflected doctors' actual performance during consultations. METHOD. Thirty nine general practitioners in the Netherlands were consulted by four simulated patients who were indistinguishable from real patients and who reported on the consultations. The complaints presented by the simulated patients were tension headache, acute diarrhoea and pain in the shoulder, and one presented for a check up for non-insulin dependent diabetes. Later, the doctors forwarded their medical records of these patients to the researchers. Content of consultations was measured against accepted standards for general practice and then compared with content of clinical notes. An index, or content score, was calculated as the measure of agreement between actions which had actually been recorded and actions which could have been recorded in the clinical notes. A high content score reflected a consultation which had been recorded well in the medical record. The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was also calculated. RESULTS. The mean content score (interquartile range) for the four types of complaint was 0.32 (0.27-0.37), indicating that of all actions undertaken, only 32% had been recorded. However, mean content scores for the categories 'medication and therapy' and 'laboratory examination' were much higher than for the categories 'history' and 'guidance and advice' (0.68 and 0.64, respectively versus 0.29 and 0.22, respectively). The correlation between number of actions across the four complaints recorded in the clinical notes and number of actions taken during the consultations was 0.54 (P < 0.05). CONCLUSION. The use of clinical notes to audit doctors' performance in Dutch general practice is invalid. However, the use of clinical notes to rank doctors according to those who perform many or a few actions in a consultation may be justified. PMID:8185988

Observed intra-cluster correlation coefficients in a cluster survey sample of patient encounters in general practice in Australia

PubMed Central

Knox, Stephanie A; Chondros, Patty

2004-01-01

Background Cluster sample study designs are cost effective, however cluster samples violate the simple random sample assumption of independence of observations. Failure to account for the intra-cluster correlation of observations when sampling through clusters may lead to an under-powered study. Researchers therefore need estimates of intra-cluster correlation for a range of outcomes to calculate sample size. We report intra-cluster correlation coefficients observed within a large-scale cross-sectional study of general practice in Australia, where the general practitioner (GP) was the primary sampling unit and the patient encounter was the unit of inference. Methods Each year the Bettering the Evaluation and Care of Health (BEACH) study recruits a random sample of approximately 1,000 GPs across Australia. Each GP completes details of 100 consecutive patient encounters. Intra-cluster correlation coefficients were estimated for patient demographics, morbidity managed and treatments received. Intra-cluster correlation coefficients were estimated for descriptive outcomes and for associations between outcomes and predictors and were compared across two independent samples of GPs drawn three years apart. Results Between April 1999 and March 2000, a random sample of 1,047 Australian general practitioners recorded details of 104,700 patient encounters. Intra-cluster correlation coefficients for patient demographics ranged from 0.055 for patient sex to 0.451 for language spoken at home. Intra-cluster correlations for morbidity variables ranged from 0.005 for the management of eye problems to 0.059 for management of psychological problems. Intra-cluster correlation for the association between two variables was smaller than the descriptive intra-cluster correlation of each variable. When compared with the April 2002 to March 2003 sample (1,008 GPs) the estimated intra-cluster correlation coefficients were found to be consistent across samples. Conclusions The demonstrated precision and reliability of the estimated intra-cluster correlations indicate that these coefficients will be useful for calculating sample sizes in future general practice surveys that use the GP as the primary sampling unit. PMID:15613248

[Manual therapy in general practice].

PubMed

Березуцкий, Владимир И

2016-01-01

The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists.

The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK

PubMed Central

Strong, Mark; South, Gail; Carlisle, Robin

2009-01-01

Background Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Methods Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated. Results Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 – 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01). Conclusion The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry. PMID:19558719

Community governance in primary health care: towards an international Ideal Type.

PubMed

Meads, Geoffrey; Russell, Grant; Lees, Amanda

2017-10-01

Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non-governmental status. Future policy and research priorities are outlined. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

PubMed Central

Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Friede, Tim; Stables, David

2010-01-01

Background Primary care databases contain cardiovascular disease risk factor data, but practical tools are required to improve identification of at-risk patients. Aim To test the effects of a system of electronic reminders (the ‘e-Nudge’) on cardiovascular events and the adequacy of data for cardiovascular risk estimation. Design of study Randomised controlled trial. Setting Nineteen general practices in the West Midlands, UK. Method The e-Nudge identifies four groups of patients aged over 50 years on the basis of estimated cardiovascular risk and adequacy of risk factor data in general practice computers. Screen messages highlight individuals at raised risk and prompt users to complete risk profiles where necessary. The proportion of the study population in the four groups was measured, as well as the rate of cardiovascular events in each arm after 2 years. Results Over 38 000 patients' electronic records were randomised. The intervention led to an increase in the proportion of patients with sufficient data who were identifiably at risk, with a difference of 1.94% compared to the control group (95% confidence interval [CI] = 1.38 to 2.50, P<0.001). A corresponding reduction occurred in the proportion potentially at risk but requiring further data for a risk estimation (difference = –3.68%, 95% CI = –4.53 to –2.84, P<0.001). No significant difference was observed in the incidence of cardiovascular events (rate ratio = 0.96, 95% CI = 0.85 to 1.10, P = 0.59). Conclusion Automated electronic reminders using routinely collected primary care data can improve the adequacy of cardiovascular risk factor information during everyday practice and increase the visibility of the at-risk population. PMID:20353659

Protocol for the 'e-Nudge trial': a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380

PubMed Central

Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen

2006-01-01

Background Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial. PMID:16646967

Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study

PubMed Central

2013-01-01

Background The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations. Method A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data. Exacerbation cases were matched to three controls and characteristics compared using conditional logistic regression. Outcomes were compared using incidence rates and Cox regression, stratified by disease severity. Variability of prescribing at the GP level was evaluated graphically and by using multilevel models. Results COPD severity was found to be associated with exacerbation and subsequent mortality (very severe vs. mild, odds ratio for exacerbation 2.12 [95%CI 19.5–2.32]), hazard ratio for mortality 2.14 [95%CI 1.59–2.88]). Whilst 61% of exacerbation cases were prescribed antibiotics, this proportion varied considerably between GP practices (interquartile range, 48–73%). This variation is greater than can be explained by patient characteristics alone. Conclusions There is significant variability between GP practices in the prescribing of antibiotics to COPD patients experiencing exacerbations. Combined with a lack of evidence on the effects of treatment, this supports the need and opportunity for a large scale pragmatic randomised trial of the prescribing of antibiotics for COPD patients with exacerbations, in order to clarify their effectiveness and long term outcomes whilst ensuring the representativeness of subjects. PMID:23724907

The Future of General Surgery: Evolving to Meet a Changing Practice.

PubMed

Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

2016-01-01

Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Fearful or functional--a cross-sectional survey of the concepts of childhood fever among German and Turkish mothers in Germany.

PubMed

Langer, Thorsten; Pfeifer, Miriam; Soenmez, Aynur; Tarhan, Bilge; Jeschke, Elke; Ostermann, Thomas

2011-05-23

Fever is one of the most common presenting complaints in paediatrics and general practice. In the majority of cases nothing harmful is diagnosed. However, the subjective meaning of fever often varies between doctors and parents. Knowledge of the parents' concept of fever may help tailor counselling to their needs.In this study we determine 1) the influence of socio-economic status and cultural background on two concepts of fever which we labelled "functional" and "fearful", each representing typical experiences of mothers, and 2) the actions taken by the mothers related to these concepts. A standardized interview study was conducted among German and Turkish mothers in Germany in 2009. The questionnaire consisted of 36 questions and 205 items. Interviews were conducted in 16 private practices of paediatricians and 2 paediatric emergency departments in an urban region of Germany. The two fever concepts were represented in 6 statements that could be rated with a six-point Likert scale. The association of the socio-economic status and the cultural background with one of the fever concepts was determined by a multiple logistic regression. A total of 338 mothers (49% with a Turkish background) completed the interview (response rate 92%). The average age of mothers with a German background was higher (34.1 years vs. 32.0 years, p=0.0001). Mothers with a Turkish background were more likely to relate to the concept "fearful" [adjusted Odds Ratio (AOR) 1.99; confidence interval (CI) 1.16-3.44]. Mothers with a middle or high socio-economic status were more likely to respond to the concept "functional" [middle: AOR, 0.53; CI, 0.30-0.92; high: AOR, 0.44; CI, 0.21-0.95].Mothers adhering to the concept "fearful" more often gave acetaminophen before the recommended interval of 6 hours (46.8% vs. 31.3%, p=0.005) and visited out-of-hours services more frequently in the preceding 9 months than the other group (0.7 vs. 0.4, p=0.001). A Turkish migrant background and a low socio-economic status are associated with the fever concept "fearful". Mothers with these attributes seem to require specific and reassuring counselling as they use antipyretic drugs extensively and out-of-hours services frequently.

Integrating counselling into general practice.

PubMed

Stone, L; Blashki, G

2000-03-01

General practice counselling has many significant differences to counselling in other settings. General practitioners have long term relationships with their patients involving physical as well as mental health care. General practitioners are often the first point of contact for distressed patients who may not perceive their problem to have a psychological basis. There are barriers to counselling including time management and cultural expectations of the consultation. To outline a practical biopsychosocial model for counselling in the general practice setting using the knowledge and skills unique to each GP. Theoretical and practical barriers to counselling commonly encountered in general practice are discussed. Assessing the problem in a biopsychosocial format highlights strengths and skills the patient already possesses and involves consideration of physical sensations, emotions, behaviours, key relationships, family, social roles and resources. Counselling in general practice requires flexibility and an ability to adapt available resources to address patient needs in an individually appropriate way.

Generalized Optical Theorem Detection in Random and Complex Media

NASA Astrophysics Data System (ADS)

Tu, Jing

The problem of detecting changes of a medium or environment based on active, transmit-plus-receive wave sensor data is at the heart of many important applications including radar, surveillance, remote sensing, nondestructive testing, and cancer detection. This is a challenging problem because both the change or target and the surrounding background medium are in general unknown and can be quite complex. This Ph.D. dissertation presents a new wave physics-based approach for the detection of targets or changes in rather arbitrary backgrounds. The proposed methodology is rooted on a fundamental result of wave theory called the optical theorem, which gives real physical energy meaning to the statistics used for detection. This dissertation is composed of two main parts. The first part significantly expands the theory and understanding of the optical theorem for arbitrary probing fields and arbitrary media including nonreciprocal media, active media, as well as time-varying and nonlinear scatterers. The proposed formalism addresses both scalar and full vector electromagnetic fields. The second contribution of this dissertation is the application of the optical theorem to change detection with particular emphasis on random, complex, and active media, including single frequency probing fields and broadband probing fields. The first part of this work focuses on the generalization of the existing theoretical repertoire and interpretation of the scalar and electromagnetic optical theorem. Several fundamental generalizations of the optical theorem are developed. A new theory is developed for the optical theorem for scalar fields in nonhomogeneous media which can be bounded or unbounded. The bounded media context is essential for applications such as intrusion detection and surveillance in enclosed environments such as indoor facilities, caves, tunnels, as well as for nondestructive testing and communication systems based on wave-guiding structures. The developed scalar optical theorem theory applies to arbitrary lossless backgrounds and quite general probing fields including near fields which play a key role in super-resolution imaging. The derived formulation holds for arbitrary passive scatterers, which can be dissipative, as well as for the more general class of active scatterers which are composed of a (passive) scatterer component and an active, radiating (antenna) component. Furthermore, the generalization of the optical theorem to active scatterers is relevant to many applications such as surveillance of active targets including certain cloaks, invisible scatterers, and wireless communications. The latter developments have important military applications. The derived theoretical framework includes the familiar real power optical theorem describing power extinction due to both dissipation and scattering as well as a reactive optical theorem related to the reactive power changes. Meanwhile, the developed approach naturally leads to three optical theorem indicators or statistics, which can be used to detect changes or targets in unknown complex media. In addition, the optical theorem theory is generalized in the time domain so that it applies to arbitrary full vector fields, and arbitrary media including anisotropic media, nonreciprocal media, active media, as well as time-varying and nonlinear scatterers. The second component of this Ph.D. research program focuses on the application of the optical theorem to change detection. Three different forms of indicators or statistics are developed for change detection in unknown background media: a real power optical theorem detector, a reactive power optical theorem detector, and a total apparent power optical theorem detector. No prior knowledge is required of the background or the change or target. The performance of the three proposed optical theorem detectors is compared with the classical energy detector approach for change detection. The latter uses a mathematical or functional energy while the optical theorem detectors are based on real physical energy. For reference, the optical theorem detectors are also compared with the matched filter approach which (unlike the optical theorem detectors) assumes perfect target and medium information. The practical implementation of the optical theorem detectors is based for certain random and complex media on the exploitation of time reversal focusing ideas developed in the past 20 years in electromagnetics and acoustics. In the final part of the dissertation, we also discuss the implementation of the optical theorem sensors for one-dimensional propagation systems such as transmission lines. We also present a new generalized likelihood ratio test for detection that exploits a prior data constraint based on the optical theorem. Finally, we also address the practical implementation of the optical theorem sensors for optical imaging systems, by means of holography. The later is the first holographic implementation the optical theorem for arbitrary scenes and targets.

Proactive cancer care in primary care: a mixed-methods study

PubMed Central

Murray, Scott A

2013-01-01

Background. Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. Objectives. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. Methods. A two-phase mixed methods action research project. An electronic Cancer Ongoing Review Document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. Results. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Conclusions. Anticipatory cancer care from diagnosis to cure or death, ‘in primary care’, is feasible in the UK and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions. PMID:23382502

Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

PubMed Central

Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

2016-01-01

Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

Vertical Integration in Teaching And Learning (VITAL): an approach to medical education in general practice.

PubMed

Dick, Marie-Louise B; King, David B; Mitchell, Geoffrey K; Kelly, Glynn D; Buckley, John F; Garside, Susan J

2007-07-16

There is increasing demand to provide clinical and teaching experiences in the general practice setting. Vertical integration in teaching and learning, whereby teaching and learning roles are shared across all learner stages, has the potential to decrease time demands and stress on general practitioners, to provide teaching skills and experience to GP registrars, and to improve the learning experience for medical students, and may also help meet the increased demand for teaching in general practice. We consider potential advantages and barriers to vertical integration of teaching in general practice, and provide results of focus group discussions with general practice principals and registrars about vertical integration. We recommend further research into the feasibility of using vertical integration to enhance the capacity to teach medical students in general practice.

Dermal Matrices and Bioengineered Skin Substitutes: A Critical Review of Current Options

PubMed Central

Hamdi, Moustapha; Abberton, Keren; Morrison, Wayne

2015-01-01

Background: Over recent decades, scientists and surgeons have collaborated to develop various bioengineered and synthetic products as an alternative to skin grafts. Despite the numerous articles and reviews written about dermal skin substitutes, there is no general consensus. Methods: This article reviews dermal skin scaffolds used in clinical applications and experimental settings. For scaffold evaluation, we focused on clinical and/or histological results, and conclusions are listed. Explanations for general trends were sought based on existing knowledge about tissue engineering principles and wound healing mechanisms. Results: Decellularized dermis seems to remain the best option with no other acellular scaffold being clinically proven to gain better results yet. In general, chemically cross-linked products were seen to be less effective in skin tissue engineering. Biocompatibility could be enhanced by preseeding substitutes with fibroblasts to allow some natural scaffold remodeling before product application. Conclusions: Skin substitutes are a useful tool in plastic and reconstructive surgery practices as an alternative to skin grafts. In the choice of substitute, the general plastic surgery principle of replacing like tissue with like tissue seems to be still standing, and products most resembling the natural dermal extracellular matrix should be preferred. PMID:25674365

Impact of the 2004 GMS contract on practice nurses:

PubMed Central

McGregor, Wendy; Jabareen, Hussein; O'Donnell, Catherine A; Mercer, Stewart W; Watt, Graham CM

2008-01-01

ABSTRACT Background The new GMS contract has led to practice nurses playing an important role in the delivery of the Quality and Outcomes Framework (QOF). Aim This study investigated how practice nurses perceive the changes in their work since the contract's inception. Design of study A qualitative approach, sampling practice nurses from practices in areas of high and low deprivation, with a range of QOF scores. Setting Glasgow, UK. Method Individual interviews were conducted, audiotaped, transcribed, and analysed using a thematic approach. Results Three themes emerged: roles and incentives, workload, and patient care. Practice nurses were positive about the development of their professional role since the introduction of the new GMS contract but had mixed views about whether their status had changed. Views on incentives (largely related to financial rewards) also varied, but most felt under-rewarded, irrespective of practice QOF achievement. All reported a substantial increase in workload, related to incentivised QOF domains with greater ‘box ticking’ and data entry, and less time to spend with patients. Although the structure created by the new contract was generally welcomed, many were unconvinced that it improved patient care and felt other important areas of care were neglected. Concern was also expressed about a negative effect of the QOF on holistic care, including ethical concerns and detrimental effects on the patient–nurse relationship, which were regarded as a core value. Conclusions The new GMS contract has given practice nurses increased responsibility. However, discontent about how financial gains are distributed and negative impacts on core values may lead to detrimental long-term effects on motivation and morale. PMID:18826783

Homogeneous Yang-Baxter deformations as generalized diffeomorphisms

NASA Astrophysics Data System (ADS)

Sakamoto, Jun-ichi; Sakatani, Yuho; Yoshida, Kentaroh

2017-10-01

Yang-Baxter (YB) deformations of string sigma model provide deformed target spaces. We propose that homogeneous YB deformations always lead to a certain class of β-twisted backgrounds and represent the bosonic part of the supergravity fields in terms of the classical r-matrix associated with the YB deformation. We then show that various β-twisted backgrounds can be realized by considering generalized diffeomorphisms in the undeformed background. Our result extends the notable relation between the YB deformations and (non-commuting) TsT transformations. We also discuss more general deformations beyond the YB deformations.

Flexible but boring: medical students' perceptions of a career in general practice.

PubMed

Koehler, Nicole; McMenamin, Christine

2016-07-01

Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

PubMed Central

Mayne, Stephanie L.; Ross, Michelle E.; Song, Lihai; McCarn, Banita; Steffes, Jennifer; Liu, Weiwei; Margolis, Benyamin; Azuine, Romuladus; Gotlieb, Edward; Grundmeier, Robert W.; Leslie, Laurel K.; Localio, Russell; Wasserman, Richard

2016-01-01

BACKGROUND: Primary care pediatricians increasingly care for children’s mental health problems, but little is known about practice-level variation in diagnosis and psychotropic medication prescribing practices. METHODS: This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with ≥1 office visit from January 1, 2009, to June 30, 2014. We examined variability in diagnosis and psychotropic prescribing across practices using logistic regression with practice fixed effects and evaluated associations of the availability of colocated or community-based mental health providers or the proportion of children in foster care with diagnosis and prescribing using generalized linear mixed models. RESULTS: Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%–16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving ≥2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied (stimulants, 3%–18%; antidepressants, 1%–12%; α-agonists, 0%–8%; second-generation antipsychotics, 0%–5%). Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care. CONCLUSIONS: The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability. Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes. PMID:27244791

A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

PubMed

Hampton, Kerry D; Newton, Jennifer M; Parker, Rhian; Mazza, Danielle

2016-07-01

To understand the barriers and enablers to fertility-awareness education in general practice. Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. A descriptive exploratory qualitative study using deductive content analysis. General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. © 2016 John Wiley & Sons Ltd.

Interest in dental implantology and preferences for implant therapy: a survey of Victorian dentists.

PubMed

Cheung, M C; Kao, Plh; Lee, N; Sivathasan, D; Vong, C W; Zhu, J; Polster, A; Darby, I

2016-12-01

The purpose of this study was to gauge dentists' interest, knowledge and training in implantology, and to compare their treatment preferences with current literature. Subsequently, this information may be used to evaluate implantology education pathways. A cross-sectional postal survey of 600 randomly selected dentists registered with the Dental Practice Board of Victoria was conducted. Respondents were asked about background, interest and training in implantology, and implant treatment preferences. Results were analysed according to primary practice location, decade of graduation and attendance at continuing professional development (CPD) programmes. One hundred and seventy-six questionnaires were included for analysis. In general, dentists rate their implant knowledge, interest and enjoyment in restoring implants favourably. No differences were found between city and country practitioners, and different graduation decades. The level of CPD significantly influenced treatment preferences. Practitioners were generally unwilling to treat patients taking bisphosphonates, or to perform grafting procedures. Most dentists provide common services to treat peri-implant conditions. Direct-to-fixture is the most popular fixture-abutment connection. Overall, there is a high level of implant knowledge corresponding to current evidence in the literature. Level of CPD attendance is the most important factor in dentists' willingness to provide more implant therapy options. © 2016 Australian Dental Association.

Are medical educators following General Medical Council guidelines on obesity education: if not why not?

PubMed Central

2013-01-01

Background Although the United Kingdom’s (UK’s) General Medical Council (GMC) recommends that graduating medical students are competent to discuss obesity and behaviour change with patients, it is difficult to integrate this education into existing curricula, and clinicians report being unprepared to support patients needing obesity management in practice. We therefore aimed to identify factors influencing the integration of obesity management education within medical schools. Methods Twenty-seven UK and Irish medical school educators participated in semi-structured interviews. Grounded theory principles informed data collection and analysis. Themes emerging directly from the dataset illustrated key challenges for educators and informed several suggested solutions. Results Factors influencing obesity management education included: 1) Diverse and opportunistic learning and teaching, 2) Variable support for including obesity education within undergraduate medical programmes, and 3) Student engagement in obesity management education. Findings suggest several practical solutions to identified challenges including clarifying recommended educational agendas; improving access to content-specific guidelines; and implementing student engagement strategies. Conclusions Students’ educational experiences differ due to diverse interpretations of GMC guidelines, educators’ perceptions of available support for, and student interest in obesity management education. Findings inform the development of potential solutions to these challenges which may be tested further empirically. PMID:23578257

Setting the stage - building and working in an ancient DNA laboratory.

PubMed

Knapp, Michael; Clarke, Andrew C; Horsburgh, K Ann; Matisoo-Smith, Elizabeth A

2012-01-20

With the introduction of next generation high throughput sequencing in 2005 and the resulting revolution in genetics, ancient DNA research has rapidly developed from an interesting but marginal field within evolutionary biology into one that can contribute significantly to our understanding of evolution in general and the development of our own species in particular. While the amount of sequence data available from ancient human, other animal and plant remains has increased dramatically over the past five years, some key limitations of ancient DNA research remain. Most notably, reduction of contamination and the authentication of results are of utmost importance. A number of studies have addressed different aspects of sampling, DNA extraction and DNA manipulation in order to establish protocols that most efficiently generate reproducible and authentic results. As increasing numbers of researchers from different backgrounds become interested in using ancient DNA technology to address key questions, the need for practical guidelines on how to construct and use an ancient DNA facility arises. The aim of this article is therefore to provide practical tips for building a state-of-the-art ancient DNA facility. It is intended to help researchers new to the field of ancient DNA research generally, and those considering the application of next generation sequencing, in their planning process. Copyright © 2011 Elsevier GmbH. All rights reserved.

'A necessary evil that does not "really" cure disease': The domestication of biomedicine by Dutch holistic general practitioners.

PubMed

Raaphorst, Nadine; Houtman, Dick

2016-05-01

Against the background of studies about the domestication of complementary and alternative medicine into biomedical settings, this article studies how biomedicine is integrated into holistic settings. Data from 19 in-depth interviews with Dutch holistic general practitioners who combine complementary and alternative medicine with conventional treatments demonstrate that they do not believe that conventional biomedicine 'really' cures patients. They feel that it merely suppresses the physical symptoms of a disease, leaving the more fundamental and non-physical causes intact. As a consequence, they use conventional biomedicine for strictly practical and instrumental reasons. This is the case in life-threatening or acute situations, understood as non-physical causes of disease having been left untreated with complementary and alternative medicine for too long. More mundane reasons for its use are the need to take patients' demands for biomedical treatment seriously or to obey authoritative rules, regulations and protocols. The integration of biomedicine into complementary and alternative medicine, then, follows the same logic of domestication of complementary and alternative medicine into biomedicine: it is made subordinate to the prevailing model of health and illness and treated as a practical add-on that does not 'really' cure people. © The Author(s) 2015.

Academic health sciences library Website navigation: an analysis of forty-one Websites and their navigation tools

PubMed Central

Brower, Stewart M.

2004-01-01

Background: The analysis included forty-one academic health sciences library (HSL) Websites as captured in the first two weeks of January 2001. Home pages and persistent navigational tools (PNTs) were analyzed for layout, technology, and links, and other general site metrics were taken. Methods: Websites were selected based on rank in the National Network of Libraries of Medicine, with regional and resource libraries given preference on the basis that these libraries are recognized as leaders in their regions and would be the most reasonable source of standards for best practice. A three-page evaluation tool was developed based on previous similar studies. All forty-one sites were evaluated in four specific areas: library general information, Website aids and tools, library services, and electronic resources. Metrics taken for electronic resources included orientation of bibliographic databases alphabetically by title or by subject area and with links to specifically named databases. Results: Based on the results, a formula for determining obligatory links was developed, listing items that should appear on all academic HSL Web home pages and PNTs. Conclusions: These obligatory links demonstrate a series of best practices that may be followed in the design and construction of academic HSL Websites. PMID:15494756

What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan.

PubMed

Ie, Kenya; Murata, Akiko; Tahara, Masao; Komiyama, Manabu; Ichikawa, Shuhei; Takemura, Yousuke C; Onishi, Hirotaka

2018-01-01

Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

33 CFR 146.135 - Markings for emergency equipment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... inch high with a contrasting background: “General Alarm.” (c) All general alarm bells shall be identified by a sign at each bell in red letters at least one inch high with a sharp contrasting background...

Smartphones and Patient Care: Exploring the Use of Text-Based Messaging for Patient-Related Communication.

PubMed

Goldfarb, Jeremy; Kayssi, Ahmed; Devon, Karen; Rossos, Peter G; Cil, Tulin D

2016-06-01

Background Text messaging (texting) has become a routine medium of communication in society. However, its use among clinicians has not been fully characterized. We explored general surgery residents' practices and views on texting for patient-related communication. Methods An email survey was distributed to all general surgery residents at a large Canadian medical school. Results Overall, 46 (57%) of those surveyed responded. All used texting for patient-related communication. Eleven percent of residents did not have a password on their cell phone and 89% did not have encrypted phones. Texting was the most common way (41%) by which residents communicated routine patient-related information with staff physicians. Most (85%) residents agreed that texting enhances patient care. The majority (66%) did not know if their hospital had a policy on texting and were unaware of legislation surrounding texting in patient care (89%). Conclusions Most general surgery residents use texting for communication of routine patient-related care issues. However, they acknowledge concerns regarding the security of this medium. © The Author(s) 2016.

Cross-cultural training of general practitioner registrars: how does it happen?

PubMed

Watt, Kelly; Abbott, Penny; Reath, Jenny

2016-01-01

An equitable multicultural society requires general practitioners (GPs) to be proficient in providing health care to patients from diverse backgrounds. GPs are required to have a certain attitudes, knowledge and skills known as cultural competence. Given its importance to registrar training, the aim of this study was to explore ways in which GP registrars are currently developing cultural competence. This study employed a survey design for GP registrars in Western Sydney. Training approaches to cultural competence that are relevant to the Australian General Practice setting include exposure to diversity, attitudes, knowledge and skills development. The 43 GP registrar respondents in Western Sydney are exposed to a culturally diverse patient load during training. Registrars report a variety of teachings related to cross-cultural training, but there is little consistency, with the most common approach entailing listening to patients' personal stories. Exposure to cultural diversity appears to be an important way in which cultural competency is developed. However, guidance and facilitation of skills development throughout this exposure is required and currently may occur opportunistically rather than consistently.

A pilot study of human response to general aviation aircraft noise

NASA Technical Reports Server (NTRS)

Stearns, J.; Brown, R.; Neiswander, P.

1983-01-01

A pilot study, conducted to evaluate procedures for measuring the noise impact and community response to general aviation aircraft around Torrance Municipal Airport, a typical large GA airport, employed Torrance Airport's computer-based aircraft noise monitoring system, which includes nine permanent monitor stations surrounding the airport. Some 18 residences near these monitor stations were equipped with digital noise level recorders to measure indoor noise levels. Residents were instructed to fill out annoyance diaries for periods of 5-6 days, logging the time of each annoying aircraft overflight noise event and judging its degree of annoyance on a seven-point scale. Among the noise metrics studied, the differential between outdoor maximum A-weighted noise level of the aircraft and the outdoor background level showed the best correlation with annoyance; this correlation was clearly seen at only high noise levels, And was only slightly better than that using outdoor aircraft noise level alone. The results indicate that, on a national basis, a telephone survey coupled with outdoor noise measurements would provide an efficient and practical means of assessing the noise impact of general aviation aircraft.

Cosmological constraints and comparison of viable f (R ) models

NASA Astrophysics Data System (ADS)

Pérez-Romero, Judit; Nesseris, Savvas

2018-01-01

In this paper we present cosmological constraints on several well-known f (R ) models, but also on a new class of models that are variants of the Hu-Sawicki one of the form f (R )=R -2/Λ 1 +b y (R ,Λ ) , that interpolate between the cosmological constant model and a matter dominated universe for different values of the parameter b , which is usually expected to be small for viable models and which in practice measures the deviation from general relativity. We use the latest growth rate, cosmic microwave background, baryon acoustic oscillations, supernovae type Ia and Hubble parameter data to place stringent constraints on the models and to compare them to the cosmological constant model but also other viable f (R ) models such as the Starobinsky or the degenerate hypergeometric models. We find that these kinds of Hu-Sawicki variant parametrizations are in general compatible with the currently available data and can provide useful toy models to explore the available functional space of f (R ) models, something very useful with the current and upcoming surveys that will test deviations from general relativity.

Orientation and mobility training for adults with low vision: a new standardized approach

PubMed Central

Ballemans, Judith; Kempen, Gertrudis IJM

2013-01-01

Background: Orientation and mobility training aims to facilitate independent functioning and participation in the community of people with low vision. Objective: (1) To gain insight into current practice regarding orientation and mobility training, and (2) to develop a theory-driven standardized version of this training to teach people with low vision how to orientate and be safe in terms of mobility. Study of current practice: Insight into current practice and its strengths and weaknesses was obtained via reviewing the literature, observing orientation and mobility training sessions (n = 5) and interviewing Dutch mobility trainers (n = 18). Current practice was mainly characterized by an individual, face-to-face orientation and mobility training session concerning three components: crystallizing client’s needs, providing information and training skills. A weakness was the lack of a (structured) protocol based on evidence or theory. New theory-driven training: A new training protocol comprising two face-to-face sessions and one telephone follow-up was developed. Its content is partly based on the components of current practice, yet techniques from theoretical frameworks (e.g. social-cognitive theory and self-management) are incorporated. Discussion: A standardized, tailor-made orientation and mobility training for using the identification cane is available. The new theory-driven standardized training is generally applicable for teaching the use of every low-vision device. Its acceptability and effectiveness are currently being evaluated in a randomized controlled trial. PMID:22734105

Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

PubMed Central

2011-01-01

Background Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored. Methods We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews. Results Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members. Conclusions We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries. PMID:21914183

Perceived Transcultural Self-Efficacy of Nurses in General Hospitals in Guangzhou, China

PubMed Central

Li, Juan; He, Zhuang; Luo, Yong; Zhang, Rong

2016-01-01

Background Conflicts arising from cultural diversity among patients and hospital staff in China have become intense. Hospitals have an urgent need to improve transcultural self-efficacy of nurses for providing effective transcultural nursing. Objective The purpose of the research was to (a) evaluate the current status of perceived transcultural self-efficacy of nurses in general hospitals in Guangzhou, China; (b) explore associations between demographic characteristics of nurses and their perceived transcultural self-efficacy; and (c) assess the reliability and validity of scores on the Chinese version of the Transcultural Self-Efficacy Tool (TSET). Methods A cross-sectional survey of registered nurses from three general hospitals was conducted. Quota and convenience sampling were used. Participants provided demographic information and answered questions on the TSET. Results A total of 1,156 registered nurses took part. Most nurses had a moderate level of self-efficacy on the Cognitive (87.9%), Practical (87%), and Affective (89.2%) TSET subscales. Nurses who were older; who had more years of work experience, higher professional titles, higher incomes, and a minority background; and who were officially employed (not temporary positions) had higher perceived transcultural self-efficacy. Reliability estimated using Cronbach’s alpha was .99 for the total TSET score; reliability for the three subscales ranged from .97 to .98. Confirmatory factor analysis of TSET scores showed good fit with a three-factor model. Conclusion The results of this study can provide insights and guidelines for hospital nursing management to facilitate design of in-service education systems to improve transcultural self-efficacy of nurses. PMID:27454552

Diffusion of an e-learning programme among Danish General Practitioners: A nation-wide prospective survey

PubMed Central

Waldorff, Frans Boch; Steenstrup, Annette Plesner; Nielsen, Bente; Rubak, Jens; Bro, Flemming

2008-01-01

Background We were unable to identify studies that have considered the diffusion of an e-learning programme among a large population of general practitioners. The aim of this study was to investigate the uptake of an e-learning programme introduced to General Practitioners as part of a nation-wide disseminated dementia guideline. Methods A prospective study among all 3632 Danish GPs. The GPs were followed from the launching of the e-learning programme in November 2006 and 6 months forward. Main outcome measures: Use of the e-learning programme. A logistic regression model (GEE) was used to identify predictors for use of the e-learning programme. Results In the study period, a total of 192 different GPs (5.3%) were identified as users, and 17% (32) had at least one re-logon. Among responders at first login most have learnt about the e-learning programme from written material (41%) or from the internet (44%). A total of 94% of the users described their ability of conducting a diagnostic evaluation as good or excellent. Most of the respondents used the e-learning programme due to general interest (90%). Predictors for using the e-learning programme were Males (OR = 1.4, 95% CI 1.1; 2.0) and members of Danish College of General Practice (OR = 2.2, 95% CI 1.5; 3.1), whereas age, experience and working place did not seem to be influential. Conclusion Only few Danish GPs used the e-learning programme in the first 6 months after the launching. Those using it were more often males and members of Danish College of General Practice. Based on this study we conclude, that an active implementation is needed, also when considering electronic formats of CME like e-learning. Trial Registration ClinicalTrials.gov Identifier: NCT00392483. PMID:18439279

Improving Breast Cancer Outcomes among Women in China: Practices, Knowledge, and Attitudes Related to Breast Cancer Screening

PubMed Central

Wu, Tsu-Yin; Liu, Yi-Lan; Chung, Scott

2012-01-01

Background. Breast cancer is a major public health issue and the most commonly diagnosed cancer for women worldwide. Despite lower incidence rates than those living in Western countries, breast cancer incidence among Chinese women has increased dramatically in the past 20 years. Nevertheless, there is a paucity of studies reporting the attitudes toward and practices of breast cancer screening among Chinese women. Methods. This cross-sectional study examined the practices, knowledge, and attitudes toward breast cancer screening (BCS) on a convenience sample of 400 Chinese women. Results. Among study participants, 75% of the women never had a mammogram and the top three barriers reported were low priority, feeling OK, and lack of awareness/knowledge toward breast cancer screening. The results from the logistic regression model showed increased self-efficacy; having performed monthly self-exams, and having had clinical breast exams in the past two years were significant correlates while demographic variables were not correlated with screening behaviors. Conclusion. The findings provide a foundation to better understand beliefs and practices of Chinese women toward BCS and highlight the critical need for general public, health professionals, and the health care system to work collaboratively toward improving the quality of breast cancer care in this population. PMID:23304529

Compliance with infection control practices in sputum microscopy centres: a study from Kerala, India

PubMed Central

Ubaid, N. P.; Nagaraja, S. B.; Shewade, H. D.; Padmanabhan, K. V.; Naik, B. R.; Satpati, M.; Blesson, S.; Jayasree, A. K.

2015-01-01

Background: One of the strategies of the Revised National Tuberculosis Control Programme in India to achieve tuberculosis control is by increasing case detection through a nationwide network of designated microscopy centres (DMC). Practice of standard precautions for infection control in these DMCs is very important to prevent transmission of infection not only to the laboratory personnel, but also to the general population. However, in India this has not been evaluated by an external agency. Method: A cross-sectional study was carried out to assess knowledge, facilities and compliance regarding infection control practices (ICP) in all 38 DMCs in Kannur district, Kerala, India, in 2015. Using observations and interviews, the investigators collected data in a structured format. Results: Overall knowledge about infection control was found to be satisfactory among 29% of laboratory technicians. Overall facilities for infection control were satisfactory in 61% of the DMCs, while adherence to ICP was satisfactory in 45% of the DMCs. Knowledge regarding ICP was better in government DMCs, whereas facilities for ICP and adherence to biomedical waste management guidelines were better in private DMCs. Conclusion: Given the higher risk of infection among laboratory technicians, there is an urgent need to address the shortcomings in infection control practices. PMID:26767180

Psychoactive Drugs in Plastic Surgery

PubMed Central

Davison, Steven P.; Hayes, Kylie D.

2017-01-01

Background: Psychoactive drug use is on the rise in the United States, with plastic surgery patients a potentially susceptible group. This study aimed to determine the incidence of cosmetic and reconstructive patients in our practice taking psychoactive drugs and to compare those values with the national average. Furthermore, we discuss the patient safety concerns when patients withhold their medical history information over the course of their treatment. Methods: Urban private plastic practice patients who underwent surgery in a closed practice from 2009 to 2016 were divided into cosmetic and reconstructive cohorts. Review for drug use was medical scripts, history, and Surescripts drug reporting. Extracted information includes age, race, procedure, psychoactive medications, and whether or not they stated a mental health diagnosis on their medical history forms. Only patients with complete records were included. Results: A total of 830 patients were included in statistical analysis. Due to minimal cohort number, 70 men were excluded, as there were no comparative national data. Our analysis found that 33.6% cosmetic patients and 46.3% reconstructive patients used at least one psychoactive drug. Conclusion: There is a statistically significant difference between psychoactive drug use at our practice compared with the general population and a significantly larger percentage of reconstructive patients taking drugs compared with the cosmetic cohort. PMID:28458985

Nurses' perceptions of the organizational attributes of their practice environment in acute care hospitals.

PubMed

Hinno, Saima; Partanen, Pirjo; Vehviläinen-Julkunen, Katri; Aaviksoo, Ain

2009-12-01

The aim of the present study was to examine Estonian nurses' thinking with regard to how they perceive their autonomy, control over practice, teamwork and organizational support in regional, central and general hospitals. BACKGROUND; Despite the well-documented fact that there is a need to improve nurses' working environments in hospitals to promote safe patient care, in Europe broader studies on this topic have not received priority thus far. A nationally representative stratified random sample of 478 acute care hospital nurses was surveyed using the Nursing Work Index-Revised (NWI-R) instrument in 2005/2006. Nurses perceived their autonomy, control over practice and organizational support remarkably lower than nurse-physician relationships. Age and tenure were highly related to the nurses' perceptions. The Estonian nurses' ambivalent perceptions of the organizational attributes reflected the effects ascribed to hospital reforms. There is an urgent need for nurse managers to be particularly alert and attentive with regard to nurses who have been practising the profession for more than a decade. Support for their practice should be provided with the long-term goal of assuring the retention of those experienced nurses. Continuous monitoring of nurses' perceptions should be used systematically as a tool for staffing decisions at the hospital level.

DRG coding practice: a nationwide hospital survey in Thailand

PubMed Central

2011-01-01

Background Diagnosis Related Group (DRG) payment is preferred by healthcare reform in various countries but its implementation in resource-limited countries has not been fully explored. Objectives This study was aimed (1) to compare the characteristics of hospitals in Thailand that were audited with those that were not and (2) to develop a simplified scale to measure hospital coding practice. Methods A questionnaire survey was conducted of 920 hospitals in the Summary and Coding Audit Database (SCAD hospitals, all of which were audited in 2008 because of suspicious reports of possible DRG miscoding); the questionnaire also included 390 non-SCAD hospitals. The questionnaire asked about general demographics of the hospitals, hospital coding structure and process, and also included a set of 63 opinion-oriented items on the current hospital coding practice. Descriptive statistics and exploratory factor analysis (EFA) were used for data analysis. Results SCAD and Non-SCAD hospitals were different in many aspects, especially the number of medical statisticians, experience of medical statisticians and physicians, as well as number of certified coders. Factor analysis revealed a simplified 3-factor, 20-item model to assess hospital coding practice and classify hospital intention. Conclusion Hospital providers should not be assumed capable of producing high quality DRG codes, especially in resource-limited settings. PMID:22040256

Business aspects and sustainability for healthgrids - an expert survey.

PubMed

Scholz, Stefan; Semler, Sebastian C; Breitner, Michael H

2009-01-01

Grid computing initiatives in medicine and life sciences are under pressure to prove their sustainability. While some first business model frameworks were outlined, few practical experiences were considered. This gap has been narrowed by an international survey of 33 grid computing experts with biomedical and non-biomedical background on business aspects. The experts surveyed were cautiously optimistic about a sustainable implementation of grid computing within a mid term timeline. They identified marketable application areas, stated the underlying value proposition, outlined trends and specify critical success factors. From a general perspective of their answers, they provided a stable basis for a road map of sustainable grid computing solutions for medicine and life sciences.

PRIME – PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice

PubMed Central

Walker, Anne E; Grimshaw, Jeremy; Johnston, Marie; Pitts, Nigel; Steen, Nick; Eccles, Martin

2003-01-01

Background Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective) in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice. The objectives of the study are: to amplify and populate scientifically validated theories of behaviour with evidence from the experience of health professionals; to use this as a basis for developing predictive questionnaires using replicable methods; to identify which elements of the questionnaire (i.e., which theoretical constructs) predict clinical practice and distinguish between evidence compliant and non-compliant practice; and on the basis of these results, to identify variables (based on theoretical constructs) that might be prime targets for behaviour change interventions. Methods We will develop postal questionnaires measuring two motivational, three action and one stage theory to explore five behaviours with 800 general medical and 600 general dental practitioners. We will collect data on performance for each of the behaviours. The relationships between predictor variables (theoretical constructs) and outcome measures (data on performance) in each survey will be assessed using multiple regression analysis and structural equation modelling. In the final phase of the project, the findings from all surveys will be analysed simultaneously adopting a random effects approach to investigate whether the relationships between predictor variables and outcome measures are modified by behaviour, professional group or geographical location. PMID:14683530

Supervision--growing and building a sustainable general practice supervisor system.

PubMed

Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

2011-06-06

This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

Video-assisted feedback in general practice internships using German general practitioner's guidelines

PubMed Central

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out. PMID:23255963

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

PubMed

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.

PubMed

Galbraith, Kevin; Ward, Alison; Heneghan, Carl

2017-05-03

Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.

Nurse prescribing: reflections on safety in practice.

PubMed

Bradley, Eleanor; Hynam, Brian; Nolan, Peter

2007-08-01

This qualitative study explores how recently qualified nurse prescribers describe, and rate, the safety of their prescribing. Internationally, the costs of drug errors are enormous and they can have serious implications for staff and patients. Nurses are now undertaking extended prescribing practice throughout the UK. Nurse prescribers work across different work settings and although safe prescribing is a priority in all of them, it is essential to ascertain the conditions that foster the highest levels of safety and how nurses can be supported in practice. Thirty-one nurses form the West Midlands area of England agreed to participate in an in-depth interview which sought to elicit their responses to various aspects of their prescribing work. They came from a variety of specialities and from hospital, community and general practice backgrounds. On completion of their training nurses were acutely aware of the responsibility that prescribing imposed on them. Although this awareness was thought to encourage caution and safety, it may also account for the fact that 26% of the nurses (n=8) had not prescribed since qualifying. Nurses felt that the multidisciplinary team had a vital role to play in supporting their prescribing practice as did collaborative working. It is concluded that those working in specialty areas that are less well-defined in terms of scope of practice (e.g. older adult nursing and learning disability) would benefit in particular from ongoing mentoring relationships with experienced prescribers and the development of individual formularies.

Self-Care Practices among Diabetes Patients in Addis Ababa: A Qualitative Study

PubMed Central

Tewahido, Dagmawit; Berhane, Yemane

2017-01-01

Background Self-care practices that include self-monitoring of blood sugar level, diet management, physical exercise, adherence to medications, and foot care are the cornerstones of diabetes management. However, very little is known about self-care in developing countries where the prevalence of diabetes is increasing. Objective The objective of this study was to describe self-care practices among individuals with type II diabetes in Addis Ababa, Ethiopia. Methods A qualitative method was used to gather data from type II diabetes patients. Patients were recruited from the outpatient diabetes clinics of two public hospitals in Addis Ababa. Data were collected using a semi structured interview guide. A thematic analysis approach was used to process the data. Results Overall self-care practices were not adequate. Most patients reported irregular self-monitoring of blood sugar. Dietary and physical exercise recommendations were inadequately practiced by most of the participants. Most patients better adhered to medication prescriptions. Patients generally lack proper information/knowledge regarding the importance of self-care and how it should be implemented. Based on reported behavior we identified three main categories of patients; which are those ‘endeavor to be compliant’, ‘confused’ and ‘negligent’. Conclusion Diabetes patients largely depend on prescribed medications to control their blood sugar level. The importance of proper self-care practices for effective management of diabetes is not adequately emphasized in diabetes care centers and patients lack sufficient knowledge for proper self-care. PMID:28045992

Supporting Primary Care Practices in Building Capacity to Use Health Information Data

PubMed Central

Fernald, Douglas; Wearner, Robyn; Dickinson, W. Perry

2014-01-01

Introduction: Our objective was to describe essential support resources and strategies in order to advance the pace and scope of the use of health information technology (HIT) data. Background and Context: Primary data were collected between January 2011 and October 2012. The primary study population comprised 51 primary care practices enrolled in the Colorado Beacon Consortium in western Colorado. Methods: We used qualitative methods embedded in a mixed-method evaluation: monthly narrative reports from practices; interviews with providers and staff; and focused, group discussions with quality improvement (QI) advisors and staff from the Health Information Technology Regional Extension Center. Findings: Practices valued effective support strategies to assist with using HIT, including the following: translating rules and regulations into individual practice settings; facilitating peer-to-peer connections; providing processes and tools for practice improvement; maintaining accountability and momentum; and providing local electronic health record (EHR) technical expertise. Benefits of support included improved quality measures, operational improvements, increased provider and staff engagement, and deeper understanding of EHR data. Discussion: The findings affirm the utility of practice facilitation for HIT-focused aims with personalized attention and cross-fertilization among practices for improvements. Facilitation to sustain ongoing improvements and prepare for future HIT-intensive improvement activities was highly valued. In addition to the general practice facilitator, an EHR technical expert was critical to improving practice capacity to use electronic clinical data. Collaborative learning expands the pool of mentors and teachers, who can further translate their own lessons into practical advice for their peers, yielding the emergence of a stronger sense of community among the practices. Conclusions: Using HIT more effectively in primary care will require sustained, focused efforts by practices as regulations, incentives and HIT evolve. Ongoing support for community-based practice facilitators; collaborative learning; and local, personalized EHR advisors will help practices care for patients while more effectively deploying HIT to improve care. PMID:25848621

The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review.

PubMed

Pettigrew, Luisa M; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

2018-03-01

Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. Systematic review. Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why. © British Journal of General Practice 2018.

Professional and spatial mobility of osteopathic physicians.

PubMed

Hassinger, E W; Gill, L S; Hobbs, D J; Hageman, R L

1979-12-01

The study examines changes in location of osteopathic and medical doctors in a 20-county area of rural Missouri over a 14-year period. Losses of osteopathic physicians were greater than medical doctors. However, there was a convergence over the 14-year period in background characteristics of the two types of physicians. The finding of greater spatial mobility of DOs is placed in the context of professional mobility of osteopathy. It is also argued that as practice opportunities for DOs increase, background factors associated with early socialization become more influential in choice of practice sites. The relationship of practice opportunities to choice of practice sites can be extended to foreign medical school graduates and "new health practitioners."

Regionalisation of general practice training--are we meeting the needs of rural Australia?

PubMed

Campbell, David G; Greacen, Jane H; Giddings, Patrick H; Skinner, Lesley P

2011-06-06

The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.

Hiring and Screening Practices of Agencies Supplying Paid Caregivers to Older Adults

PubMed Central

Lindquist, Lee A.; Cameron, Kenzie A.; Messerges-Bernstein, Joanne; Friesema, Elisha; Zickuhr, Lisa; Baker, David W.; Wolf, Michael

2012-01-01

Objectives To assess what screening practices agencies use in hiring caregivers and how caregiver competency is measured prior to assigning older adult responsibilities. Design One-to-one phone interviewers where interviewers posed as prospective clients seeking a caregiver for an older adult relative. Setting Cross-sectional cohort of agencies supplying paid caregivers to older adults in Illinois, California, Florida, Colorado, Arizona, Wisconsin, and Indiana. Participants 462 home care agencies were contacted, of which 84 were no longer in service, 165 offered only nursing care, and 33 were excluded. 180 agencies completed interviews. Measurements Agencies were surveyed about their hiring methods, screening measures, training practices, skill competencies assessments, and supervision. Open ended responses were qualitatively analyzed by two coders. Results To recruit caregivers, agencies primarily used print and internet (e.g. Craigslist.com) advertising (n=69, 39.2%) and word-of-mouth referrals (n=49, 27.8%). In hiring, agencies required prior “life experiences” (n=121, 68.8%) of which less (n=33, 27.2%) were specific to care giving. Screening measures included federal criminal background checks (n=96, 55.8%) and drug testing (n= 56, 31.8%). Agencies stated that the paid caregiver could perform medication reminding (n=169, 96.0%).Skill competency was assessed by caregiver self-report (n=103, 58.5%), testing (n=62, 35.2%), and client feedback (n=62, 35.2%). General caregiver training length ranged from 0–7 days. Supervision ranged from none to weekly and included home visits, phone calls, and caregivers visiting the central office. Conclusion Using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregiver. PMID:22724430

The Fallacy of the Longevity Elixir: Negligible Senescence May be Achieved, but Not by Using Something Physical.

PubMed

Kyriazis, Marios; Apostolides, Andreas

2015-01-01

The process of aging is a continuum of degeneration which eventually leads to loss of function and clinically manifest disease. Yet, in the purely therapeutic sense, there is a distinct clinical and practical separation between age-related degenerative diseases and the background process of aging itself. It is quite possible that biomedical technologies will prove invaluable in treating or alleviating the impact of distinct age-related degenerative diseases such as cardiovascular disease, arthritis or dementia. However, when it comes to addressing the fundamental, background stochastic nature of aging, it is unlikely that regenerative biotechnologies will have any appreciable impact in continually counteracting the process. In this paper we discuss some essential conceptual obstacles, both functional and translational, which will prove overwhelming and which preclude the notion that aging can be eliminated by using physical therapies. Our reasoning is two-fold: 1. Disruptive regenerative biotechnologies interfere with the complex, dynamic topological architecture of the human organism, in a manner that will render them unsuitable for clinical use against all age-related degeneration. 2. Even if some regenerative biotechnological treatments are developed in the laboratory, the translational issues will be insurmountable, and the treatments will thus be practically unusable by the general public at large. Predictions about the near or mid-term development of rejuvenating biotechnologies are not sufficiently grounded, and do not provide a framework for effective practical achievement of negligible senescence. Instead, the answer must lie in more global and abstract methods which align well with evolutionary mechanisms based on techno-cultural societal necessities. These are likely to operate in a way which ultimately may downgrade the importance of human aging and make it an evolutionarily unnecessary process.

Australian GPs' perceptions about child and adolescent overweight and obesity the Weight of Opinion study

PubMed Central

King, Lesley A; Loss, Julika HM; Wilkenfeld, Rachel L; Pagnini, Deanna L; Booth, Michael L; Booth, Susan L

2007-01-01

Background GPs can potentially play a significant role in assessing weight status, providing advice, and making referrals to address overweight and obesity and its consequences among children and adolescents. Aim To investigate the perceptions of GPs about overweight and obesity in children and adolescents, including the extent to which they perceive it as a concern, the factors they see as causal, what actions they consider might be needed, and their sense of responsibility and self-efficacy. Design of study A cross-sectional qualitative study of GPs' perceptions. Setting General practice and primary health care services in the state of New South Wales, Australia. Method Focus groups using a structured protocol were conducted with samples of GPs. Groups comprised a mix of male and female GPs from a range of cultural backgrounds and working in practices in low, medium and high socioeconomic areas. Data were recorded and transcribed. Content analysis was used to identify key themes. Results Many GPs are concerned about the increasing prevalence of childhood overweight and obesity. They are committed to dealing with the medical consequences, but are aware of the broad range of social causes. GPs perceived that parents are sensitive about this topic, making it difficult for them to raise the issue directly in clinical practice, unless they use lateral strategies. GPs were confident about providing advice, with some managing the problem independently, while others preferred to refer to specialised services. GPs perceived that there were significant barriers to patient compliance with advice. Conclusion Whereas some GPs manage patients' lifestyle change directly, including children's weight management, others prefer to refer. Programmes, service delivery systems, and resources to support both approaches are required. PMID:17263929

Hiring and screening practices of agencies supplying paid caregivers to older adults.

PubMed

Lindquist, Lee A; Cameron, Kenzie A; Messerges-Bernstein, Joanne; Friesema, Elisha; Zickuhr, Lisa; Baker, David W; Wolf, Michael

2012-07-01

To assess what screening practices agencies use in hiring caregivers and how caregiver competency is measured before assigning responsibilities in caring for older adults. One-to-one phone interviews in which interviewers posed as prospective clients seeking a caregiver for an older adult relative. Cross-sectional cohort of agencies supplying paid caregivers to older adults in Illinois, California, Florida, Colorado, Arizona, Wisconsin, and Indiana. Four hundred sixty-two home care agencies were contacted, of which 84 were no longer in service, 165 offered only nursing care, and 33 were excluded; 180 agencies completed interviews. Agencies were surveyed about their hiring methods, screening measures, training practices, skill competencies assessments, and supervision. Two coders qualitatively analyzed open-ended responses. To recruit caregivers, agencies primarily used print and Internet (e.g., Craigslist.com) advertising (n = 69, 39.2%) and word-of-mouth referrals (n = 49, 27.8%). In hiring, agencies required prior "life experiences" (n = 121, 68.8%) few of which (n = 33, 27.2%) were specific to caregiving. Screening measures included federal criminal background checks (n = 96, 55.8%) and drug testing (n = 56, 31.8%). Agencies stated that the paid caregiver could perform skills, such as medication reminding (n = 169, 96.0%). Skill competency was assessed according to caregiver self-report (n = 103, 58.5%), testing (n = 62, 35.2%), and client feedback (n = 62, 35.2%). General caregiver training length ranged from 0 to 7 days. Supervision ranged from none to weekly and included home visits, telephone calls, and caregivers visiting the central office. Using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregiver. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

A Cluster Randomised Controlled Trial of a Pharmacist-Led Collaborative Intervention to Improve Statin Prescribing and Attainment of Cholesterol Targets in Primary Care

PubMed Central

Lowrie, Richard; Lloyd, Suzanne M.; McConnachie, Alex; Morrison, Jill

2014-01-01

Background Small trials with short term follow up suggest pharmacists’ interventions targeted at healthcare professionals can improve prescribing. In comparison with clinical guidance, contemporary statin prescribing is sub-optimal and achievement of cholesterol targets falls short of accepted standards, for patients with atherosclerotic vascular disease who are at highest absolute risk and who stand to obtain greatest benefit. We hypothesised that a pharmacist-led complex intervention delivered to doctors and nurses in primary care, would improve statin prescribing and achievement of cholesterol targets for incident and prevalent patients with vascular disease, beyond one year. Methods We allocated general practices to a 12-month Statin Outreach Support (SOS) intervention or usual care. SOS was delivered by one of 11 pharmacists who had received additional training. SOS comprised academic detailing and practical support to identify patients with vascular disease who were not prescribed a statin at optimal dose or did not have cholesterol at target, followed by individualised recommendations for changes to management. The primary outcome was the proportion of patients achieving cholesterol targets. Secondary outcomes were: the proportion of patients prescribed simvastatin 40 mg with target cholesterol achieved; cholesterol levels; prescribing of simvastatin 40 mg; prescribing of any statin and the proportion of patients with cholesterol tested. Outcomes were assessed after an average of 1.7 years (range 1.4–2.2 years), and practice level simvastatin 40 mg prescribing was assessed after 10 years. Findings We randomised 31 practices (72 General Practitioners (GPs), 40 nurses). Prior to randomisation a subset of eligible patients were identified to characterise practices; 40% had cholesterol levels below the target threshold. Improvements in data collection procedures allowed identification of all eligible patients (n = 7586) at follow up. Patients in practices allocated to SOS were significantly more likely to have cholesterol at target (69.5% vs 63.5%; OR 1.11, CI 1.00–1.23; p = 0.043) as a result of improved simvastatin prescribing. Subgroup analysis showed the primary outcome was achieved by prevalent but not incident patients. Statistically significant improvements occurred in all secondary outcomes for prevalent patients and all but one secondary outcome (the proportion of patients with cholesterol tested) for incident patients. SOS practices prescribed more simvastatin 40 mg than usual care practices, up to 10 years later. Interpretation Through a combination of educational and organisational support, a general practice based pharmacist led collaborative intervention can improve statin prescribing and achievement of cholesterol targets in a high-risk primary care based population. Trial Registration International Standard Randomised Controlled Trials Register ISRCTN61233866 PMID:25405478

[Historical background of the acceptance of induced abortion].

PubMed

Obayashi, M

1982-12-01

Japanese attitude toward induced abortion with its historical background is examined. There is a record of induced abortion as early as the beginning of the 12th century. Abortion was practiced frequently as a means of family planning during Edo Period (1603-1867), especially among the poor. Shogunate and feudal lords were aware of the problem but generally acquiesced. Some Buddhist priest preached on the vice of abortion from a humanitarian point of view and suggested that each community should cooperate and regulate the practice. In 1842 Shogunate at last banned induced abortion in the capital, Edo, but left the rest of the country alone. Ironically this practice of voluntary abortion among the poor and the killing of newborns among peasants controlled the size of population of the nation throughout Edo Period, which saw 35 famines and undue taxation on peasants. In 1868 the new government of Meiji announced to have a tight control over midwives who performed abortion in most cases. In modernizing the nation the government advocated enlarged population under the slogan: rich nation with strong soldiers. This trend persisted till the end of World War II. Overpopulation and shortage of food after World War II with soldiers and people from lost colonies returning home prompted Japan to control her population and adopt a eugenic law. It was not until 1970's in the midst of women's liberation movement that Japanese women became aware of their own right to the reproductive aspect of their life. In comparison, in the United States Supreme Court decision in 1973 virtually legalized abortion and each state has responded to it differently. Prior to 1900 induced abortion was accepted as a means of birth control in the United States, and midwives had monopolized that area of medicine. Crusaders of anti-abortion from the turn of the century were not necessarily well publicized Catholics but "licensed" doctors who joined forces in their attempt to shut out midwives from medical practice.

The place of knowledge and evidence in the context of Australian general practice nursing.

PubMed

Mills, Jane; Field, John; Cant, Robyn

2009-01-01

The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.

Virtual Convergence: Exploring Culture and Meaning in Playscapes

ERIC Educational Resources Information Center

Abrams, Sandra Schamroth; Rowsell, Jennifer; Merchant, Guy

2017-01-01

Background: Research into digital practices and cultures repeatedly calls attention to the complexity of communication spaces and meaning-making practices. With the blurring of boundaries between online and offline, these entangled practices involve the interweaving of human, material, semiotic, and discursive practices. Purpose: This introductory…

General practitioners’ experiences using cognitive behavioural therapy in general practice: A qualitative study

PubMed Central

Aschim, Bente; Lundevall, Sverre; Martinsen, Egil W.; Frich, Jan C.

2011-01-01

Objective To explore GPs’ experiences using cognitive behavioural therapy (CBT), with a focus on factors that promote or limit the use of CBT in general practice. Design Qualitative study using data from written evaluation reports and focus-group interviews. Setting Norwegian general practice. Subjects GPs who participated in a longitudinal CBT course in the continuous medical education (CME) programme for GPs in Norway, of whom 19 filled in evaluation forms and 15 participated in focus-group interviews. Main outcome measures Experiences with the use of CBT in general practice. Results GPs used CBT mainly in the treatment of patients with anxiety disorders and depression. Factors that promoted the use of CBT in general practice were structured supervision and group counselling, receiving feedback on individual video-recorded consultations, and experiencing that one mastered the therapeutic techniques. Limiting factors were that it took some time before one mastered the techniques, lack of eligible patients, constraints related to attending group supervision during office hours, and the lack of financial incentives to use CBT in general practice. Conclusion Tailored training programmes in CBT for GPs may contribute to more frequent use of CBT in general practice. A formal recognition of CBT in the reimbursement scheme for GPs might counter limiting factors to an increased use of CBT in general practice. PMID:21861599

Improving vaccination cold chain in the general practice setting.

PubMed

Page, Sue L; Earnest, Arul; Birden, Hudson; Deaker, Rachelle; Clark, Chris

2008-10-01

This study compared temperature control in different types of vaccine storing refrigerators in general practice and tested knowledge of general practice staff in vaccine storage requirements. Temperature data loggers were set to serially record the temperature within vaccine refrigerators in 28 general practices, recording at 12 minute intervals over a period of 10 days on each occasion. A survey of vaccine storage knowledge and records of divisions of general practice immunisation contacts were also obtained. There was a significant relationship between type of refrigerator and optimal temperature, with the odds ratio for bar style refrigerator being 0.005 (95% CI: 0.001-0.044) compared to the purpose built vaccine refrigerators. Score on a survey of vaccine storage was also positively associated with optimal storage temperature. General practices that invest in purpose built vaccine refrigerators will achieve standards of vaccine cold chain maintenance significantly more reliably than can be achieved through regular cold chain monitoring and practice supports.

Specialization and the current practices of general surgeons.

PubMed

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area. There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005). Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

PubMed Central

Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

2015-01-01

Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

Global measures of outcome in a controlled comparison of pharmacological and psychological treatment of panic disorder and agoraphobia in primary care.

PubMed Central

Sharp, D M; Power, K G; Simpson, R J; Swanson, V; Anstee, J A

1997-01-01

BACKGROUND: Panic disorder, with and without agoraphobia, is a prevalent condition which presents primarily in general practice. Previous clinical outcome studies have been conducted mainly in specialist university departments or hospital settings, and have tended to employ complex rating scales that are not well suited for use as outcome measures in primary care. AIM: To evaluate the outcome, in a primary care setting, of fluvoxamine versus cognitive behaviour therapy, each used alone and in combination in a double-blind placebo-controlled framework, balanced for therapist contact. METHOD: A total of 149 patients satisfying DSMIII-R criteria for panic disorder were randomly allocated to receive one of the following: fluvoxamine, placebo, fluvoxamine plus cognitive behaviour therapy, placebo plus cognitive behaviour therapy, and cognitive behaviour therapy alone. These five treatment groups represent the minimum number acceptable for such a comparison to be made. All patients received an identical schedule of contact over 13 weeks. Measures of symptom severity, general health and social disruption were taken at entry point and end point; measures of change in symptoms were taken at end point only. Outcome was reported in terms of brief global ratings of severity of illness and change in symptoms, and of ratings of general health and social disruption that are suitable for use in general practice. RESULTS: All active treatment groups showed statistically significant advantages over placebo over a range of outcome ratings. The groups employing cognitive behaviour therapy showed the most robust and consistent response. CONCLUSION: The brief global measures reported here proved adequate to the task of assessing treatment outcome. Results indicate that treatments including cognitive behaviour therapy can be effective in the treatment of panic disorder and agoraphobia in primary care. PMID:9167318

Shared learning in general practice--facilitators and barriers.

PubMed

van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

2013-03-01

Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

PubMed Central

2013-01-01

Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs. PMID:23394162