What's in a dental practice-based research network? Characteristics of Northwest PRECEDENT dentists, their patients and office visits.

PubMed

DeRouen, Timothy A; Cunha-Cruz, Joana; Hilton, Thomas J; Ferracane, Jack; Berg, Joel; Zhou, Lingmei; Rothen, Marilynn

2010-07-01

The authors conducted a study to describe the general dentists, practices, patients and patient care patterns of the dental practice-based research network (PBRN) Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT). Northwest PRECEDENT is a dental PBRN of general and pediatric dentists and orthodontists from five U.S. states in the Northwest: Idaho, Montana, Oregon, Utah and Washington. The authors collected data from general dentists in Northwest PRECEDENT (n = 101) regarding the diagnosis and treatment of oral diseases in a survey with a systematic random sample of patients (N = 1,943) visiting their practices. They also obtained demographic data from the general dentists and their patients. The authors found that 50 percent of the general dentists were 51 to 60 years of age, 14 percent were female and 76 percent were non-Hispanic white. More than one-half (55 percent) of the dentists had practiced dentistry for more than 20 years, 83 percent had private solo practices and 32 percent practiced in rural community settings. The majority (71 percent) of patients visiting the dental practices was in the age range of 18 to 64 years, 55 percent were female and 84 percent were non-Hispanic white. In terms of reasons for seeking dental care, 52 percent of patients overall visited the dentist for oral examinations, checkups, prophylaxis or caries-preventive treatment. In the preceding year, 85 percent of the patients had received prophylaxis, 49 percent restorative treatments, 34 percent caries-preventive treatments and 10 percent endodontic treatments. Northwest PRECEDENT general dentists are dispersed geographically and are racially and ethnically diverse, owing in part to efforts by network administrators and coordinators to enroll minority dentists and those who practice in rural areas. Estimates of characteristics of dentists and patients in Northwest PRECEDENT will be valuable in planning future studies of oral diseases and treatments.

Barriers and facilitators to using a web-based tool for diagnosis and monitoring of patients with depression: a qualitative study among Danish general practitioners.

PubMed

Krog, Mette Daugbjerg; Nielsen, Marie Germund; Le, Jette Videbæk; Bro, Flemming; Christensen, Kaj Sparle; Mygind, Anna

2018-06-27

Depression constitutes a significant part of the global burden of diseases. General practice plays a central role in diagnosing and monitoring depression. A telemedicine solution comprising a web-based psychometric tool may reduce number of visits to general practice and increase patient empowerment. However, the current use of telemedicine solutions in the field of general practice is limited. This study aims to explore barriers and facilitators to using a web-based version of the Major Depression Inventory (eMDI) for psychometric testing of potentially depressive patients in general practice. Semi-structured individual interviews were conducted with nine general practitioners (GPs) from eight general practices in the Central Denmark Region. All interviewees had previous experience in using the eMDI in general practice. Determinants for using the eMDI were identified in relation to the GPs' capability, opportunity and motivation to change clinical behaviour (the COM-B system). Our results indicate that the main barriers for using the eMDI are related to limitations in the GPs' opportunity in regards to having the time it takes to introduce change. Further, the use of the eMDI seems to be hampered by the time-consuming login process. Facilitating factors included behavioural aspects of capability, opportunity and motivation. The implementation of the eMDI was facilitated by the interviewees' previous familiarity with the paper-based version of the tool. Continued use of the eMDI was facilitated by a time-saving documentation process and motivational factors associated with clinical core values. These factors included perceptions of improved consultation quality and services for patients, improved possibilities for GPs to prioritise their patients and improved possibilities for disease monitoring. Furthermore, the flexible nature of the eMDI allowed the GPs to use the paper-based MDI for patients whom the eMDI was not considered appropriate. Implementation of a telemedicine intervention in general practice can be facilitated by resemblance between the intervention and already existing tools as well as the perception among GPs that the intervention is time-saving and improves quality of care for the patients.

What do students actually do on an internal medicine clerkship? A log diary study.

PubMed

Murray, E; Alderman, P; Coppola, W; Grol, R; Bouhuijs, P; van der Vleuten, C

2001-12-01

There are limited data on the amount of time students spend on teaching and learning while on internal medicine clerkships, and existing data suggest a wide international variation. Community-based teaching of internal medicine is now widespread; but its strengths and weaknesses compared to traditional hospital based teaching are still unclear. To determine the proportion of time students spend on different activities on an internal medicine clerkship, and to determine whether this differs in general practice and in hospital. In addition we aimed to determine students' views on the educational value and enjoyment of various activities. Prospective completion of log diaries recording student activities. Each student was asked to complete the diary for two separate weeks of their internal medicine clerkship: one week of general practice-based teaching and one week of hospital-based teaching. The response rate was 68% (88/130). Students spent approximately 5.5 h per day on teaching and learning activities in both environments, with more time (50 min vs. 30 min, P = 0.007) on unsupervised interaction with patients in hospital than in general practice, and more time (53 min vs. 21 min, P < 0.001) undergoingassessment in general practice than in hospital. Standard deviations were wide, demonstrating the heterogeneous nature of the data. Students perceived supervised interaction with patients and teaching by doctors as the most educational activities in both environments, but found it even more educationally valuable and enjoyable in general practice than in hospital (mean score for educational value: 4.27 in general practice, 3.88 in hospital, P = 0.048; mean score for enjoyment 4.13 in general practice, 3.66 in hospital, P = 0.03). Students greatly value interactions with patients, perceiving these as both educational and enjoyable. Curriculum planners must continue to place patient-based learning at the centre of undergraduate medical education. The heterogeneity of the data suggests that individual students have very different experiences, despite apparently similar timetables.

Register-Recall Systems: Tools for Chronic Disease Management in General Practice.

PubMed

Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark

2004-09-01

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines.

PubMed

Barton, Christopher; Proudfoot, Judith; Amoroso, Cheryl; Ramsay, Emmae; Holton, Christine; Bubner, Tanya; Harris, Mark; Beilby, Justin

2009-06-01

We investigated the quality of primary care asthma management in a sample of Australian general practices. 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.

Cheques and challenges: business performance in New Zealand general practice.

PubMed

Greatbanks, Richard; Doolan-Noble, Fiona; McKenna, Alex

2017-09-01

INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.

Research in dental practice: a 'SWOT' analysis.

PubMed

Burke, F J T; Crisp, R J; McCord, J F

2002-03-01

Most dental treatment, in most countries, is carried out in general dental practice. There is therefore a potential wealth of research material, although clinical evaluations have generally been carried out on hospital-based patients. Many types of research, such as clinical evaluations and assessments of new materials, may be appropriate to dental practice. Principal problems are that dental practices are established to treat patients efficiently and to provide an income for the staff of the practice. Time spent on research therefore cannot be used for patient treatment, so there are cost implications. Critics of practice-based research have commented on the lack of calibration of operative diagnoses and other variables; however, this variability is the stuff of dental practice, the real-world situation. Many of the difficulties in carrying out research in dental practice may be overcome. For the enlightened, it may be possible to turn observations based on the volume of treatment carried out in practice into robust, clinically related and relevant research projects based in the real world of dental practice.

Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry.

PubMed

Chiang, Harmeet K; Best, Al M; Sarrett, David C

2017-09-01

To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice. Copyright © 2017 Elsevier Inc. All rights reserved.

A one-year practice-based learning programme for new general practice nurses in Scotland: evaluation of the pilot.

PubMed

Wakeling, Judy; Ferguson, Julie; Kennedy, Susan

2016-01-01

This paper summarises the evaluation of a pilot programme introduced by NHS Education for Scotland to provide education and skills training for nurses new to general practice. The programme was developed through extensive consultation with existing general practice nurses and was educationally accredited by the Royal College of General Practitioners and the Royal College of Nursing in 2013. Twelve nurses embarked upon the programme 2012-2013 and nine completed it. The programme was extensively evaluated through questionnaires (with supervisors, practice staff and participants), analysis of programme documentation and interviews with participants. Based on the evaluation feedback, alterations have been made to subsequent deliveries of the programme. These include removing some topic areas and lengthening the programme by three months. The programme continues to be successfully delivered and evaluation is ongoing to ensure it continues to meet nurses' needs.

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.

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

[Development of a pharmacological curriculum for general practice: Identifying and prescribing orally administered pharmacological substances with relevance for general practice].

PubMed

Straßner, Cornelia; Kaufmann-Kolle, Petra; Flum, Elisabeth; Schwill, Simon; Brandt, Bettina; Steinhäuser, Jost

2017-05-01

General practitioners (GPs) are among the specialists who prescribe the highest number of medication. Therefore the improvement of pharmacological competencies is an important part of the GP specialist training. The self-concept of general practice stating that GPs are the first contact persons for all health problems makes it challenging to define and acquire competencies for specialist training. While the "Competence-based Curriculum" developed by the German College of General Practitioners and Family Physicians defines diagnoses, reasons for counselling and competencies which are essential for general practice, a similar orientation guide is lacking for the pharmacological field. The aim of this study is to define and characterize pharmacological substances which every GP should know so well that he or she is able to conduct counselling and monitoring. We analysed private and public health insurance prescriptions of all general practices participating in the CONTENT project in the period from 2009 to 2014. The analysis was limited to substances with oral application which were prescribed at least once by at least 25 % (n = 11) of the practices. While the 100 most frequent prescriptions were included due to their frequency, less frequently prescribed substances were assessed concerning their relevance for general practice in a rating procedure. The substances included were classified by diagnoses and reasons for counselling. We analysed 1,912,896 prescriptions from 44 practices and 112,535 patients on the basis of the Anatomical Therapeutic Chemical (ATC) classification system. After applying the inclusion criteria, 453 substances were left, 302 of which were considered relevant for general practice and could be assigned to 45 diagnoses / reasons for counselling. The result of this study could be considered a working draft for a pharmacological curriculum for general practice, which may complement the "Competence-based Curriculum" in the medium term. Copyright © 2017. Published by Elsevier GmbH.

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

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

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

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

2009-03-23

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. 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. 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. Current Controlled Trials ISRCTN63355948.

Quality improvement activities associated with organisational capacity in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, Mark

2007-01-01

Clinical audit is recognised worldwide as a useful tool for quality improvement. A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice's capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.

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

PubMed

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

2017-04-01

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. 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. Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching. 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. 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. 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. © British Journal of General Practice 2017.

Stirring the Pot: Supporting and Challenging General Education Science, Technology, Engineering, and Mathematics Faculty to Change Teaching and Assessment Practice

ERIC Educational Resources Information Center

Stieha, Vicki; Shadle, Susan E.; Paterson, Sharon

2016-01-01

Evidence-based instructional practices (ebips) have been associated with positive student outcomes; however, institutions struggle to catalyze widespread adoption of these practices in general education science, technology, engineering, and mathematics (stem) courses. Further, linking ebips with integrated learning assessment is rarely discussed…

Provision of mental health care in general practice in Italy.

PubMed Central

Tansella, M; Bellantuono, C

1991-01-01

The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identify the best model of collaboration between psychiatric services and general practice services is becoming increasingly urgent. The chances of improving links between the two services and of developing a satisfactory liaison model are probably greater in countries such as Italy where psychiatric services are highly decentralized and community-based, than in countries where the psychiatric services are hospital-based. PMID:1807308

ARCADO - Adding random case analysis to direct observation in workplace-based formative assessment of general practice registrars.

PubMed

Ingham, Gerard; Fry, Jennifer; Morgan, Simon; Ward, Bernadette

2015-12-10

Workplace-based formative assessments using consultation observation are currently conducted during the Australian general practice training program. Assessment reliability is improved by using multiple assessment methods. The aim of this study was to explore experiences of general practice medical educator assessors and registrars (trainees) when adding random case analysis to direct observation (ARCADO) during formative workplace-based assessments. A sample of general practice medical educators and matched registrars were recruited. Following the ARCADO workplace assessment, semi-structured qualitative interviews were conducted. The data was analysed thematically. Ten registrars and eight medical educators participated. Four major themes emerged - formative versus summative assessment; strengths (acceptability, flexibility, time efficiency, complementarity and authenticity); weaknesses (reduced observation and integrity risks); and contextual factors (variation in assessment content, assessment timing, registrar-medical educator relationship, medical educator's approach and registrar ability). ARCADO is a well-accepted workplace-based formative assessment perceived by registrars and assessors to be valid and flexible. The use of ARCADO enabled complementary insights that would not have been achieved with direct observation alone. Whilst there are some contextual factors to be considered in its implementation, ARCADO appears to have utility as formative assessment and, subject to further evaluation, high-stakes assessment.

Evidence-Based Practice for Teachers of Children with Autism: A Dynamic Approach

ERIC Educational Resources Information Center

Lubas, Margaret; Mitchell, Jennifer; De Leo, Gianluca

2016-01-01

Evidence-based practice related to autism research is a controversial topic. Governmental entities and national agencies are defining evidence-based practice as a specific set of interventions that educators should implement; however, large-scale efforts to generalize autism research, which are often single-subject case designs, may be a setback…

Specialization and the Current Practices of General Surgeons

PubMed Central

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

Background 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. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of 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. Results 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 comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions 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. PMID:24210145

The characteristics of general practice and the attractiveness of working as a GP: medical students' views.

PubMed

Landstrom, Bjorn; Mattsson, Bengt; Nordin, Per; Rudebeck, Carl E

2014-03-15

The aim of the study was to investigate medical students' views on general practice based on their experiences in training, and to find out whether there were certain views associated with the intention to become a GP. A questionnaire, based on our earlier studies about GP working behaviour, was handed out to medical students in terms 1, 3, 5, 7, 10 and 11 of undergraduate studies in Gothenburg, Sweden. The analysis comprised statistical descriptions and comparisons. The students regarded general practice positively. They found the work environment good, the GP's awareness of patients' living conditions necessary, and that GP work requires medical breadth. The status of the GP in the medical profession was not considered high. One-fourth of the students strongly agreed with the possibility of a future as a GP. This attitude was statistically associated with support to the statements that general practice offers a good work environment and should be a major component in undergraduate training. Students with a negative attitude to working as GPs were also negative to having a major component of general practice in undergraduate training. Medical students with a positive stated attitude towards becoming GPs support changes in undergraduate training to include more general practice. The risk of increasing a negative attitude should be considered when changes are discussed.

Beyond the specific child. What is 'a child's case' in general practice?

PubMed

Hølge-Hazelton, Bibi; Tulinius, Charlotte

2010-01-01

Too many abused and neglected children are being overlooked by GPs and other professionals who are in contact with the families. Some suggestions for a definition of 'a child in need' have been given, but the functionality of these definitions has not been tested in general practice. To describe the problems presented by GPs as cases with children in need during supervision, and from here to suggest an empirically-based definition of a child in need in general practice. A mixed-method evaluation design was used. Twenty-one GPs, in Denmark, participated in supervision groups concerning cases with children in need in general practice. The data were analysed via field notes and video recordings; case categorisation into sex, ethnicity, and developmental stages; thematically using the GPs' own descriptions; and a theoretically supported style. Analysis of the data led to the suggested definition of a case concerning 'a child in need' in general practice as one that directly or indirectly involves problems with a specific child, an as-yet unborn child, or one or both parents of a family currently or potentially threatening the wellbeing of the family or the child. Based on this analysis, one suggestion as to why some abused and neglected children are overlooked in general practice is that GPs often have to navigate in difficult indirect consultations, where there is a high risk of losing the overview.

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.

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.

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

Gensichen, Jochen; Hiller, Thomas S; Breitbart, Jörg; Teismann, Tobias; Brettschneider, Christian; Schumacher, Ulrike; Piwtorak, Alexander; König, Hans-Helmut; Hoyer, Heike; Schneider, Nico; Schelle, Mercedes; Blank, Wolfgang; Thiel, Paul; Wensing, Michel; Margraf, Jürgen

2014-04-06

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. 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. Current Controlled Trials [http://ISCRTN64669297].

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

Operator priming and generalization of practice in adults' simple arithmetic.

PubMed

Chen, Yalin; Campbell, Jamie I D

2016-04-01

There is a renewed debate about whether educated adults solve simple addition problems (e.g., 2 + 3) by direct fact retrieval or by fast, automatic counting-based procedures. Recent research testing adults' simple addition and multiplication showed that a 150-ms preview of the operator (+ or ×) facilitated addition, but not multiplication, suggesting that a general addition procedure was primed by the + sign. In Experiment 1 (n = 36), we applied this operator-priming paradigm to rule-based problems (0 + N = N, 1 × N = N, 0 × N = 0) and 1 + N problems with N ranging from 0 to 9. For the rule-based problems, we found both operator-preview facilitation and generalization of practice (e.g., practicing 0 + 3 sped up unpracticed 0 + 8), the latter being a signature of procedure use; however, we also found operator-preview facilitation for 1 + N in the absence of generalization, which implies the 1 + N problems were solved by fact retrieval but nonetheless were facilitated by an operator preview. Thus, the operator preview effect does not discriminate procedure use from fact retrieval. Experiment 2 (n = 36) investigated whether a population with advanced mathematical training-engineering and computer science students-would show generalization of practice for nonrule-based simple addition problems (e.g., 1 + 4, 4 + 7). The 0 + N problems again presented generalization, whereas no nonzero problem type did; but all nonzero problems sped up when the identical problems were retested, as predicted by item-specific fact retrieval. The results pose a strong challenge to the generality of the proposal that skilled adults' simple addition is based on fast procedural algorithms, and instead support a fact-retrieval model of fast addition performance. (c) 2016 APA, all rights reserved).

Examining the Case for Functional Behavior Assessment as an Evidence-Based Practice for Students with Emotional and Behavioral Disorders in General Education Classrooms

ERIC Educational Resources Information Center

Scott, Terrance M.; Alter, Peter J.

2017-01-01

This article is a review of functional behavior assessment studies in general education setting for students with emotional and behavioral disorders. The studies were assessed in accordance with published standards for evidence-based practices. Overall, few studies met criteria for inclusion in this review and even fewer studies included all three…

Comparison of the Effects of Computer-Based Practice and Conceptual Understanding Interventions on Mathematics Fact Retention and Generalization

ERIC Educational Resources Information Center

Kanive, Rebecca; Nelson, Peter M.; Burns, Matthew K.; Ysseldyke, James

2014-01-01

The authors' purpose was to determine the effects of computer-based practice and conceptual interventions on computational fluency and word-problem solving of fourth- and fifth-grade students with mathematics difficulties. A randomized pretest-posttest control group design found that students assigned to the computer-based practice intervention…

Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities.

PubMed

Del Fante, Peter; Allan, Don; Babidge, Elizabeth

2006-01-01

The Practice Health Atlas (PHA) is a decision support tool for general practice, designed by the Adelaide Western Division of General Practice (AWDGP). This article describes the features of the PHA and its potential role in enhancing health care. In developing the PHA, the AWDGP utilises a range of software tools and consults with a practice to understand its clinical data management approach. The PHA comprises three sections: epidemiology, business and clinical modelling systems, access to services. The objectives include developing a professional culture around quality health data and synthesis of aggregated de-identified general practice data at both practice and divisional level (and beyond) to assist with local health needs assessment, planning, and funding. Evaluation occurs through group feedback sessions and from the general practitioners and staff. It has demonstrated its potential to fulfill the objectives in outcome areas such as data quality and management, team based care, pro-active practice population health care, and business systems development, thereby contributing to improved patient health outcomes.

GP wellbeing and general practice issues.

PubMed

Murfett, Amanda; Charman, Denise

2006-09-01

Studies of general practitioner wellbeing have demonstrated remarkably consistent findings. However, the implications for day-to-day general practice have been unclear. This study was based on a survey comprising items extracted from transcripts of interviews with GPs and designed to link general practice issues with self reported wellbeing. 480 GP Australian Family Physician (AFP) subscribers (2.18% response rate); aged 26-81 years (mean 45.5 years); 273 (56.9%) men and 199 (43.1%) women. A survey insert in AFP September 2003 with questions about wellbeing, demographic details and 27 items about general practice issues. Almost 15% reported poor/very poor wellbeing, 47% reported good wellbeing and 38% reported very good/excellent wellbeing. Poor wellbeing was associated with being single, divorced or widowed, and reports of being alone in an adversarial context and more negative reactions to patients. Excellent or very good wellbeing was associated with being coupled and reports of general practice as a vocation. Targeted wellbeing strategies advocating social support may ameliorate the stress of general practice, especially for those GPs who are single.

Non-steroidal anti-inflammatory drug prescribing patterns in general practice: comparison of a general practitioner-based survey and a pharmacy-based survey in France.

PubMed

Clinard, F; Sgro, C; Bardou, M; Dumas, M; Hillon, P; Bonithon-Kopp, C

2001-01-01

In order to assess biases occurring in primary care prescription studies, we compared non-steroidal anti-inflammatory drug (NSAID) prescribing patterns reported by general practitioners directly (GP-based survey) and from a pharmacy-based survey of general practitioner prescribing (pharmacy-based survey). Volunteer GPs of the administrative area of Côte d'Or (France) returned a mailed questionnaire on NSAID prescribing patterns for consecutive patients seen during a 2-month period. In order to obtain a reference basis, pharmacies of the same administrative area provided all prescriptions that included NSAIDs during a 1-week period originating in general practice. The rate of participation was 25% for the GPs and 40% for the pharmacies. Participant GPs were representative of GPs of the area with regard to sex, year of graduation and practice area but pharmacies from rural areas were over-represented. The GP-based survey and the pharmacy-based survey provided respectively 770 and 1050 prescriptions. There were no differences between either survey in the type of NSAIDs prescribed and in the most frequently associated drugs. GPs who volunteered in the GP survey prescribed NSAIDs more frequently orally and at higher doses than GPs involved in the pharmacy-based survey. They also prescribed more gastroprotective drugs, especially in the elderly. None of these results could be explained by differences in patient characteristics and GP practice areas. GPs who actively participate in prescription surveys exhibit prescribing patterns that fit better with official recommendations than the average. Although selection biases cannot be ruled out, it is suggested that some changes in GP prescription habits may have been induced by the survey itself.

Need of Department of General Practice / Family Medicine at AIIMS (All India Institute of Medical Sciences): Why the apex medical institute in India should also contribute towards training and education of general practitioners and family physicians.

PubMed

Pal, Ranabir; Kumar, Raman

2017-01-01

Family medicine or general practice is the practicing discipline of the majority doctors in India, however formal academic departments of general practice (or family medicine) do not exist in India, as it is not a mandatory requirement as prescribed by the Medical Council of India; the principal regulator of medical education. Currently India has capacity to produce more than 60,000 medical graduates per year, majority of whom are expected to become general practitoners or primary care doctors without under going any vocational training in general practice or family medicine. The 92 nd parliamentary standing committee report (on health and family welfare) of the Indian Parliament recommended that Government of India in coordination with State Governments should establish robust postgraduate programs in Family Medicine and facilitate introducing Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous health care for the individuals and families. The authors concur with the parliament of India and strongly feel that "Family Medicine" (community-based comprehensive clinical practice) deserves dedicated and distinct department at all medical colleges in India in order to availability of qualified medical doctors in the community-based health system. AIIMS, New Delhi, along with other newly established AIIMS, should rise to their foundation mandate of supporting excellence in all disciplines of medical science and to this historic responsibility; and not just remain an ivory tower of tertiary care based fragmented (into sub specialties) hospital culture.

Need of Department of General Practice / Family Medicine at AIIMS (All India Institute of Medical Sciences): Why the apex medical institute in India should also contribute towards training and education of general practitioners and family physicians

PubMed Central

Pal, Ranabir; Kumar, Raman

2017-01-01

Family medicine or general practice is the practicing discipline of the majority doctors in India, however formal academic departments of general practice (or family medicine) do not exist in India, as it is not a mandatory requirement as prescribed by the Medical Council of India; the principal regulator of medical education. Currently India has capacity to produce more than 60,000 medical graduates per year, majority of whom are expected to become general practitoners or primary care doctors without under going any vocational training in general practice or family medicine. The 92nd parliamentary standing committee report (on health and family welfare) of the Indian Parliament recommended that Government of India in coordination with State Governments should establish robust postgraduate programs in Family Medicine and facilitate introducing Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous health care for the individuals and families. The authors concur with the parliament of India and strongly feel that “Family Medicine” (community-based comprehensive clinical practice) deserves dedicated and distinct department at all medical colleges in India in order to availability of qualified medical doctors in the community-based health system. AIIMS, New Delhi, along with other newly established AIIMS, should rise to their foundation mandate of supporting excellence in all disciplines of medical science and to this historic responsibility; and not just remain an ivory tower of tertiary care based fragmented (into sub specialties) hospital culture. PMID:29302511

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.

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.

A Phytase Enzyme-Based Biochemistry Practical Particularly Suited to Students Undertaking Courses in Biotechnology and Environmental Science

ERIC Educational Resources Information Center

Boyce, Angela; Casey, Anne; Walsh, Gary

2004-01-01

Courses in introductory biochemistry invariably encompass basic principles of enzymology, with reinforcement of lecture-based material in appropriate laboratory practicals. Students undertaking practical classes are more enthusiastic, and generally display improved performance, when the specific experiments undertaken show direct relevance to…

Irritable bowel syndrome in general practice: an overview.

PubMed

Oberndorff-Klein Woolthuis, A H; Brummer, R J M; de Wit, N J; Muris, J W M; Stockbrügger, R W

2004-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is frequently seen in gastroenterological practice. Population-based studies have shown that at any point in time IBS symptoms are present in about 3%-22% of the general Western population. In general practice, half of all new patients have functional disorders and IBS is responsible for about five consultations per week. General practitioners (GPs) manage the majority of IBS patients, but most knowledge (and research) is based on the smaller percentage of patients managed in secondary care. There is a paucity of literature on differences or similarities between these two groups with regard to clinical characteristics or diagnostic approach. The literature published in English about IBS in general practice was reviewed. Irritable bowel syndrome is frequently encountered in primary care. Primary care IBS patients, compared to secondary care patients, are likely to be young, female and to have less severe symptoms. But this is only true for some symptoms; for example, non-abdominal complaints are equally reported in both groups. The disorder can be diagnosed safely using internationally agreed symptom-based criteria, such as the Rome II criteria. Additional diagnostic measures will be necessary to support the diagnosis in only a minority of situations. Many primary care IBS patients can be managed given adequate reassurance and education, frequently without additional pharmacological treatment.

The Role of Food Parenting Skills and the Home Food Environment in Children's Weight Gain and Obesity.

PubMed

Gerards, S M P L; Kremers, S P J

2015-03-01

This paper presents an overview to provide readers with an update on the literature about the relation between parental influences (general parenting and food parenting practices) and children's weight-related outcomes. It first summarizes the evidence regarding the role of food parenting practices in shaping and maintaining children's nutritional and weight status. It then describes empirical evidence on the relation between general parenting and children's weight status. This evidence is less convincing, possibly because general parenting has a different, more distal role in influencing child behavior than parenting practices. General parenting may moderate the impact of food parenting practices on children's nutrition behaviors. Finally, we discuss studies on interventions targeting childhood overweight and obesity. There is no consensus on the optimal intervention targets (i.e., general parenting and/or food parenting practices). Based on the overview, we offer suggestions for future research.

Patient Engagement and Coaching for Health: The PEACH study--a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.

PubMed

Young, Doris; Furler, John; Vale, Margarite; Walker, Christine; Segal, Leonie; Dunning, Patricia; Best, James; Blackberry, Irene; Audehm, Ralph; Sulaiman, Nabil; Dunbar, James; Chondros, Patty

2007-04-11

The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice. In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures. Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.

Transforming family practice in British Columbia: the General Practice Services Committee.

PubMed

Cavers, William J R; Tregillus, Valerie H F; Micco, Angela; Hollander, Marcus J

2010-12-01

To describe a new approach to primary care reform developed in British Columbia (BC) under the leadership of the General Practice Services Committee (GPSC). COMPOSITION OF THE COMMITTEE: The GPSC is a joint committee of the BC Ministry of Health Services, the BC Medical Association, and the Society of General Practitioners of BC. Representatives of BC's health authorities also attend as guests. This paper is based on the 2008-2009 annual report of the GPSC. It summarizes the history and main activities of the GPSC. The GPSC is currently supporting a number of key activities to transform primary care in BC. These activities include the Full Service Family Practice Incentive Program, which provides incentive payments to promote enhanced primary care; the Practice Support Program, which provides family physicians and their medical office assistants with various practical evidence-based strategies and tools for managing practice enhancement; the Family Physicians for BC Program to develop family practices in areas of identified need; the Shared Care Committee, which supports and enables the determination of appropriate scopes of practice among GPs, specialists, and other health care professionals; the Divisions of Family Practice, which are designed to facilitate interactions among family doctors and between doctors and their respective health authorities; and the Community Healthcare and Resource Directory, a Web-based resource to help health care providers find appropriate mental health resources. Early results indicate that the GPSC's initiatives are enhancing the delivery of primary care services in BC.

Job satisfaction of practice assistants in general practice in Germany: an observational study.

PubMed

Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Brodowski, Marc; Steinhaeuser, Jost; Wensing, Michel; Szecsenyi, Joachim

2013-08-01

Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations. The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design. The study population consisted of 1158 practice assistants from 345 general practices across Germany. Job satisfaction was measured with the 10-item Warr-Cook-Wall questionnaire. Organizational culture was evaluated with four items. A linear regression analysis was performed in which each of the job satisfaction items was handled as dependent variable. Out of 1716 staff member questionnaires handed out to practice assistants, 1158 questionnaires were completed (response rate: 67.5%). Practice assistants were most satisfied with their colleagues and least satisfied with their income. Higher job satisfaction was associated with issues of organizational culture, particularly a good working atmosphere, opportunities to suggest and influence areas for improvement and clear responsibilities within the practice team. Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.

Educators' Self-Reported Training, Use, and Perceived Effectiveness of Evidence-Based Classroom Management Practices

ERIC Educational Resources Information Center

Cooper, Justin T.; Gage, Nicholas A.; Alter, Peter J.; LaPolla, Stefanie; MacSuga-Gage, Ashley S.; Scott, Terrance M.

2018-01-01

A survey study of 248 educators in four states was conducted to identify respondents' formal training, use, and perceived effectiveness of 37 evidence-based classroom management practices within four general categories: (a) antecedent-based, (b) instructionally based, (c) consequence-based, and (d) self-management. Results indicated that, on…

Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

PubMed

Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert

2015-05-06

Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

Investigation of under-ascertainment in epidemiological studies based in general practice.

PubMed

Sethi, D; Wheeler, J; Rodrigues, L C; Fox, S; Roderick, P

1999-02-01

One of the aims of the Study of Infectious Intestinal Disease (IID) in England is to estimate the incidence of IID presenting to general practice. This sub-study aims to estimate and correct the degree of under-ascertainment in the national study. Cases of presumed IID which presented to general practice in the national study had been ascertained by their GP. In 26 general practices, cases with computerized diagnoses suggestive of IID were identified retrospectively. Cases which fulfilled the case definition of IID and should have been ascertained to the coordinating centre but were not, represented the under-ascertainment. Logistic regression modelling was used to identify independent factors which influenced under-ascertainment. The records of 2021 patients were examined, 1514 were eligible and should have been ascertained but only 974 (64%) were. There was variation in ascertainment between the practices (30% to 93%). Patient-related factors independently associated with ascertainment were: i) vomiting only as opposed to diarrhoea with and without vomiting (OR 0.37) and ii) consultation in the surgery as opposed to at home (OR 2.18). Practice-related factors independently associated with ascertainment were: i) participation in the enumeration study component (OR 1.78), ii) a larger number of partners (OR 0.3 for 7-8 partners); iii) rural location (OR 2.27) and iv) previous research experience (OR 1.92). Predicted ascertainment percentages were calculated according to practice characteristics. Under-ascertainment of IID was substantial (36%) and non-random and had to be corrected. Practice characteristics influencing variation in ascertainment were identified and a multivariate model developed to identify adjustment factors which could be applied to individual practices. Researchers need to be aware of factors which influence ascertainment in acute epidemiological studies based in general practice.

Office and 24-h ambulatory blood pressure control by treatment in general practice: the 'Monitoraggio della pressione ARteriosa nella medicina TErritoriale' study.

PubMed

Zaninelli, Augusto; Parati, Gianfranco; Cricelli, Claudio; Bignamini, Angelo A; Modesti, Pietro A; Pamparana, Franco; Bilo, Grzegorz; Mancia, Giuseppe; Gensini, Gian F

2010-05-01

Guidelines recommend that blood pressure (BP) should be lowered in hypertensive patients to prevent cardiovascular accidents. Management of antihypertensive treatment by general practitioners is usually based on office measurements, which may not allow an assessment of BP control over 24 h, which requires ambulatory BP monitoring (ABPM) to be implemented. This is rarely done in general practice, and limited information is available on the consistency between the evaluations of the response to treatment provided by office measurement and by ABPM in this setting. To assess concordance between office BP measurements and ABPM-based estimates of hypertension control in a general practice setting. Prospective, comparative between techniques. General practice. Seventy-eight general practices, representative of all Italian regions, participated in this study by recruiting sequential hypertensive adults on stabilized treatment, who were subdivided into even groups with office BP, respectively, controlled or noncontrolled by treatment. In each individual, ABPM was applied by the general practitioner after appropriate training, and 24-h ABP values were defined as controlled or not according to current guidelines. Concordance between office and ABPM evaluation of BP control was assessed with kappa statistics. Positive and negative predictive values of office measurement versus ABPM were estimated. Between July 2005 and November 2006, 190 general practitioners recruited 2059 hypertensive patients based on office BP measurements; in 1728 patients, a 24-h ABPM was performed, yielding 1524 recordings considered as valid for further analysis. The agreement between the assessment of BP control by office measurement and by ABPM was poor (kappa = 0.120), with office measurements showing a satisfactory positive predictive value (0.842) and a poor negative predictive value (0.278); the situation was worse in patients with three or more among the following features: male sex, age of at least 65 years, alcohol consumption, diabetes, and obesity (negative predictive value = 0.149). In general practice, the agreement between assessment of BP control by treatment provided by office and ambulatory BP measurements is better in patients of 'uncontrolled' office BP than in 'controlled' office BP patients. This emphasizes the need for the larger use of out-of-office BP monitoring in a general practice setting, in particular, in patients considered as 'controlled' during consultation.

The conduct of practice-based research in community clinics compared to private practices: similarities, differences, and challenges

PubMed Central

Gillette, Jane; Cunha-Cruz, Joana; Gilbert, Ann; Speed-McIntyre, Pollene; Zhou, Lingmei; DeRouen, Timothy

2013-01-01

Practice-based research should be performed in all practice settings if the results are to be applied to all settings. However, some practice settings, such as community clinics, have unique features that may make the conduct of such research more challenging. The purpose of this article is to describe and compare the similarities and unique challenges related to conducting research in community clinics compared to private practices within the Northwest Practice-Based REsearch Collaborative in Evidence-Based DENTistry (PRECEDENT) network. Information was obtained from meetings with general dentists, a survey of general dentists (N = 253), and a clinical examination and record review of a systemic random sample of patients visiting community clinics and private practices. (N = 1903)—all part of a dental practice-based research network. The processes of conducting research, the dentist and patient sociodemographic characteristics, the prevalence of oral diseases, and the dental treatments received in community clinics and private practices were compared. Both community clinics and private practices have the clinical treatment of the patients as their priority and have time constraints on research. The processes of research training, obtaining informed consent, and collecting, transmitting, and securely maintaining research data are also similar. The patient populations and treatment needs differ substantially between community clinics and private practices, with a higher prevalence of dental caries and higher restorative treatment needs in the community clinic patients. The process of study participant selection and follow-up for research and the dentist and staff work arrangements also vary between the two practice settings. Although community clinic patients and their dental healthcare providers have different research needs and challenges than their counterparts in private practice, practice-based research can be successfully PMID:25429251

Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers

PubMed Central

Hartley, Sarah; Macfarlane, Fraser; Gantley, Madeleine; Murray, Elizabeth

1999-01-01

Objective To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice. Design Qualitative semistructured interview study. Setting General practices throughout north London. Subjects 30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice. Results The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching. Conclusions Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with. Key messagesThe increase in community based teaching of clinical skills requires an increase in the number of general practitioner teachersLittle evidence is available about the effect of teaching of clinical skills and teacher training on general practitioner teachers and practicesGeneral practitioner teachers reported an increase in morale, improvements in clinical skills, and changes in clinical practice and in practice infrastructure as a result of teaching and trainingGeneral practitioner teachers reported problems because of pressure on time, lack of space, problems recruiting patients, and unsupportive practice partnersPositive effects on morale and clinical practice may be important for sustainable teaching and continuing medical education PMID:10541508

Guidelines for computer security in general practice.

PubMed

Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

2007-01-01

As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

["General Practice is a great job anyway" - a qualitative study with vocational trainees].

PubMed

Steinhäuser, Jost; Paulus, Jan; Roos, Marco; Peters-Klimm, Frank; Ledig, Thomas; Szecsenyi, Joachim; Joos, Stefanie

2011-01-01

Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession. Copyright © 2010. Published by Elsevier GmbH.

Design, Development, and Psychometric Analysis of a General, Organic, and Biological Chemistry Topic Inventory Based on the Identified Main Chemistry Topics Relevant to Nursing Clinical Practice

ERIC Educational Resources Information Center

Brown, Corina E.

2013-01-01

This two-stage study focused on the undergraduate nursing course that covers topics in general, organic, and biological (GOB) chemistry. In the first stage, the central objective was to identify the main concepts of GOB chemistry relevant to the clinical practice of nursing. The collection of data was based on open-ended interviews of both nursing…

Chronic heart failure management in Australia -- time for general practice centred models of care?

PubMed

Scott, Ian; Jackson, Claire

2013-05-01

Chronic heart failure (CHF) is an increasingly prevalent problem within ageing populations and accounts for thousands of hospitalisations and deaths annually in Australia. Disease management programs for CHF (CHF-DMPs) aim to optimise care, with the predominant model being cardiologist led, hospital based multidisciplinary clinics with cardiac nurse outreach. However, findings from contemporary observational studies and clinical trials raise uncertainty around the effectiveness and sustainability of traditional CHF-DMPs in real-world clinical practice. To suggest an alternative model of care that involves general practitioners with a special interest in CHF liaising with, and being up-skilled by, specialists within community based, multidisciplinary general practice settings. Preliminary data from trials evaluating primary care based CHF-DMPs are encouraging, and further studies are underway comparing this model of care with traditional hospital based, specialist led CHF-DMPs. Results of studies of similar primary care models targeting diabetes and other chronic diseases suggest potential for its application to CHF.

Continuing education for general practice. 2. Systematic learning from experience.

PubMed Central

al-Shehri, A; Stanley, I; Thomas, P

1993-01-01

Prompted by evidence that the recently-adopted arrangements for ongoing education among established general practitioners are unsatisfactory, the first of a pair of papers examined the theoretical basis of continuing education for general practice and proposed a model of self-directed learning in which the experience of established practitioners is connected, through the media of reading, reflection and audit, with competence for the role. In this paper a practical, systematic approach to self-directed learning by general practitioners is described based on the model. The contribution which appropriate participation in continuing medical education can make to enhancing learning from experience is outlined. PMID:8373649

Community hospitals and general practice: extended attachments for medical students.

PubMed

Grant, J; Ramsay, A; Bain, J

1997-09-01

The first year experience of an innovative experiment in undergraduate medical education is described. The study investigated the educational effectiveness of prolonged clinical attachments for medical undergraduates in community hospital-based general practice. It has also assessed the ability of students to take some responsibility for their own learning in a clinically challenging environment. A retrospective evaluation of the experience obtained during the 3 month attachments for a self-selected group of fourth year Dundee medical school undergraduates was made. These undergraduates were placed in 10 mainly rural Scottish general practices with attached community hospitals providing a wide spectrum of inpatient and outpatient medical and surgical care. Students were assessed on the satisfactory completion of a portfolio of learning experiences and a practical clinical skills list. They were also required to submit a clinical project based on some aspect of their work during the attachment. The initial results showed a high degree of student and tutor satisfaction with the attachments. The assessment of all 10 of the students' educational achievements in their attachment were regarded as satisfactory and two were assessed as outstanding. Tutor assessment confirmed the validity of the initiative. Prolonged attachments in community hospital-based general practice for medical undergraduates have proved educationally valid and popular with both students and tutors. The development and dissemination of this model on a wider scale has resource issues which require to be addressed.

Health sciences libraries’ subscriptions to journals: expectations of general practice departments and collection-based analysis

PubMed Central

Barreau, David; Bouton, Céline; Renard, Vincent; Fournier, Jean-Pascal

2018-01-01

Objective The aims of this study were to (i) assess the expectations of general practice departments regarding health sciences libraries’ subscriptions to journals and (ii) describe the current general practice journal collections of health sciences libraries. Methods A cross-sectional survey was distributed electronically to the thirty-five university general practice departments in France. General practice departments were asked to list ten journals to which they expected access via the subscriptions of their health sciences libraries. A ranked reference list of journals was then developed. Access to these journals was assessed through a survey sent to all health sciences libraries in France. Adequacy ratios (access/need) were calculated for each journal. Results All general practice departments completed the survey. The total reference list included 44 journals. This list was heterogeneous in terms of indexation/impact factor, language of publication, and scope (e.g., patient care, research, or medical education). Among the first 10 journals listed, La Revue Prescrire (96.6%), La Revue du Praticien–Médecine Générale (90.9%), the British Medical Journal (85.0%), Pédagogie Médicale (70.0%), Exercer (69.7%), and the Cochrane Database of Systematic Reviews (62.5%) had the highest adequacy ratios, whereas Family Practice (4.2%), the British Journal of General Practice (16.7%), Médecine (29.4%), and the European Journal of General Practice (33.3%) had the lowest adequacy ratios. Conclusions General practice departments have heterogeneous expectations in terms of health sciences libraries’ subscriptions to journals. It is important for librarians to understand the heterogeneity of these expectations, as well as local priorities, so that journal access meets users’ needs. PMID:29632446

Clinical accuracy of point-of-care urine culture in general practice.

PubMed

Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller; Jessen, Lisbeth Rem; Frimodt-Møller, Niels; Siersma, Volkert; Bjerrum, Lars

2017-06-01

To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. Prospective diagnostic accuracy study comparing two index tests (Flexicult™ SSI-Urinary Kit or ID Flexicult™) with a reference standard (urine culture performed in the microbiological department). General practice in the Copenhagen area patients. Adult female patients consulting their general practitioner with suspected uncomplicated, symptomatic UTI. (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply in boric acid used for transportation for the reference standard. (4) Accuracy based on expert reading of photographs of POC urine cultures performed in general practice. Standard culture performed in the microbiological department was used as reference standard for all four measures. Twenty general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci excluded was 0.82 (0.77-0.86) and agreement between expert readings of photographs and reference results was 0.81 (CI: 0.76-0.85). POC culture used in general practice has high SEN but low SPE. Low SPE could be due to both misinterpretation in general practice and an imperfect reference standard. Registration number: ClinicalTrials.gov NCT02323087.

A person based formula for allocating commissioning funds to general practices in England: development of a statistical model.

PubMed

Dixon, Jennifer; Smith, Peter; Gravelle, Hugh; Martin, Steve; Bardsley, Martin; Rice, Nigel; Georghiou, Theo; Dusheiko, Mark; Billings, John; Lorenzo, Michael De; Sanderson, Colin

2011-11-22

To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices. All general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date. All individuals registered with a general practice in England at 1 April 2007. Power of the statistical models to predict the costs of the individual patient or each practice's registered population for 2007-8 tested with a range of metrics (R(2) reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice. Models including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups. A model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year's costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models.

Going for gold: the health promoting general practice.

PubMed

Watson, Michael

2008-01-01

The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.

PubMed

Huby, Guro; Guthrie, Bruce; Grant, Suzanne; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

2008-01-01

The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact? The article is based on comparative in-depth case studies of four UK practices. There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract. The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

Conditions for research in general practice. Can the Dutch and British experiences be applied to other countries, for example Spain?

PubMed

van der Zee, Jouke; Kroneman, Madelon; Bolíbar, Bonaventura

2003-06-01

The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals; control of work; the establishment of specialised education; the development of professional knowledge; and the creation of organised structures for professional work. Two countries with a well-established research tradition in general practice (the UK and the Netherlands) and one country where GP research development is still limited (Spain) were evaluated on the basis of these conditions. The conditions identified as favourable were as follows: the existence of a scientific association; a peer-reviewed journal; a defined population resulting in a population denominator for practices; a gatekeeping system; chairs and departments of general practice at universities; the integration of education centres and research centres; GPs working in group practices or health centres; a certain degree of independence from the Ministry of Health; and financial support for practicing GPs to conduct research activities. We showed that most conditions for the successful scientific progress of general practice in Spain are present. However there is still a gap between academia and general practice and a lack of research organisation and support.

Physical Activity Promotion in General Practices of Barcelona: A Case Study

ERIC Educational Resources Information Center

Puig Ribera, Anna; McKenna, Jim; Riddoch, Chris

2006-01-01

This case study aimed to generate explanations for the lack of integration of physical activity (PA) promotion in general practices of Barcelona, the capital of Catalonia. This explanatory study adopted a qualitative approach, based on three techniques; focus groups (n = 3), semi-structured (n = 25) and short individual interviews (n = 5). These…

On the validity of the Middlesex Hospital Questionnaire: a comparison of diagnostic self-ratings in psychiatric out-patients, general practice patients, and 'normals' based on the Hebrew version.

PubMed

Dasberg, H; Shalif, I

1978-09-01

The short clinical diagnostic self-rating scale for psycho-neurotic patients (The Middlesex Hospital Questionnaire) was translated into everyday Hebrew and tested on 216 subjects for: (1) concurrent validity with clinical diagnoses; (2) discriminatory validity on a psychoneurotic gradient of psychiatric out-patients, general practice patients, and normal controls; (3) validity of subscales and discrete items using matrices of Spearman rank correlation coefficients; (4) construct validity using Guttman's smallest space analysis based on coefficients of similarity. The Hebrew MHQ was found to retain its validity and to be easily applicable in waiting-room situations. It is a useful method for generating and substantiating hypotheses on psychosomatic and psychosocial interrelationships. The MHQ seems to enable the expression of the 'neurotic load' of a general practice subpopulation as a centile on a scale, thereby corroborating previous epidemiological findings on the high prevalence of neurotic illness in general practice. There is reason to believe that the MHQ is a valid instrument for the analysis of symptom profiles of subjects involved in future drug trials.

Monitoring of continuous-variable quantum key distribution system in real environment.

PubMed

Liu, Weiqi; Peng, Jinye; Huang, Peng; Huang, Duan; Zeng, Guihua

2017-08-07

How to guarantee the practical security of continuous-variable quantum key distribution (CVQKD) system has been an important issue in the quantum cryptography applications. In contrast to the previous practical security strategies, which focus on the intercept-resend attack or the Gaussian attack, we investigate the practical security strategy based on a general attack, i.e., an arbitrated individual attack or collective attack on the system by Eve in this paper. The low bound of intensity disturbance of the local oscillator signal for eavesdropper successfully concealing herself is obtained, considering all noises can be used by Eve in the practical environment. Furthermore, we obtain an optimal monitoring condition for the practical CVQKD system so that legitimate communicators can monitor the general attack in real-time. As examples, practical security of two special systems, i.e., the Gaussian modulated coherent state CVQKD system and the middle-based CVQKD system, are investigated under the intercept-resend attacks.

Allergen-specific immunotherapy prescription patterns in veterinary practice: a US population-based cohort study.

PubMed

Tater, Kathy Chu; Cole, William Elliott; Pion, Paul David

2017-08-01

Poor adherence to continuing allergen-specific immunotherapy treatment (ASIT) may be an issue in veterinary medicine. No studies describe how allergen tests are used in general veterinary practice, including the percentage of patients that receive ASIT after allergen testing. Assess veterinary ASIT patterns in United States general practices. Dogs (n = 2,557) and 121 cats allergen-tested at 177 hospitals (173 general practice and four specialty practices) in 44 states. Invoiced service descriptions of allergen tests and ASIT orders were retrieved from an aggregated database of veterinary practices. In general practice, 42% (992 of 2,360) of patients did not begin ASIT after allergen testing. ASIT was not refilled for 29% (398 of 1,368) of patients after the initial order. ASIT was initiated and refilled more often in dogs (56.6%, 71.4%, respectively) than cats (38%, 67.4%). Specialty practice patients had the highest ASIT initiation (94.4%) and refill (92.7%) percentages in comparison to general practices (P < 0.001). Size, age, geographical region and type of practice were associated with whether dogs were started on ASIT. Geographical region was also associated with refilling a prescription for ASIT, which was considered to be evidence of adherence to continuing treatment. Almost one third of clients failed to continue ASIT beyond the initial order, which is a much shorter duration of therapy than the 12 months recommended for determining ASIT efficacy. A large number of general practice patients did not begin ASIT after allergen testing, likely due to differences in how clinicians in general and dermatology practices use allergen tests. © 2017 ESVD and ACVD.

Interactive web-based learning modules prior to general medicine advanced pharmacy practice experiences.

PubMed

Isaacs, Alex N; Walton, Alison M; Nisly, Sarah A

2015-04-25

To implement and evaluate interactive web-based learning modules prior to advanced pharmacy practice experiences (APPEs) on inpatient general medicine. Three clinical web-based learning modules were developed for use prior to APPEs in 4 health care systems. The aim of the interactive modules was to strengthen baseline clinical knowledge before the APPE to enable the application of learned material through the delivery of patient care. For the primary endpoint, postassessment scores increased overall and for each individual module compared to preassessment scores. Postassessment scores were similar among the health care systems. The survey demonstrated positive student perceptions of this learning experience. Prior to inpatient general medicine APPEs, web-based learning enabled the standardization and assessment of baseline student knowledge across 4 health care systems.

Getting governance right for a sustainable regionalised business model.

PubMed

Laurence, Caroline O; Black, Linda E; Rowe, Mark; Pearce, Rod

2011-06-06

The 1998 Ministerial Review of General Practice Training identified several areas for improvement that led to major changes in the provision of general practice training, including the establishment of General Practice Education and Training (GPET) and the regionalisation of training. The regionalised training business model has been in place for nearly 10 years, and several key organisations have been involved in its evolution, including the Australian Government, speciality colleges, GPET and regionalised training providers. Both the college-focused and regionalised-focused models have had some successes. These include recognition and support of general practice as a vocational specialty, increased numbers of junior doctors undertaking placements in general practice, and increased numbers of registrars training in rural areas. This period has also seen changes in the governance and decision-making processes with creation of a new framework that is inclusive of all the key players in the new regionalised training system. The future holds challenges for the regionalised training business model as the general practice education and training landscape becomes more complex. The framework in the current model will provide a base to help meet these challenges and allow for further sustainable expansion.

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

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.

General practitioners, complementary therapies and evidence-based medicine: the defence of clinical autonomy.

PubMed

Adams, J

2000-12-01

Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM). This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM. Copyright 2000 Harcourt Publishers Ltd.

7 CFR 1437.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... (including ornamental fish), and floriculture, an environment in which everything that can practicably be..., as determined by CCC. Good farming practices means the cultural practices generally used for the crop... good farming practices. T-Yield means the yield which is based on the county expected yield of the crop...

Providers' Attitudes Toward Evidence-Based Practices: Is it Just About Providers, or do Practices Matter, Too?

PubMed Central

Reding, Michael E. J.; Chorpita, Bruce F.; Lau, Anna S.; Innes-Gomberg, Debbie

2014-01-01

Evidence-based practice (EBP) attitudes were measured in a sample of Los Angeles County mental health service providers. Three types of data were collected: provider demographic characteristics, attitudes toward EBP in general, and attitudes toward specific EBPs being implemented in the county. Providers could reliably rate characteristics of specific EBPs, and these ratings differed across interventions. Preliminary implementation data indicate that appealing features of an EBP relate to the degree to which providers use it. These findings suggest that assessing EBP-specific attitudes is feasible and may offer implementation-relevant information beyond that gained solely from providers' general attitudes toward EBP. PMID:24166077

Graduates' perceptions of their clinical competencies in allergy and immunology: results of a survey.

PubMed

Li, James T-C; Stoll, Doris A; Smith, June E; Lin, John J; Swing, Susan R

2003-09-01

The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) have identified six areas of general competency. This study surveyed graduates of allergy and immunology training programs about their perceived clinical competency and the adequacy of their subspecialty training. In August 2000 and May 2001, a questionnaire was mailed to 373 physicians who had completed a fellowship in allergy and immunology in the United States between 1995 and 2001. Physicians were asked to rate the perceived importance and adequacy of their training in, and their level of competency for, 57 general competencies and subspecialty-specific competencies and procedures. A total of 253 physicians responded (68%). All items in the six ACGME/ABMS general competencies had high ratings (>/= 90%) for perceived importance. One item in the practice-based learning area had low ratings for adequacy of training (57%) and intermediate for competency (75%). Two items in the system-based practice area had low ratings for training (65% and 67%) and intermediate for competency (86% and 88%). Generally, core specialty-specific items (allergic rhinitis, asthma, and urticaria) had high ratings (>/= 90%) for importance, training, and competency. Without exception, items with ratings of less than 70% for adequacy of training also had ratings of less than 90% for competency. The general competencies were considered important, but training in system-based practice and practice-based learning may be deficient. Although self-perceived competency in core areas of allergy and immunology was high, weaknesses in training and self-perceived competency in selected areas were identified.

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

[Teaching family medicine in Lausanne].

PubMed

Bischoff, Thomas; Junod, Michel; Cornuz, Jacques; Herzig, Lilli; Bonvin, Raphael

2010-12-01

The Faculty of Biology and Medicine of Lausanne has integrated education of family medicine all along its new undergraduate medical curriculum. The Institute of general medicine is in charge to implement those offers among which two are presented hereafter. In the new module "Generalism" several courses cover the specificities of the discipline as for example medical decision in the practice. A mandatory one-month internship in the medical practice offers an experiential immersion into family medicine for all students. In a meeting at the end of their internship, students discuss in group with their peers their individual experiences and are asked to identify, based on their personal experience, the general concepts of the specialty of family medicine and general practice.

Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial.

PubMed

Hoffmann, B; Müller, V; Rochon, J; Gondan, M; Müller, B; Albay, Z; Weppler, K; Leifermann, M; Mießner, C; Güthlin, C; Parker, D; Hofinger, G; Gerlach, F M

2014-01-01

The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations. In this study we assessed the effects of FraTrix on safety culture in general practice. We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12 months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management. During the team sessions, practice teams reflected on their safety culture and decided on about 10 actions per practice to improve it. After 12 months, no significant differences were found between intervention and control groups in terms of error management (competing probability=0.48, 95% CI 0.34 to 0.63, p=0.823), 11 further patient safety culture indicators and safety climate scales. Intervention practices showed better reporting of patient safety incidents, reflected in a higher number of incident reports (mean (SD) 4.85 (4.94) vs 3.10 (5.42), p=0.045) and incident reports of higher quality (scoring 2.27 (1.93) vs 1.49 (1.67), p=0.038) than control practices. Applied as a team-based instrument to assess safety culture, FraTrix did not lead to measurable improvements in error management. Comparable studies with more positive results had less robust study designs. In future research, validated combined methods to measure safety culture will be required. In addition, more attention should be paid to evaluation of process parameters. Implemented actions and incident reporting may be more appropriate target endpoints. German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) No. DRKS00000145.

Implementing Evidence-Based Practices for People With Schizophrenia

PubMed Central

Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

2009-01-01

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

Effectiveness of a training course for general practice nurses in motivation support in type 2 diabetes care: a cluster-randomised trial.

PubMed

Juul, Lise; Maindal, Helle T; Zoffmann, Vibeke; Frydenberg, Morten; Sandbaek, Annelli

2014-01-01

Type 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population. Forty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory-based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40-74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed. The differences between the intervention- and the control practices' mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: -0.02%-points (95% CI: -0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: -0.12%-points (-0.23 to -0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01. Offering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention. ClinicalTrials.gov (Identifier NCT01187069).

Adapting total quality management for general practice: evaluation of a programme.

PubMed Central

Lawrence, M; Packwood, T

1996-01-01

OBJECTIVE: Assessment of the benefits and limitations of a quality improvement programme based on total quality management principles in general practice over a period of one year (October 1993-4). DESIGN: Questionnaires to practice team members before any intervention and after one year. Three progress reports completed by facilitators at four month intervals. Semistructured interviews with a sample of staff from each practice towards the end of the year. SETTING: 18 self selected practices from across the former Oxford Region. Three members of each practice received an initial residential course and three one day seminars during the year. Each practice was supported by a facilitator from their Medical Audit Advisory Group. MEASURES: Extent of understanding and implementation of quality improvement methodology. Number, completeness, and evaluation of quality improvement projects. Practice team members' attitudes to and involvement in team working and quality improvement. RESULTS: 16 of the 18 practices succeeded in implementing the quality improvement methods. 48 initiatives were considered and staff involvement was broad. Practice members showed increased involvement in, and appreciation of, strategic planning and team working, and satisfaction from improved patients services. 11 of the practices intend to continue with the methodology. The commonest barrier expressed was time. CONCLUSION: Quality improvement programmes based on total quality management principles produce beneficial changes in service delivery and team working in most general practices. It is incompatible with traditional doctor centred practice. The methodology needs to be adapted for primary care to avoid quality improvement being seen as separate from routine activity, and to save time. PMID:10161529

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

Tips from the toolkit: 1 - know yourself.

PubMed

Steer, Neville

2010-01-01

High performance organisations review their strategy and business processes as part of usual business operations. If you are new to the field of general practice, do you have a career plan for the next 5-10 years? If you are an experienced general practitioner, are you using much the same business model and processes as when you started out? The following article sets out some ideas you might use to have a fresh approach to your professional career. It is based on The Royal Australian College of General Practitioners' 'General practice management toolkit'.

Perspectives of dental students and faculty about evidence-based dental practice.

PubMed

Abdelkarim, Ahmad; Sullivan, Donna

2014-12-01

The study aimed at evaluating attitudes and perceptions of dental students and faculty toward evidence-based practice, integration of technology and social media, general practitioners' and specialists' scope of practice, and dental practice rewards and disadvantages. A survey instrument was designed with 10 statements rated on a five-point Likert scale (strongly agree to strongly disagree) and an optional comment section. The survey instrument was delivered through SurveyMonkey, whereby 401 students and 182 faculty members from ten U.S. dental schools participated (16% estimated response rate). Null hypotheses regarding the equality between the responses of the two groups were statistically tested using Mann-Whitney U test. Statistical significance was set at .05. Evidence-based practice is positively perceived by both groups, but with significantly higher support by faculty than students (P = 0.002). Both groups agreed that technological advancements are advantageous (P = 0.95), but do not constitute good dentistry and cannot mask poor clinical skills. Students showed higher support for social media than faculty (P = 0.000). Both groups perceived group practices positively. Faculty members showed higher agreement than students toward limitation of dental specialists' practices to their specialties (P = 0.000). Both groups are aware of practice disadvantages, such as increased litigation, health risks, and detriment to the dentist's posture. However, they both perceive dental practice positively despite all these challenges. Students and faculty share generally comparable perspectives toward dental practice. They are both in agreement with evidence-based practice and adoption of technology. They both acknowledge practice limitations. Copyright © 2014 Elsevier Inc. All rights reserved.

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

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

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

2016-02-29

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. 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. 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. 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: χ(2)1=10.9, P=.004; vegetable: χ(2)1=5.3, P=.02) and the researchers' intervention group (fruit: χ(2)1=18.0, P=.001; vegetable: χ(2)1=12.8, P<.001) increased their intake of fruit and vegetables. 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. ClinicalTrials.gov NCT02211040; https://clinicaltrials.gov/ct2/show/NCT02211040 (Archived by WebCite® at http://www.webcitation.org/6f8yxTRii).

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

Recruitment for a clinical trial of chronic disease self-management for older adults with multimorbidity: a successful approach within general practice.

PubMed

Reed, Richard L; Barton, Christopher A; Isherwood, Linda M; Baxter, Jodie M Oliver; Roeger, Leigh

2013-08-28

A robust research base is required in General Practice. The research output for General Practice is much less than those of other clinical disciplines. A major impediment to more research in this sector is difficulty with recruitment. Much of the research in this area focuses on barriers to effective recruitment and many projects have great difficulty with this process. This paper seeks to describe a systematic approach to recruitment for a randomized controlled trial that allowed the study team to recruit a substantial number of subjects from General Practice over a brief time period. A systematic approach to recruitment in this setting based on prior literature and the experience of the investigator team was incorporated into the design and implementation of the study. Five strategies were used to facilitate this process. These included designing the study to minimize the impact of the research on the day-to-day operations of the clinics, engagement of general practitioners in the research, making the research attractive to subjects, minimizing attrition and ensuring recruitment was a major focus of the management of the study. Outcomes of the recruitment process were measured as the proportion of practices that agreed to participate, the proportion of potentially eligible subjects who consented to take part in the trial and the attrition rate of subjects. Qualitative interviews with a subset of successfully recruited participants were done to determine why they chose to participate in the study; data were analyzed using thematic analysis. Five out of the six general practices contacted agreed to take part in the study. Thirty-eight per cent of the 1663 subjects who received a letter of invitation contacted the university study personnel regarding their interest in the project. Recruitment of the required number of eligible participants (n = 256) was accomplished in seven months. Thematic analysis of interviews with 30 participants regarding key factors in their study participation identified a personalised letter of endorsement from their general practitioner, expectation of personal benefit and altruism as important factors in their decision to participate. Recruitment can be successfully achieved in General Practice through design of the research project to facilitate recruitment, minimize the impact on general practice operations and ensure special care in enrolling and maintaining subjects in the project.

A general model-based design of experiments approach to achieve practical identifiability of pharmacokinetic and pharmacodynamic models.

PubMed

Galvanin, Federico; Ballan, Carlo C; Barolo, Massimiliano; Bezzo, Fabrizio

2013-08-01

The use of pharmacokinetic (PK) and pharmacodynamic (PD) models is a common and widespread practice in the preliminary stages of drug development. However, PK-PD models may be affected by structural identifiability issues intrinsically related to their mathematical formulation. A preliminary structural identifiability analysis is usually carried out to check if the set of model parameters can be uniquely determined from experimental observations under the ideal assumptions of noise-free data and no model uncertainty. However, even for structurally identifiable models, real-life experimental conditions and model uncertainty may strongly affect the practical possibility to estimate the model parameters in a statistically sound way. A systematic procedure coupling the numerical assessment of structural identifiability with advanced model-based design of experiments formulations is presented in this paper. The objective is to propose a general approach to design experiments in an optimal way, detecting a proper set of experimental settings that ensure the practical identifiability of PK-PD models. Two simulated case studies based on in vitro bacterial growth and killing models are presented to demonstrate the applicability and generality of the methodology to tackle model identifiability issues effectively, through the design of feasible and highly informative experiments.

Participants' evaluation of a group-based organisational assessment tool in Danish general practice: the Maturity Matrix.

PubMed

Buch, Martin Sandberg; Edwards, Adrian; Eriksson, Tina

2009-01-01

The Maturity Matrix is a group-based formative self-evaluation tool aimed at assessing the degree of organisational development in general practice and providing a starting point for local quality improvement. Earlier studies of the Maturity Matrix have shown that participants find the method a useful way of assessing their practice's organisational development. However, little is known about participants' views on the resulting efforts to implement intended changes. To explore users' perspectives on the Maturity Matrix method, the facilitation process, and drivers and barriers for implementation of intended changes. Observation of two facilitated practice meetings, 17 semi-structured interviews with participating general practitioners (GPs) or their staff, and mapping of reasons for continuing or quitting the project. General practices in Denmark Main outcomes: Successful change was associated with: a clearly identified anchor person within the practice, a shared and regular meeting structure, and an external facilitator who provides support and counselling during the implementation process. Failure to implement change was associated with: a high patient-related workload, staff or GP turnover (that seemed to affect small practices more), no clearly identified anchor person or anchor persons who did not do anything, no continuous support from an external facilitator, and no formal commitment to working with agreed changes. Future attempts to improve the impact of the Maturity Matrix, and similar tools for quality improvement, could include: (a) attention to matters of variation caused by practice size, (b) systematic counselling on barriers to implementation and support to structure the change processes, (c) a commitment from participants that goes beyond participation in two-yearly assessments, and (d) an anchor person for each identified goal who takes on the responsibility for improvement in practice.

Preliminary trial of the effect of general practice based nutritional advice.

PubMed Central

Baron, J A; Gleason, R; Crowe, B; Mann, J I

1990-01-01

Despite formal recommendations for dietary change to reduce the incidence of ischaemic heart disease, the acceptability and effectiveness of the proposed diets have not been well investigated in population based studies. In this preliminary investigation of nutritional advice in a well population, subjects in one group practice were randomized to receive either dietary instruction or simple follow up without instruction. The dietary recommendations were well received, and a substantial proportion of subjects reported altering their diets in accordance with them. There were modest beneficial changes in plasma lipid levels among men. Thus, using general practice as an avenue for promoting dietary change is feasible, and may be effective among men. PMID:2115348

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Current good tissue practice requirements. 1271... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150 Current good tissue practice requirements. (a) General. This subpart D and subpart C of this part set...

Professional Development with Video Modeling: Effects on Behavior Specific Praise in General Education Classrooms

ERIC Educational Resources Information Center

Barry, Colleen

2016-01-01

Federal mandates require teachers to implement evidence-based strategies in their classrooms; however, due to gaps between research and practice, these evidence-based practices are inconsistently implemented across educational settings. Although intended to address this, teacher professional developments are most commonly delivered in a…

Update in outpatient general internal medicine: practice-changing evidence published in 2014.

PubMed

Sundsted, Karna K; Wieland, Mark L; Szostek, Jason H; Post, Jason A; Mauck, Karen F

2015-10-01

The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine. Copyright © 2015 Elsevier Inc. All rights reserved.

Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study.

PubMed

Lawton, Rebecca; Heyhoe, Jane; Louch, Gemma; Ingleson, Emma; Glidewell, Liz; Willis, Thomas A; McEachan, Rosemary R C; Foy, Robbie

2016-08-08

There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations.

Why do general practitioners from France choose to work in London practices? A qualitative study.

PubMed

Ballard, Karen D; Robinson, Susan I; Laurence, Priscilla B

2004-10-01

Growing concerns about the ability to maintain and increase the general practitioner (GP) workforce has led to active recruitment of GPs from overseas. However, little is known about why these GPs choose to leave their countries and come to work in London. To investigate the motivations and expectations of French GPs migrating to work in general practices in London. A qualitative study using semi-structured interviews. General practice induction programme in southeast London. Individual interviews with 31 French GPs, who attended an induction programme for international recruits, were taped, transcribed, and analysed using a categorical approach. Three factors led to the process of migration: instigating factors, creating the stimulus for migration; activating factors, based on the perception that English general practice offered greater opportunities; and facilitating factors, which make migration possible. Particular emphasis was placed on personal and professional instigating factors, with a desire for new cultural experiences and a widespread discontent surrounding the infrastructure of French general practice, playing crucial roles in the stimulus to migrate. Ease of travel and a paid induction programme facilitated the move to their chosen destination. French GPs' decisions were part of a process of migration influenced by a series of integrated factors. Consideration of these factors will not only enhance recruitment to English general practice, but will also facilitate foreign GPs' transition to work in the National Health Service (NHS) and, ultimately, maximise their retention.

Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

PubMed

Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura

2015-01-01

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. Copyright © 2015 Elsevier Inc. All rights reserved.

Bushfires, 2003. A rural GP's perspective.

PubMed

Robinson, Mark

2003-12-01

Extensive bushfires in January and February of 2003 had a major impact on many communities in northeast Victoria, East Gippsland, southern New South Wales and Canberra. These fires eventually engulfed an area roughly equivalent to the entire area of Germany. This article describes the impact of the fires and the role of the general practitioner in the emergency response, and presents recommendations for the role of general practice in future disaster planning. General practitioners have critical roles in the provision of round the clock general medical services to their communities in times of bushfire or natural disaster. They also act as gatekeepers to mental health services, psychiatric referral and counselling alongside other community based programs. Divisions of general practice have a pivotal role to play in disaster plans, particularly in coordinating the maintenance of ongoing medical services, facilitating communication between GPs and essential services, and integrating general practice into postdisaster recovery.

Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour.

PubMed

McNulty, Cliodna A M; Hogan, Angela H; Ricketts, Ellie J; Wallace, Louise; Oliver, Isabel; Campbell, Rona; Kalwij, Sebastian; O'Connell, Elaine; Charlett, Andre

2014-05-01

To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15-24 years attending English general practitioner (GP) practices. A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention. Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15-24-year-olds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15-24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93). This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63%) and efficacy of this educational intervention in general practice; it should be used more often. The trial was registered on the UK Clinical Research Network Study Portfolio database. UKCRN number 9722.

Incentives and control in primary health care: findings from English pay-for-performance case studies.

PubMed

McDonald, Ruth; Harrison, Stephen; Checkland, Kath

2008-01-01

The authors' aim was to investigate mechanisms and perceptions of control following the implementation of a new "pay-for-performance" contract (the new General Medical Services, or GMS, contract) in general practice. This article was based on an in-depth qualitative case study approach in two general practices in England. A distinction is emerging amongst ostensibly equal partners between those general practitioners conducting and those subject to surveillance. Attitudes towards the contract were largely positive, although discontent was higher in the practice which employed a more intensive surveillance regime and greater amongst nurses than doctors. The sample was small and opportunistic. Further research is required to examine the longer-term effects as new contractual arrangements evolve. Increased surveillance and feedback mechanisms associated with new pay-for-performance schemes have the potential to constrain and shape clinical practice. The paper highlights the emergence of new tensions within and between existing professional groupings.

Exploring female GPs' perceptions about medical leadership.

PubMed

Price, Karen; Clearihan, Lynette

2015-06-01

Women are increasingly entering the Australian general practice workforce. This study aims to explore female general practitioners' (GPs') perceptions of possible barriers to leadership and professional roles in the workforce. A purposive, convenience sample of 30 female GPs in active practice was approached in February, 2012. An anonymous, pa-per-based, semi-quantitative survey sought to identify participation and leadership confidence within general practice in a number of professional roles. The top two barriers participants identified for after-hours medical meetings were energy to attend and geographical location. For after-hours care, the top two barriers identified were energy and self-motivation. Few participants aspired to 'leadership' activities. 'Medical mentoring' was most likely to attract them into leadership. It is important female GPs' perspectives are explored in general practice. This small survey suggests further studies are needed in the importance of energy limitations and lack of self-confidence in restricting female GPs' capacity to fully engage in professional roles.

Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

PubMed

Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

2017-11-01

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

A person based formula for allocating commissioning funds to general practices in England: development of a statistical model

PubMed Central

Smith, Peter; Gravelle, Hugh; Martin, Steve; Bardsley, Martin; Rice, Nigel; Georghiou, Theo; Dusheiko, Mark; Billings, John; Lorenzo, Michael De; Sanderson, Colin

2011-01-01

Objectives To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice Design Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices. Setting All general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date. Subjects All individuals registered with a general practice in England at 1 April 2007. Main outcome measures Power of the statistical models to predict the costs of the individual patient or each practice’s registered population for 2007-8 tested with a range of metrics (R2 reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice. Results Models including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups. Conclusions A model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year’s costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models. PMID:22110252

Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation.

PubMed

Cullen, Walter; Stanley, June; Langton, Deirdre; Kelly, Yvonne; Staines, Anthony; Bury, Gerard

2006-11-01

Hepatitis C is a common infection among injecting drug users and has important implications for general practice. Although several clinical guidelines concerning the infection have been published, their effectiveness has yet to be tested. To assess the effectiveness of a general practice-based complex intervention to support the implementation of clinical guidelines for hepatitis C management among current or former drug users attending general practice. Cluster randomised controlled trial. General practices in the Eastern Regional Health Authority area of Ireland. Twenty-six practices were randomly allocated within strata to receive the intervention under study or to provide care as usual for a period of 6 months. There was screening for patients attending general practice for methadone maintenance treatment for hepatitis C and referral of anti-HCV antibody positive patients to a specialist hepatology department for assessment. At study completion, patients in the intervention group were significantly more likely to have been screened for hepatitis C than those in the control group, odds ratio adjusted for clustering 3.76 (95% confidence interval [CI] = 1.3 to 11.3) and this association remained significant after adjusting for other potentially confounding variables, using multiple logistic regression, with the odds ratio adjusted for clustering 4.53 (95% CI = 1.39 to 14.78). Although anti-HCV antibody positive patients in the intervention group were more likely to have been referred to a hepatology clinic, this was not statistically significant (P = 0.06). General practice has an important role in the care of people at risk of hepatitis C and when appropriately supported can effectively implement current best practice.

Hospital adoption of automated surveillance technology and the implementation of infection prevention and control programs.

PubMed

Halpin, Helen; Shortell, Stephen M; Milstein, Arnold; Vanneman, Megan

2011-05-01

This research analyzes the relationship between hospital use of automated surveillance technology (AST) for identification and control of hospital-acquired infections (HAI) and implementation of evidence-based infection control practices. Our hypothesis is that hospitals that use AST have made more progress implementing infection control practices than hospitals that rely on manual surveillance. A survey of all acute general care hospitals in California was conducted from October 2008 through January 2009. A structured computer-assisted telephone interview was conducted with the quality director of each hospital. The final sample includes 241 general acute care hospitals (response rate, 83%). Approximately one third (32.4%) of California's hospitals use AST for monitoring HAI. Adoption of AST is statistically significant and positively associated with the depth of implementation of evidence-based practices for methicillin-resistant Staphylococcus aureus and ventilator-associated pneumonia and adoption of contact precautions and surgical care infection practices. Use of AST is also statistically significantly associated with the breadth of hospital implementation of evidence-based practices across all 5 targeted HAI. Our findings suggest that hospitals using AST can achieve greater depth and breadth in implementing evidenced-based infection control practices. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

The Positive Effect on Determinants of Physical Activity of a Tailored, General Practice-Based Physical Activity Intervention

ERIC Educational Resources Information Center

Van Sluijs, E. M. F.; Van Poppel, M. N. M.; Twisk, J. W. R.; Brug, J.; Van Mechelen, W.

2005-01-01

PACE (Physician-based Assessment and Counseling for Exercise) is an individualized theory-based minimal intervention strategy aimed at the enhancement of regular physical activity. The aim of this study was to evaluate the effectiveness of a PACE intervention applied by general practitioners (GPs) on potential determinants of physical activity. A…

Practical quantum retrieval games

NASA Astrophysics Data System (ADS)

Arrazola, Juan Miguel; Karasamanis, Markos; Lütkenhaus, Norbert

2016-06-01

Complex cryptographic protocols are often constructed from simpler building blocks. In order to advance quantum cryptography, it is important to study practical building blocks that can be used to develop new protocols. An example is quantum retrieval games (QRGs), which have broad applicability and have already been used to construct quantum money schemes. In this work, we introduce a general construction of quantum retrieval games based on the hidden matching problem and show how they can be implemented in practice using available technology. More precisely, we provide a general method to construct (1-out-of-k ) QRGs, proving that their cheating probabilities decrease exponentially in k . In particular, we define QRGs based on coherent states of light, which can be implemented even in the presence of experimental imperfections. Our results constitute a tool in the arsenal of the practical quantum cryptographer.

Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation.

PubMed

Clement, T; Brown, J; Morrison, J; Nestel, D

2016-05-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management.

PubMed

Fernández, O; Delvecchio, M; Edan, G; Fredrikson, S; Giovannoni, G; Hartung, H-P; Havrdova, E; Kappos, L; Pozzilli, C; Soerensen, P S; Tackenberg, B; Vermersch, P; Comi, G

2018-05-01

The European Charcot Foundation supported the development of a set of surveys to understand current practice patterns for the diagnosis and management of multiple sclerosis (MS) in Europe. Part 2 of the report summarizes survey results related to secondary progressive MS (SPMS), primary progressive MS (PPMS), pregnancy, paediatric MS and overall patient management. A steering committee of MS neurologists developed case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Respondents generally favoured changing rather than stopping disease-modifying treatment (DMT) in patients transitioning from relapsing-remitting MS to SPMS, particularly with active disease. Respondents would not initiate DMT in patients with typical PPMS symptoms, although the presence of ≥1 spinal cord or brain gadolinium-enhancing lesion might affect that decision. For patients considering pregnancy, respondents were equally divided on whether to stop treatment before or after conception. Respondents strongly favoured starting DMT in paediatric MS with active disease; recommended treatments included interferon, glatiramer acetate and, in John Cunningham virus negative patients, natalizumab. Additional results regarding practice-based questions and management are summarized. Results of part 2 of the survey of diagnostic and treatment practices for MS in Europe largely mirror results for part 1, with neurologists in general agreement about the treatment and management of SPMS, PPMS, pregnancy and paediatric MS as well as the general management of MS. However, there are also many areas of disagreement, indicating the need for evidence-based recommendations and/or guidelines. © 2018 EAN.

The influence of experiential learning on medical equipment adoption in general practices.

PubMed

Bourke, Jane; Roper, Stephen

2014-10-01

The benefits of the availability and use of medical equipment for medical outcomes are understood by physicians and policymakers alike. However, there is limited understanding of the decision-making processes involved in adopting and using new technologies in health care organisations. Our study focuses on the adoption of medical equipment in Irish general practices which are marked by considerable autonomy in terms of commercial practice and the range of medical services they provide. We examine the adoption of six items of medical equipment taking into account commercial, informational and experiential stimuli. Our analysis is based on primary survey data collected from a sample of 601 general practices in Ireland on practice characteristics and medical equipment use. We use a multivariate Probit to identify commonalities in the determinants of the adoption. Many factors, such as GP and practice characteristics, influence medical equipment adoption. In addition, we find significant and consistent evidence of the influence of learning-by-using effects on the adoption of medical equipment in a general practice setting. Knowledge generated by experiential or applied learning can have commercial, organisational and health care provision benefits in small health care organisations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Developing a general practice library: a collaborative project between a GP and librarian.

PubMed

Pearson, D; Rossall, H

2001-12-01

The authors report on a self-completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work.

Improving the Teaching of Evidence-Based Practice: Challenges and Priorities

ERIC Educational Resources Information Center

Soydan, Haluk

2007-01-01

This article explores some of the main challenges of improving the teaching of evidence-based practice in schools of social work. The priority challenges are the needs for a general professional cultural shift, for adequate curricula, to overcome the controversy of scientific methodology, to better understand the state of the art of the…

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

Television-based health promotion in general practice waiting rooms in London: a cross-sectional study evaluating patients' knowledge and intentions to access dental services.

PubMed

Jawad, Mohammed; Ingram, Sam; Choudhury, Imran; Airebamen, Anne; Christodoulou, Kostakis; Wilson Sharma, Amanda

2016-07-20

This study aimed to evaluate whether television-based dental health promotion initiatives in General Practice waiting rooms would increase patients' knowledge of and intentions to seek dental services. This cross-sectional survey of 2,345 patients attending 49 General Practices in Brent, northwest London, evaluated the 'Life Channel' - a series of six brief health promotion advertisements, including one dental health promotion advertisement, displayed over ten minutes on television in General Practice waiting rooms. Primary outcome measures were a self-reported gain in the knowledge to contact a National Health Service (NHS) and emergency dentist, and an intention to seek dental services, attributed to viewing the Life Channel. Among the 1,088 patients who did not know how to contact an NHS dentist prior to the survey, and the 1,247 patients who did not know how to contact an emergency dentist prior to the survey, 48.0 % (95 % CI 45.0-51.0 %) and 35.1 % (95 % CI 32.4-37.8 %) attributed the Life Channel to educating them how to do so, respectively. Among the 1,605 patients who did not have any intention to contact a dentist prior to the survey, 15.2 % (95 % CI 13.4-17.0 %) attributed the Life Channel to creating such an intention. We report adjusted odds ratios on sociodemographic disparities in this evaluation. Television-based dental health promotion may significantly increase knowledge of and intention to seek dental services in this sample in London. Television-based dental health promotion may appeal more to certain population groups. More research is needed to identify longer term outcomes of television-based health promotion.

Moving into the 'patient-centred medical home': reforming Australian general practice.

PubMed

Hayes, Paul; Lynch, Anthony; Stiffe, Jenni

2016-09-01

The Australian healthcare system is a complex network of services and providers funded and administered by federal, state and territory governments, supplemented by private health insurance and patient contributions. The broad geographical range, complexity and increasing demand within the Australian healthcare sector mean health expenditure is high. Aspects of current funding for the healthcare system have attracted criticism from medical practitioners, patients, representative organisations and independent statutory agencies. In response to the problems in primary care funding in Australia, The Royal Australian College of General Practitioners developed the Vision for general practice and a sustainable healthcare system (the Vision). The Vision presents a plan to improve healthcare delivery in Australia through greater quality, access and efficiency by reorienting how general practice services are funded based on the 'patient-centred medical home' model.

Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention.

PubMed

Ricketts, Ellie J; Francischetto, Elaine O'Connell; Wallace, Louise M; Hogan, Angela; McNulty, Cliodna A M

2016-03-22

Chlamydia trachomatis remains a significant public health problem. We used a complex intervention, with general practice staff, consisting of practice based workshops, posters, computer prompts and testing feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England. We aimed to evaluate how intervention components were received by staff and to understand what determined their implementation into ongoing practice. We used face-to-face and telephone individual interviews with 29 general practice staff analysed thematically within a Normalisation Process Theory Framework which explores: 1. Coherence (if participants understand the purpose of the intervention); 2. Cognitive participation (engagement with and implementation of the intervention); 3. Collective action (work actually undertaken that drives the intervention forwards); 4. Reflexive monitoring (assessment of the impact of the intervention). Our results showed coherence as all staff including receptionists understood the purpose of the training was to make them aware of the value of chlamydia screening tests and how to increase this in their general practice. The training was described by nearly all staff as being of high quality and responsible for creating a shared understanding between staff of how to undertake routine chlamydia screening. Cognitive participation in many general practice staff teams was demonstrated through their engagement by meeting after the training to discuss implementation, which confirmed the role of each staff member and the use of materials. However several participants still felt unable to discuss chlamydia in many consultations or described sexual health as low priority among colleagues. National targets were considered so high for some general practice staff that they didn't engage with the screening intervention. Collective action work undertaken to drive the intervention included use of computer prompts which helped staff remember to make the offer, testing rate feedback and having a designated lead. Ensuring patients collected samples when still in the general practice was not attained in most general practices. Reflexive monitoring showed positive feedback from patients and other staff about the value of screening, and feedback about the general practices testing rates helped sustain activity. A complex intervention including interactive workshops, materials to help implementation and feedback can help chlamydia screening testing increase in general practices.

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

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. 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. 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. 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.

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.

Attitudes of mental health occupational therapists toward evidence-based practice.

PubMed

Hitch, Danielle P

2016-02-01

Evidence-based practice is an important driver in modern health care and has become a priority in mental health occupational therapy in recent years. The aim of this study was to measure the attitudes of a cohort of mental health occupational therapists toward evidence-based practice. Forty-one mental health occupational therapists were surveyed using the Evidence-Based Practice Attitude Scale (EBPAS). Mann-Whitney U tests and Spearman's rho were used to analyze the data. The occupational therapy respondents had generally positive attitudes toward evidence-based practices comparable to established norms. Respondents with further qualifications beyond their professional degree were significantly more likely to try new interventions (p = .31). Significant negative correlations were found also for the subscales of Appeal and Openness in relation to years of occupational therapy practice (rho = -.354, p = .023; rho = -.344, p = 0.28) and mental health experience (rho = -.390, p = 0.12; rho = -.386, p = .013). Therapist factors can significantly impact attitudes toward evidence-based practice. © CAOT 2015.

Managing corneal foreign bodies in office-based general practice.

PubMed

Fraenkel, Alison; Lee, Lawrence R; Lee, Graham A

2017-03-01

Patients with a corneal foreign body may first present to their general practitioner (GP). Safe and efficacious management of these presentations avoids sight-threatening and eye-threatening complications. Removal of a simple, superficial foreign body without a slit lamp is within The Royal Australian College of General Practitioners' (RACGP's) curriculum and scope of practice. Knowing the rele-vant procedural skills and indications for referral is equally important. The objective of this article is to provide an evidence-based and expert-based guide to the management of corneal foreign bodies in the GP's office. History is key to identifying patient characteristics and mechanisms of ocular injury that are red flags for referral. Examination tech-niques and methods of superficial foreign body removal without a slit lamp are outlined, as well as the procedural threshold for referral to an ophthalmologist.

Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

PubMed

Catzikiris, Nigel; Tapley, Amanda; Morgan, Simon; Holliday, Elizabeth G; Ball, Jean; Henderson, Kim; Elliott, Taryn; Spike, Neil; Regan, Cathy; Magin, Parker

2017-08-10

Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (P<0.05) associated with alumni currently undertaking in-practice clinical teaching and supervision were: Australian medical graduation (odds ratio (OR) for international graduates 0.36; 95% CI 0.14-0.92), working in a regional or remote area (OR 2.75; 95% CI 1.24-6.11) and currently undertaking nursing home visits, home visits or after-hours work (OR 2.01; CI 1.02-3.94). Conclusions Rural-urban and country-of-graduation differences in the engagement of early career GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity. What is known about the topic? Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to sustain an effective teaching and supervisory capacity within general practice. The findings of the present study suggest that exploring focused strategies to facilitate and support international medical graduates to engage in teaching during their vocational training, aided by focused supervisor support, may be of particular value.

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

PubMed

Marshall, Martin N; Hiscock, Julia; Sibbald, Bonnie

2002-11-30

To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. Qualitative focus group study using mock quality report cards as prompts for discussion. 12 focus groups held in an urban area in north west England and a semirural area in the south of England. 35 service users, 24 general practitioners, and 18 clinical governance leads. There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

PubMed

Appleby, N J; Dunt, D; Southern, D M; Young, D

1999-08-01

To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

Interpretive medicine: Supporting generalism in a changing primary care world.

PubMed

Reeve, Joanne

2010-01-01

Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the recognition of quality in interpretation and knowledge generation within the qualitative research field, I propose a framework by which to evaluate the quality of knowledge generated within generalist, interpretive clinical practice. I describe three priorities for research in developing this model further, which will strengthen and preserve core elements of the discipline of general practice, and thus promote and support the health needs of the public.

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

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements.

PubMed

Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun

2012-01-01

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?

Advocacy--answering old mail. Canadian Association of General Surgeons.

PubMed

Keith, R G

1999-06-01

Since its inception in 1977, the Canadian Association of General Surgeons (CAGS) has struggled with its responsibility to represent general surgeons in practices across this country. The CAGS has tended to be mute in the presentation of many of its accomplishments, which have improved the role of specialists in community practice, training programs and the subspecialties of general surgery. With the forthcoming changes in direction for the Royal College of Physicians and Surgeons of Canada, based on a recent external survey, the CAGS has a golden opportunity to advocate for a clear identity, autonomous from the Royal College for the purposes of scientific meetings, continuing professional development, scientific and practice affiliation with other surgical specialty societies, and new developments with corporate sector support for advancements in science technology and education. Advocacy for general surgery must be stressed as the priority for the CAGS into the future.

Methodological convergence of program evaluation designs.

PubMed

Chacón-Moscoso, Salvador; Anguera, M Teresa; Sanduvete-Chaves, Susana; Sánchez-Martín, Milagrosa

2014-01-01

Nowadays, the confronting dichotomous view between experimental/quasi-experimental and non-experimental/ethnographic studies still exists but, despite the extensive use of non-experimental/ethnographic studies, the most systematic work on methodological quality has been developed based on experimental and quasi-experimental studies. This hinders evaluators and planners' practice of empirical program evaluation, a sphere in which the distinction between types of study is changing continually and is less clear. Based on the classical validity framework of experimental/quasi-experimental studies, we carry out a review of the literature in order to analyze the convergence of design elements in methodological quality in primary studies in systematic reviews and ethnographic research. We specify the relevant design elements that should be taken into account in order to improve validity and generalization in program evaluation practice in different methodologies from a practical methodological and complementary view. We recommend ways to improve design elements so as to enhance validity and generalization in program evaluation practice.

Individualized population care: linking personal care to population care in general practice.

PubMed

Buetow, Stephen; Getz, Linn; Adams, Peter

2008-10-01

General practice is increasingly expected to deliver population care to individual patients. The feasibility and ethics of this policy shift have been challenged. Our aim is to suggest how to deliver population care while protecting personal care. We outline and discuss concepts of these types of care, their relation to the prevailing discourse regarding intervention benefits, and arguments for individualized population care. Individualized population care can enable general practice to meet the health targets of individual patients in the light of population-based goals. It unifies the concepts of personal care and whole population care. Personal care focuses on the individual good in particular consultations. Whole population care focuses on the overall health good of a population without reference to the individuality of each population member. These types of care constitute elements of a continuum that varies in purpose and objects of focus. The limitations of a crude dichotomy of personal care and population care are made explicit in a series of five arguments that lend support to the concept of individualized population care. We advocate a constructive but critical attitude towards the idea of population-based interventions in everyday general practice. Traditional personal care and whole population care can theoretically be integrated into individualized population care. However, this presupposes clinical-epidemiological expertise and moral awareness in practising clinicians.

Medical students, early general practice placements and positive supervisor experiences.

PubMed

Henderson, Margaret; Upham, Susan; King, David; Dick, Marie-Louise; van Driel, Mieke

2018-03-01

Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptions of student development; and triggers enhancing the experience. A model was developed to reflect these themes. Conclusions Training experiences were enhanced for GPs supervising medical students in early longitudinal clinical placements by the synergy of motivated students and keen teachers with support from patients, practice staff and academic institutions. We developed an explanatory model to better understand the mechanism of positive experiences. Understanding the interaction of factors enhancing teaching satisfaction is important for clinical disciplines wishing to maintain sustainable, high quality teaching.

[Association between productivity, list size, patient and practice characteristics in general practice].

PubMed

Olsen, Kim Rose; Sørensen, Torben Højmark; Gyrd-Hansen, Dorte

2010-04-19

Due to shortage of general practitioners, it may be necessary to improve productivity. We assess the association between productivity, list size and patient- and practice characteristics. A regression approach is used to perform productivity analysis based on national register data and survey data for 1,758 practices. Practices are divided into four groups according to list size and productivity. Statistical tests are used to assess differences in patient- and practice characteristics. There is a significant, positive correlation between list size and productivity (p < 0.01). Nevertheless, 19% of the practices have a list size below and a productivity above mean sample values. These practices have relatively demanding patients (older, low socioeconomic status, high use of pharmaceuticals) and they are frequently located in areas with limited access to specialized care and have a low use of assisting personnel. 13% of the practices have a list size above and a productivity below mean sample values. These practices have relatively less demanding patients, are located in areas with good access to specialized care, and have a high use of assisting personnel. Lists and practice characteristics have substantial influence on both productivity and list size. Adjusting list size to external factors seems to be an effective tool to increase productivity in general practice.

The TextBase project--implementation of a base level message supporting electronic patient record transfer in English general practice.

PubMed

Booth, N; Jain, N L; Sugden, B

1999-01-01

The TextBase project is a laboratory experiment to assess the feasibility of a common exchange format for sending a transcription of the contents of the Electronic Patient Record (EPR) between different general practices, when patients move from one practice to another in the NHS in England. The project was managed using a partnership arrangement between the four EPR systems vendors who agreed to collaborate and the project team. It lasted one year and consisted of an iterative design process followed by creation of message generation and reading modules within the collaborating EPR systems according to a software requirement specification created by the project team. The paper describes the creation of a common record display format, the implementation of transfer using a floppy disk in the lab, and considers the further barriers before a national implementation might be achieved.

An extension of the QZ algorithm for solving the generalized matrix eigenvalue problem

NASA Technical Reports Server (NTRS)

Ward, R. C.

1973-01-01

This algorithm is an extension of Moler and Stewart's QZ algorithm with some added features for saving time and operations. Also, some additional properties of the QR algorithm which were not practical to implement in the QZ algorithm can be generalized with the combination shift QZ algorithm. Numerous test cases are presented to give practical application tests for algorithm. Based on results, this algorithm should be preferred over existing algorithms which attempt to solve the class of generalized eigenproblems where both matrices are singular or nearly singular.

10 CFR 719.7 - Is there a procedure for exceptions or deviations from this part?

Code of Federal Regulations, 2010 CFR

2010-01-01

.... (b) The General Counsel may authorize exceptions based on a recommendation of Department counsel. The General Counsel may also establish exceptions to this part based on current field office and contractor practices which satisfy the purpose of these requirements. (c) Exceptions to this part which are also a...

The Common Core State Standards and Evidence-Based Educational Practices: The Case of Writing

ERIC Educational Resources Information Center

Troia, Gary A.; Olinghouse, Natalie G.

2013-01-01

Although writing plays an important role in the academic, psychosocial, and economic success of individuals, typical writing instruction and assessment in the United States generally does not reflect evidence-based practices. The Common Core State Standards (CCSS) place a great deal of emphasis on written expression and may encourage an increased…

Improving general practice based epidemiologic surveillance using desktop clients: the French Sentinel Network experience.

PubMed

Turbelin, Clément; Boëlle, Pierre-Yves

2010-01-01

Web-based applications are a choice tool for general practice based epidemiological surveillance; however their use may disrupt the general practitioners (GPs) work process. In this article, we propose an alternative approach based on a desktop client application. This was developed for use in the French General Practitioners Sentinel Network. We developed a java application running as a client on the local GP computer. It allows reporting cases to a central server and provides feedback to the participating GPs. XML was used to describe surveillance protocols and questionnaires as well as instances of case descriptions. An evaluation of the users' feelings was carried out and the impact on the timeliness and completeness of surveillance data was measured. Better integration in the work process was reported, especially when the software was used at the time of consultation. Reports were received more frequently with less missing data. This study highlights the potential of allowing multiple ways of interaction with the surveillance system to increase participation of GPs and the quality of surveillance.

Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting.

PubMed

Tytgat, G N; Heading, R C; Müller-Lissner, S; Kamm, M A; Schölmerich, J; Berstad, A; Fried, M; Chaussade, S; Jewell, D; Briggs, A

2003-08-01

Gastro-oesophageal reflux disease (GERD) and constipation have a major impact on public health; however, the wide variety of treatment options presents difficulties for recommending therapy. Lack of definitive guidelines in pharmacy and general practice medicine further exacerbates the decision dilemma. To address these issues, a panel of experts discussed the principles and practice of treating GERD and constipation in the general population and in pregnancy, with the aim of developing respective treatment guidelines. The panel recommended antacids 'on-demand' as the first-line over-the-counter treatment in reflux, and as rescue medication for immediate relief when reflux breaks through with proton pump inhibitors. Calcium/magnesium-based antacids were recommended as the treatment of choice for pregnant women because of their good safety profile. In constipation, current data do not distinguish a hierarchy between polyethylene glycol (PEG)-based laxatives and other first-line treatments, although limitations are associated with stimulant- and bulk-forming laxatives. Where data are available, PEG is superior to lactulose in terms of efficacy. In pregnancy, PEG-based laxatives meet the criteria for the ideal treatment. The experts developed algorithms that present healthcare professionals with clear treatment options and management strategies for GERD and constipation in pharmacy and general practice medicine.

The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.

PubMed

Grant, Suzanne; Huby, Guro; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw; Guthrie, Bruce

2009-03-01

The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.

Assimilating Traditional Healing Into Preventive Medicine Residency Curriculum.

PubMed

Kesler, Denece O; Hopkins, L Olivia; Torres, Eliseo; Prasad, Arti

2015-11-01

Comprehensive cultural competency includes knowledge and awareness of culturally based healing and wellness practices. Healthcare providers should be aware of the individual patient's beliefs, culture, and use of culturally based health practices because patients may adopt such practices for general wellness or as adjunct therapies without the benefit of discussion with their healthcare provider. This article describes the culturally based traditional healing curriculum that has been implemented in the University of New Mexico Public Health and General Preventive Medicine Residency Program in order to fulfill this knowledge necessity. Curricular elements were added in a stepwise manner starting in 2011, with the full content as described implemented starting in 2013. Data were collected annually with evaluation of the full curriculum occurring in 2015. New Mexico has a diverse population base that includes predominantly Hispanic and Native American cultures, making the inclusion of curriculum regarding traditional healing practices very pertinent. Residents at the University of New Mexico were educated through several curricular components about topics such as Curanderismo, the art of Mexican Folk Healing. An innovative approach was used, with a compendium of training methods that included learning directly from traditional healers and participation in healing practices. The incorporation of this residency curriculum resulted in a means to produce physicians well trained in approaching patient care and population health with knowledge of culturally based health practices in order to facilitate healthy patients and communities. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Vulnerability and the 'slippery slope' at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands.

PubMed

Norwood, Frances; Kimsma, Gerrit; Battin, Margaret P

2009-12-01

One enduring criticism of the Dutch euthanasia policy is the 'slippery slope' argument that suggests that allowing physicians to conduct legal euthanasia or assisted suicide would eventually lead to patients being killed against their will. What we currently know about euthanasia and its practices in The Netherlands is predominantly based on retrospective quantitative or interview-based studies, but these studies fail to detail the mechanisms of day-to-day practice. To examine the practices that surround euthanasia, particularly among vulnerable patients, using qualitative observation-based data. A 15-month qualitative, observation-based study of home death and general practice in the greater Amsterdam region of The Netherlands. Study included observation and interviews with a sample of 15 (GPs and 650 of their patients, 192 of whom were living with terminal or life-threatening illness (with and without requests for euthanasia). Euthanasia practice typically involves extensive deliberations, the majority of which do not end in a euthanasia death. Euthanasia discussions or 'euthanasia talk' share at least two consequences: (i) the talk puts the onus on patients to continue discussions towards a euthanasia death and (ii) there is a socio-therapeutic component, which tends to affirm social bonds and social life. While this qualitative evidence cannot disprove existence of abuse, it suggests that euthanasia practices have evolved in such a way that patients are more likely to talk about euthanasia than to die a euthanasia death.

Practice-based learning can improve osteoporosis care.

PubMed

Hess, Brian J; Johnston, Mary M; Iobst, William F; Lipner, Rebecca S

2013-10-01

To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis. Retrospective cohort study. Internal medicine and subspecialty clinics. Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty. Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review. Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement. Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Transforming family practice in British Columbia

PubMed Central

Cavers, William J.R.; Tregillus, Valerie H.F.; Micco, Angela; Hollander, Marcus J.

2010-01-01

ABSTRACT OBJECTIVE To describe a new approach to primary care reform developed in British Columbia (BC) under the leadership of the General Practice Services Committee (GPSC). COMPOSITION OF THE COMMITTEE The GPSC is a joint committee of the BC Ministry of Health Services, the BC Medical Association, and the Society of General Practitioners of BC. Representatives of BC’s health authorities also attend as guests. METHOD This paper is based on the 2008–2009 annual report of the GPSC. It summarizes the history and main activities of the GPSC. REPORT The GPSC is currently supporting a number of key activities to transform primary care in BC. These activities include the Full Service Family Practice Incentive Program, which provides incentive payments to promote enhanced primary care; the Practice Support Program, which provides family physicians and their medical office assistants with various practical evidence-based strategies and tools for managing practice enhancement; the Family Physicians for BC Program to develop family practices in areas of identified need; the Shared Care Committee, which supports and enables the determination of appropriate scopes of practice among GPs, specialists, and other health care professionals; the Divisions of Family Practice, which are designed to facilitate interactions among family doctors and between doctors and their respective health authorities; and the Community Healthcare and Resource Directory, a Web-based resource to help health care providers find appropriate mental health resources. CONCLUSION Early results indicate that the GPSC’s initiatives are enhancing the delivery of primary care services in BC. PMID:21156899

Effective domain-dependent reuse in medical knowledge bases.

PubMed

Dojat, M; Pachet, F

1995-12-01

Knowledge reuse is now a critical issue for most developers of medical knowledge-based systems. As a rule, reuse is addressed from an ambitious, knowledge-engineering perspective that focuses on reusable general purpose knowledge modules, concepts, and methods. However, such a general goal fails to take into account the specific aspects of medical practice. From the point of view of the knowledge engineer, whose goal is to capture the specific features and intricacies of a given domain, this approach addresses the wrong level of generality. In this paper, we adopt a more pragmatic viewpoint, introducing the less ambitious goal of "domain-dependent limited reuse" and suggesting effective means of achieving it in practice. In a knowledge representation framework combining objects and production rules, we propose three mechanisms emerging from the combination of object-oriented programming and rule-based programming. We show these mechanisms contribute to achieve limited reuse and to introduce useful limited variations in medical expertise.

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

Grant, Aileen; Sullivan, Frank; Dowell, Jon

2013-06-21

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. 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. 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. 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.

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

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

The Responsible Inclusion of Students Receiving Special Education Services for Emotional Disturbance: Unraveling the Practice to Research Gap.

PubMed

McKenna, John William; Solis, Michael; Brigham, Frederick; Adamson, Reesha

2018-03-01

The majority of students receiving special education services for emotional disturbance (ED) receive a significant amount of instruction in general education classrooms, which emphasizes curriculums based on college and career readiness standards. In turn, those teachers who provide instruction to students with ED in inclusive settings are responsible for using evidence-based practices (EBPs) for those teaching situations in which they exist to meet free appropriate public education (FAPE) mandates. However, the identification of EBPs is a necessary pre-condition to eventual school adoption and teacher use of such practices. In this investigation, we completed a synthesis of syntheses to (a) determine the degree to which academic intervention research has focused on students with ED in general education classrooms and (b) identify practices that are effective at improving the academic performance of students with ED in these settings. Overall, few studies were identified. Of those studies identified, half did not disaggregate outcomes for students with ED. A quality indicator coding based on the What Works Clearinghouse (WWC) design standards revealed that no studies with disaggregated outcomes permitted causal inferences. Implications for school practice and areas for future research are discussed.

Evaluation of computerized decision support for oral anticoagulation management based in primary care.

PubMed

Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

1996-09-01

Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability.

Narrating practice: reflective accounts and the textual construction of reality.

PubMed

Taylor, Carolyn

2003-05-01

Two approaches dominate current thinking in health and welfare: evidence-based practice and reflective practice. Whilst there is debate about the merits of evidence-based practice, reflective practice is generally accepted with critical debate as an important educational tool. Where critique does exist it tends to adopt a Foucauldian approach, focusing on the surveillance and self-regulatory aspects of reflective practice. This article acknowledges the critical purchase on the concept of reflective practice offered by Foucauldian approaches but argues that microsociological and discourse analytic approaches can further illuminate the subject and thus serve as a complement to them. The claims of proponents of reflective practice are explored, in opposition to the technical-rational approach of evidence-based practice. Reflective practice tends to adopt a naive or romantic realist position and fails to acknowledge the ways in which reflective accounts construct the world of practice. Microsociological approaches can help us to understand reflective accounts as examples of case-talk, constructed in a narrative form in the same way as case records and presentations.

General dentist characteristics associated with rural practice location.

PubMed

McKernan, Susan C; Kuthy, Raymond A; Kavand, Golnaz

2013-08-01

To examine whether there is a difference in the likelihood that a general dentist practices in a rural location based on individual characteristics, including dental school attended, birth state, practice arrangement, sex, and age. All private practice, general dentists in Iowa were included in this study. Data were extracted from the year 2010 version of the Iowa Dentist Tracking System, which monitors practice patterns of active dentists. Rurality of primary office location, categorized using Rural-Urban Commuting Area codes, served as the outcome variable. Chi-square tests and multivariable logistic regression were used to explain associations between rural practice location and dentist characteristics. Fifteen percent of the state's population resided in isolated small rural towns, but only 8% of general dentists practiced here. Approximately 17% of dentists in isolated small rural towns were age 40 or younger, compared to 32% of dentists in urban areas. Among male dentists, those who were born in Iowa (P = .002) were older (P = .020), and graduated from dental schools other than the University of Iowa (P = .009) were more likely to practice in rural areas than were their counterparts. Conversely, among female dentists, solo practice (P = .016) was the only variable significantly associated with rural practice location. The dentist workforce in rural areas of Iowa is dominated by older males who were born in Iowa. As this generation retires and increasing numbers of women enter the profession, state policy makers and planners will need to monitor changing trends in the rural workforce. © 2013 National Rural Health Association.

How psychosocial factors affect well-being of practice assistants at work in general medical care?--a questionnaire survey.

PubMed

Goetz, Katja; Berger, Sarah; Gavartina, Amina; Zaroti, Stavria; Szecsenyi, Joachim

2015-11-11

Well-being at work is an important aspect of a workforce strategy. The aim of the study was to explore and evaluate psychosocial factors and health and work-related outcomes of practices assistants depending on their employment status in general medical practices. This observational study was based on a questionnaire survey to evaluate psychosocial aspects at work in general medical practices. A standardized questionnaire was used, the Copenhagen Psychosocial Questionnaire (COPSOQ). Beside descriptive analyses linear regression analyses were performed for each health and work-related outcome scale of the COPSOQ. 586 practice assistants out of 794 respondents (73.8 %) from 234 general medical practices completed the questionnaire. Practice assistants reported the highest scores for the psychosocial factor 'sense of community' (mean = 85.9) and the lower score for 'influence at work' (mean = 41.2). Moreover, practice assistants who worked part-time rated their psychosocial factors at work and health-related outcomes more positively than full-time employees. Furthermore, the two scales of health related outcomes 'burnout' and 'job satisfaction' showed strong associations between different psychosocial factors and socio-demographic variables. Psychosocial factors at work influence well-being at work and could be strong risk factors for poor health and work-related outcomes. Effective management of these issues could have an impact on the retention and recruitment of health care staff.

16 CFR 1018.33 - Change of status.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Change of status. 1018.33 Section 1018.33 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Administration... based), shall immediately notify, in writing, the Advisory Committee Management Officer. Such...

Translating research and into everyday clinical practice: Lessons learned from a USA national dental practice-based research network

PubMed Central

Gordan, Valeria V.

2012-01-01

Clinical studies are of paramount importance for testing and translation of the research findings to the community. Despite the existence of clinical studies, a significant delay exists between the generation of new knowledge and its application into the medical/dental community and their patients. One example is the repair of defective dental restorations. About 75% of practitioners in general dental practices do not consider the repair of dental restorations as a viable alternative to the replacement of defective restorations. Engaging and partnering with health practitioners in the field on studies addressing everyday clinical research questions may offer a solution to speed up the translation of the research findings. Practice-based research (PBR) offers a unique opportunity for practitioners to be involved in the research process, formulating clinical research questions. Additionally, PBR generates evidence-based knowledge with a broader spectrum that can be more readily generalized to the public. With PBR, clinicians are involved in the entire research process from its inception to its dissemination. Early practitioner interaction in the research process may result in ideas being more readily incorporated into practice. This paper discusses PBR as a mean to speed up the translation of research findings to clinical practice. It also reviews repair versus replacement of defective restorations as one example of the delay in the application of research findings to clinical practice. PMID:22889478

Effects of Inquiry-Based Instruction on Science Achievement for Students with Disabilities: An Analysis of the Literature

ERIC Educational Resources Information Center

Rizzo, Karen L.; Taylor, Jonte C.

2016-01-01

In comparison to the past, more students with disabilities are being included in the general education classroom for science instruction. Though inquiry-based instruction has not shown to be an effective practice for students with disabilities, it is vastly becoming the dominant practice in science education. The purpose of this review is to…

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

Tell Me What You Hear: Vocabulary Acquisition and Application in the General Music Middle School Classroom

ERIC Educational Resources Information Center

Walby, Nathan

2011-01-01

Teaching musical vocabulary in a middle school general music class can often be challenging to the performance-based teacher. This article provides several teaching strategies for approaching words from both a theoretical and a practical standpoint. Based on a dialectical "this-with-that" approach by Estelle Jorgensen, this article argues that…

Improved Characters and Student Learning Outcomes through Development of Character Education Based General Physics Learning Model

ERIC Educational Resources Information Center

Derlina; Sabani; Mihardi, Satria

2015-01-01

Education Research in Indonesia has begun to lead to the development of character education and is no longer fixated on the outcomes of cognitive learning. This study purposed to produce character education based general physics learning model (CEBGP Learning Model) and with valid, effective and practical peripheral devices to improve character…

Theory and interpretation in qualitative studies from general practice: Why and how?

PubMed

Malterud, Kirsti

2016-03-01

In this article, I want to promote theoretical awareness and commitment among qualitative researchers in general practice and suggest adequate and feasible theoretical approaches. I discuss different theoretical aspects of qualitative research and present the basic foundations of the interpretative paradigm. Associations between paradigms, philosophies, methodologies and methods are examined and different strategies for theoretical commitment presented. Finally, I discuss the impact of theory for interpretation and the development of general practice knowledge. A scientific theory is a consistent and soundly based set of assumptions about a specific aspect of the world, predicting or explaining a phenomenon. Qualitative research is situated in an interpretative paradigm where notions about particular human experiences in context are recognized from different subject positions. Basic theoretical features from the philosophy of science explain why and how this is different from positivism. Reflexivity, including theoretical awareness and consistency, demonstrates interpretative assumptions, accounting for situated knowledge. Different types of theoretical commitment in qualitative analysis are presented, emphasizing substantive theories to sharpen the interpretative focus. Such approaches are clearly within reach for a general practice researcher contributing to clinical practice by doing more than summarizing what the participants talked about, without trying to become a philosopher. Qualitative studies from general practice deserve stronger theoretical awareness and commitment than what is currently established. Persistent attention to and respect for the distinctive domain of knowledge and practice where the research deliveries are targeted is necessary to choose adequate theoretical endeavours. © 2015 the Nordic Societies of Public Health.

Implementation of evidence-based knowledge in general practice.

PubMed

Le, Jette Videbæk

2017-12-01

Background Keeping up with the evidence and implementing it into the daily care for patients are fundamental prerequisites for delivering a high quality of care in general practice. However, despite many years of research into dissemination and implementation of evidence-based recommendations, significant challenges remain. In recent years, organisational factors have become widely acknowledged as vitally important for ensuring successful implementation. Further knowledge is needed to understand more about which factors affect the seeking and implementation of evidence-based knowledge in general practice. Aim The overall aim was to investigate how evidence-based knowledge is sought and implemented in general practice and to analyse associations with GP characteristics and quality of care. Three separate studies, each covering a specific part of the overall aim, were undertaken: I. To examine how GPs implement clinical practice guidelines in everyday clinical practice, and how implementation approaches differ between practices. II. To assess GPs’ information seeking behaviour with regard to the use and perceived importance of scientific medical information sources and to investigate associations with GP characteristics. III. To investigate if there are associations between specific formalised implementation activities within general practice and quality of care – exemplified by the use of spirometry testing among first-time users of medication against obstructive lung diseases. Methods The study was designed as a mixed methods study combining qualitative interviews, questionnaire and register data. Study I was a qualitative interview study that involved purposefully selected GPs representing seven different practices. The interviews were analysed using systematic text condensation, and results were used to qualify the development of a national survey of general practitioners regarding their seeking and implementation of evidence-based knowledge. This survey was distributed on December 4th to all GPs in Denmark who at the time had an email address registered at the Danish Organisation of GPs (N = 3,440). Study II was a cross-sectional study based on the survey data. In study III, while also applying a cross-sectional design, data on quality of care from national registers were linked to data from the survey. Spirometry testing among patients redeeming a first-time prescription for medication targeted obstructive lung diseases (R03 medication) was used as an example of an evidence-based recommendation, and thereby as a proxy for quality of care. Results Study I: The analysis of the semi-structured individual interviews revealed that approaches to implementation of clinical guidelines differed substantially between practices. Overall, three different approaches were identified, depending on the degree to which implementation was collectively and formally organised. In some practices, the GPs prioritised time and resources for collective implementation activities and organized their everyday practice to support these activities. In other practices, GPs discussed guidelines collectively, but left the application up to the individual GP whilst others saw no need for discussion or collective activities depending entirely on the individual GP’s decision on whether and how to manage implementation. The GPs’ attitudes to consistency in patient care appeared to be closely related to their approach to implementation. Study II: A total of 1,580 (46.4%) GPs responded to the questionnaire. Results showed that GPs’ information-seeking behaviour is associated with gender, age and practice form. Single-handed GPs use their colleagues as an information source significantly less than GPs working in partnership practices, and they do not use other sources more frequently. Compared with their younger colleagues, GPs aged over 44 years are less likely to seek information from colleagues, guidelines and websites, but more likely to seek information from medical journals. Male and female GPs seek information equally frequently. However, whereas male GPs are more likely than female GPs to find that pharmaceutical sales representative and non-refundable CME meetings are important sources in keeping medically updated, they are less likely to find that colleagues, refundable CME meetings, guidelines and drug information websites are important. Study III: GPs from 1,114 practices (58%) responded to the questionnaire, and 33,788 patients were linked to a responding practice. In partnership practices, compared with less frequent or no meetings, weekly interdisciplinary and weekly GP meetings were significantly associated with higher quality of care measured by patients’ OR of having spirometry performed. Furthermore, the development of practice protocols and standard recordings in the EMR in a range of disease areas, compared with only a few areas or none at all, were significantly associated with quality of care. The effect of formalised implementation activities was not as evident in single-handed practices as in partnerships. Conclusion The results show how GP characteristics could be taken into consideration when disseminating scientific medical information to better ensure that patients are provided with medically updated, high-quality care. Further, the study demonstrates the variation in approaches to implementation of evidence-based knowledge in general practices. This variation should be taken into consideration when developing quality improvement initiatives or interventions. Thus, knowledge of which approaches are used in specific practice settings could prove essential when deciding where to put the focus and support. Finally, the study indicates that important factors to be considered in that respect are the presence of formalised implementation activities in the practices as some degree of formalisation appears to contribute to sustaining a high quality of care by supporting implementation of evidence-based recommendations. Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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

Williamson, Margaret; Cardona-Morrell, Magnolia; Elliott, Jeffrey D; Reeve, James F; Stocks, Nigel P; Emery, Jon; Mackson, Judith M; Gunn, Jane M

2012-08-23

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. 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. 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. Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.

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

A shared-care model of obesity treatment for 3-10 year old children: protocol for the HopSCOTCH randomised controlled trial.

PubMed

Wake, Melissa; Lycett, Kate; Sabin, Matthew A; Gunn, Jane; Gibbons, Kay; Hutton, Cathy; McCallum, Zoe; York, Elissa; Stringer, Michael; Wittert, Gary

2012-03-28

Despite record rates of childhood obesity, effective evidence-based treatments remain elusive. While prolonged tertiary specialist clinical input has some individual impact, these services are only available to very few children. Effective treatments that are easily accessible for all overweight and obese children in the community are urgently required. General practitioners are logical care providers for obese children but high-quality trials indicate that, even with substantial training and support, general practitioner care alone will not suffice to improve body mass index (BMI) trajectories. HopSCOTCH (the Shared Care Obesity Trial in Children) will determine whether a shared-care model, in which paediatric obesity specialists co-manage obesity with general practitioners, can improve adiposity in obese children. Randomised controlled trial nested within a cross-sectional BMI survey conducted across 22 general practices in Melbourne, Australia. Children aged 3-10 years identified as obese by Centers for Disease Control criteria at their family practice, and randomised to either a shared-care intervention or usual care. A single multidisciplinary obesity clinic appointment at Melbourne's Royal Children's Hospital, followed by regular appointments with the child's general practitioner over a 12 month period. To support both specialist and general practice consultations, web-based shared-care software was developed to record assessment, set goals and actions, provide information to caregivers, facilitate communication between the two professional groups, and jointly track progress. Primary - change in BMI z-score. Secondary - change in percentage fat and waist circumference; health status, body satisfaction and global self-worth. This will be the first efficacy trial of a general-practitioner based, shared-care model of childhood obesity management. If effective, it could greatly improve access to care for obese children. Australian New Zealand Clinical Trials Registry ACTRN12608000055303.

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia.

PubMed

Chew, Derek P; Carter, Robert; Rankin, Bree; Boyden, Andrew; Egan, Helen

2010-05-01

The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model. A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented. Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program's ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis. Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.

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

General practice consultations, diagnostic investigations, and prescriptions in the year preceding a lung cancer diagnosis.

PubMed

Guldbrandt, Louise M; Møller, Henrik; Jakobsen, Erik; Vedsted, Peter

2017-01-01

Patterns of general practice utilization in the period before lung cancer (LC) diagnosis may provide new knowledge to ensure timelier and earlier diagnosis of LC. This study aimed to explore the prediagnostic activity in general practice in the year preceding LC diagnosis. The activity was compared to a matched comparison group. We compared LC patients with different stage, and patients with and without chronic obstructive pulmonary disease (COPD). Using Danish registers, we performed a population-based matched cohort study including lung cancer patients (n = 34,017) and matched comparison subjects (n = 340,170). During months 12 to 1 prior to diagnosis, 92.6% of LC patients and 88.4% of comparison subjects had one or more contacts with general practice. 13.0% of LC patients and 3.3% of comparison subjects had two or more X-rays. 20.8% of LC patients and 8.5% of comparison subjects had two or more first-time antibiotics prescriptions. The incidence rate ratio for having a contact to general practice was similar for LC patients with localized disease compared to LC patients with metastatic disease. LC patients with COPD had more frequent contacts, lung functions tests, X-rays, and prescriptions than COPD patients without lung cancer, but not as pronounced as compared to patients without COPD. There was a significant increase in healthcare seeking and diagnostic activity in the year prior to a LC diagnosis, regardless of stage at diagnosis. COPD may mask the symptoms of LC. This indicates the presence of a "diagnostic time window" and a potential for more timely diagnosis of LC based on clinical signs and symptoms. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

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

PubMed

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

2013-02-01

Urinary tract infection (UTI) in children may be associated with long-term complications that could be prevented by prompt treatment. 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. Prospective observational study with systematic urine sampling, in general practices in Wales, UK. 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. 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%. 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.

Empathy in general practice-the gap between wishes and reality: comparing the views of patients and physicians.

PubMed

Derksen, F A W M; Olde Hartman, Tim; Bensing, Jozien; Lagro-Janssen, Antoine

2018-03-27

Empathy is regarded by patients and general practitioners (GPs) as fundamental in patient-GP communication. Patients do not always experience empathy and GPs encounter circumstances which hamper applying it. To explore why receiving and offering empathy during the encounter in general practice does not always meet the wishes of both patients and GPs. A qualitative research method, based on focus group interviews with patients and in-depth interviews with GPs, was carried out. Within the research process, iterative data collection and analysis were applied. Both patients and GPs perceive a gap between what they wish for with regard to empathy, and what they actually encounter in general practice. Patients report on circumstances which hamper receiving empathy and GPs on circumstances offering it. Various obstacles were mentioned: (i) circumstances related to practice organization, (ii) circumstances related to patient-GP communication or connectedness, (iii) differences between the patient's and the GP's expectations, (iv) time pressure and its causes and (v) the GP's individual capability to offer empathy. When patients do not receive empathy from their GP or practice staff, they feel frustrated. This causes a gap between their expectations on the one hand and their actual experiences on the other. GPs generally want to incorporate empathy; the GP's private, professional and psychological well-being appears to be an important contributing factor in practicing empathy in daily practice. But they encounter various obstacles to offer this. It is up to GPs to take responsibility for showing practice members the importance of an appropriate empathical behaviour towards patients.

The hospital component of general practice vocational training--the Irish experience.

PubMed

Murphy, A W

1992-12-01

All second and third year general practice vocational trainees in the Irish Republic in 1991 were invited to complete a questionnaire concerning the hospital component of their training. The questionnaire was based on specific recommendations published by the I.C.G.P. regarding hospital training posts. Replies were received from 39 trainees constituting 70% of the total number of eligible trainees. In general, hospital posts were perceived to be of relevance and to offer adequate exposure to outpatient management and to the development of useful practical skills. More than 70% of the trainees were free to attend at least 75% of the study release course. Everyone entitled to study leave for examination purposes obtained it. However, 95% of trainees found their hospital teachers unfamiliar with the aims and objectives of Vocational Training. Two-thirds of trainees received less than two hours a week of formal or informal teaching. More than two-thirds did not participate in an introductory general practice period and less than a quarter had their individual needs assessed early on. Substantial realisation of the guidelines issued by the ICGP has been achieved. Further work is necessary in the areas of individual needs assessment, relevant structured teaching and general practice liaison. Three specific recommendations are made to achieve these aims.

Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress.

PubMed

Marchand, William R

2012-07-01

Mindfulness has been described as a practice of learning to focus attention on moment-bymoment experience with an attitude of curiosity, openness, and acceptance. Mindfulness practices have become increasingly popular as complementary therapeutic strategies for a variety of medical and psychiatric conditions. This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain. The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). All three approaches originated from Buddhist spiritual practices, but only Zen is an actual Buddhist tradition. MBSR and MBCT are secular, clinically based methods that employ manuals and standardized techniques. Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress. MBCT is strongly recommended as an adjunctive treatment for unipolar depression. The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms. MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals. Finally, MBSR and Zen meditation have a role in pain management.

Diffusion of surgical techniques in early stage breast cancer: variables related to adoption and implementation of sentinel lymph node biopsy.

PubMed

Vanderveen, Kimberly A; Paterniti, Debora A; Kravitz, Richard L; Bold, Richard J

2007-05-01

Understanding how physicians acquire and adopt new technologies for cancer diagnosis and treatment is poorly understood, yet is critical to the dissemination of evidence-based practices. Sentinel lymph node biopsy (SLNB) has recently become a standard technique for axillary staging in early breast cancer and is an ideal platform for studying medical technology diffusion. We sought to describe the timing of SLNB adoption and patterns of surgeon interactions with the following educational sources: local university training program, surgical literature, national meetings/courses, national specialty centers, and other local surgeons. A cross-sectional survey that used semistructured interviews was used to assess timing of adoption, practice patterns, and learning sources for SLNB among surgical oncologists and general surgeons in a single metropolitan area. A total of 44 eligible surgeons were identified; 38 (86%) participated. All surgical oncologists (11 of 11) and most general surgeons (26 of 27) had implemented SLNB. Surgical oncologists were older (mean 51 vs. 48 years, P = .02) and had used SLNB longer (6.1 vs. 3.3 years, P = .01) than general surgeons. By use of social network diagrams, surgical oncologists and the university training program were shown to be key intermediaries between general surgeons and national specialty centers. Surgeons in group practice tended to use more learning sources than solo practitioners. Surgical oncologists and university-based surgeons play key educational roles in disseminating new cancer treatments and therefore have a professional responsibility to educate other community physicians to increase the use of the most current, evidence-based practices.

The pond is wider than you think! Problems encountered when searching family practice literature.

PubMed Central

Rosser, W. W.; Starkey, C.; Shaughnessy, R.

2000-01-01

OBJECTIVE: To explain differences in the results of literature searches in British general practice and North American family practice or family medicine. DESIGN: Comparative literature search. SETTING: The Department of Family and Community Medicine at the University of Toronto in Ontario. METHOD: Literature searches on MEDLINE demonstrated that certain search strategies ignored certain key words, depending on the search engine and the search terms chosen. Literature searches using the key words "general practice," "family practice," and "family medicine" combined with the topics "depression" and then "otitis media" were conducted in MEDLINE using four different Web-based search engines: Ovid, HealthGate, PubMed, and Internet Grateful Med. MAIN OUTCOME MEASURES: The number of MEDLINE references retrieved for both topics when searched with each of the three key words, "general practice," "family practice," and "family medicine" using each of the four search engines. RESULTS: For each topic, each search yielded very different articles. Some search engines did a better job of matching the term "general practice" to the terms "family medicine" and "family practice," and thus improved retrieval. The problem of language use extends to the variable use of terminology and differences in spelling between British and American English. CONCLUSION: We need to heighten awareness of literature search problems and the potential for duplication of research effort when some of the literature is ignored, and to suggest ways to overcome the deficiencies of the various search engines. Images Figure 1 Figure 2 PMID:10660792

Four sexually transmitted infections (STIs) in Belgian general practice: first results (2013-2014) of a nationwide continuing surveillance study.

PubMed

Boffin, N; Moreels, S; Deblonde, J; Van Casteren, V

2017-01-27

To describe and explore data from the surveillance of chlamydia, syphilis, gonorrhoea and genital warts by the Belgian Network of Sentinel General Practices (SGP) over the first 2 years (2013 and 2014) and to estimate the incidence of these 4 sexually transmitted infections (STIs). A special focus is put on data quality. Retrospective observational study. General practices from the nationwide representative SGP network. Agreement between data distributions by year, agreement between SGP-based incidence and incidence based on mandatory notification, missingness of patient age or gender and incompleteness of sexual risk history of patients. 306 new STI episodes were reported from 298 patients, corresponding with an episode-based incidence of 91.9/100 000 (95% CI 81.9 to 102.8) general practice patients, with almost half of it due to chlamydia. The incidence of chlamydia in men was significantly higher in 2014 than in 2013. Population characteristics were similarly distributed in 2013 and 2014. The SGP-based incidence of gonorrhoea and syphilis in Flanders were in agreement with the incidence based on mandatory notification of cases. Patient age or gender was missing from 35 episodes (11.4%). Independent determinants of missingness of patient age or gender were the Flemish region (OR 3.46; 95% CI 1.02 to 11.73) and genital warts infection (OR 2.23; 95% CI 1.07 to 4.63). An incomplete sexual risk history was reported for 54.6% STI episodes. The odds for an incomplete sexual history were higher for older patients (OR 1.72; 95% CI 1.06 to 2.76) and for patients infected with syphilis, gonorrhoea or co-infection(s) (OR 1.71; 95% CI 1.03 to 2.83). Incompleteness of reports about patients with STI sexual risk histories is important from the perspective of quality of data and of quality of care. Together with the low rates of both HIV testing and discussion of partner notification, this suggests that a general practice guideline is needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Buffers or Boosters? The Role of HRM Practices in Older Workers' Experience of Stereotype Threat.

PubMed

Oliveira, Eduardo André da Silva; Cabral-Cardoso, Carlos José

2018-01-02

Building on the social identity approach and the HRM literature, this two-wave cross-sectional study examined the effects of negative age-based metastereotypes on the age-based stereotype threat experience of older workers and on organizational disidentification. The moderator role of HRM practices in the relationship between negative age-based metastereotypes and age-based stereotype threat was also investigated. Older workers survey results (n = 469) from 14 manufacturing companies indicated that negative age-based metastereotypes correlate positively with stereotype threat. Moderation results showed that age-awareness HRM practices (training for older workers) reinforced age-based stereotype threat, whereas general HRM practices (recognition and respect) impaired it. The article suggests that the combination of age-based metastereotypes with a stereotype threat framework contributes to further understand older workers' beliefs and attitudes. It also indicates that to be effective, HRM practices should emphasize positive social identities older workers share with their colleagues, rather than giving older workers special treatment that may, after all, reinforce stigmatization.

Interpretive Medicine

PubMed Central

Reeve, Joanne

2010-01-01

Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the recognition of quality in interpretation and knowledge generation within the qualitative research field, I propose a framework by which to evaluate the quality of knowledge generated within generalist, interpretive clinical practice. I describe three priorities for research in developing this model further, which will strengthen and preserve core elements of the discipline of general practice, and thus promote and support the health needs of the public. PMID:21805819

New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory.

PubMed

Hoare, Karen J; Mills, Jane; Francis, Karen

2013-07-01

Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses' use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X. © 2013 John Wiley & Sons Ltd.

Problem solving therapy - use and effectiveness in general practice.

PubMed

Pierce, David

2012-09-01

Problem solving therapy (PST) is one of the focused psychological strategies supported by Medicare for use by appropriately trained general practitioners. This article reviews the evidence base for PST and its use in the general practice setting. Problem solving therapy involves patients learning or reactivating problem solving skills. These skills can then be applied to specific life problems associated with psychological and somatic symptoms. Problem solving therapy is suitable for use in general practice for patients experiencing common mental health conditions and has been shown to be as effective in the treatment of depression as antidepressants. Problem solving therapy involves a series of sequential stages. The clinician assists the patient to develop new empowering skills, and then supports them to work through the stages of therapy to determine and implement the solution selected by the patient. Many experienced GPs will identify their own existing problem solving skills. Learning about PST may involve refining and focusing these skills.

Full journal publication of abstracts presented at the Nordic Congress of General Practice in 2009 and 2011.

PubMed

Waldorff, Frans Boch; Petersen, Kristine; Vinther, Siri; Sandholdt, Håkon; Siersma, Volkert; Andersen, John Sahl

2017-03-01

To determine the overall publication rates for abstracts presented at two consecutive Nordic Congresses of General Practice and to evaluate determinants for these publication rates. Prospective study. MEDLINE (PubMed) and Google Scholar were searched for relevant publications from 1 January 2009 up until 31 August 2014. Abstracts accepted for oral or poster presentation were identified from the original congress booklets from the Nordic Congresses of General Practice in 2009 and 2011. Based on PubMed and Google Scholar searches, we subsequently identified full journal publications within a 36-month follow-up from both congresses. In cases of doubt, the first author was contacted directly. Full journal publication within 36 months after the congress. A total of 200 abstracts were analyzed. Of these, 85 (42.5%) were identified with a full publication within 36 months after the congress. More abstracts from the 2011 congress were published compared to the 2009 congress odds ratio (OR) 1.97, 95% confidence interval (CI) (1.10; 3.50). Abstracts accepted for oral presentation were more often published OR 1.94, 95% CI (1.08; 3.50) than accepted poster abstracts. In the multivariate analysis, a university affiliation for both first and last author increased the probability for publication OR 4.23, 95% CI (1.71; 10.42), as well as more than two authors. An optimal number, based on the highest OR, seems to be 3-4 authors with OR 2.43, 95% CI (1.07; 5.54). Qualitative studies were published at the same frequency as quantitative studies OR 1.36, 95% CI (0.57; 3.24). Less than half of the abstracts accepted for oral or poster presentation at two consecutive Nordic Congresses of General Practice were published as full text articles within 36 months. Key points Congress abstracts accepted for Nordic Congress of General Practice are not indexed in international search databases. Less than half of the abstracts accepted for oral or poster presentation at two consecutive Nordic Congresses of General Practice were published as full text articles within 36 months. Future congress committees could address this aspect in order to increase the visibility of and accessibility to research within the field of general practice.

Full journal publication of abstracts presented at the Nordic Congress of General Practice in 2009 and 2011

PubMed Central

Waldorff, Frans Boch; Petersen, Kristine; Vinther, Siri; Sandholdt, Håkon; Siersma, Volkert; Andersen, John Sahl

2017-01-01

Objective To determine the overall publication rates for abstracts presented at two consecutive Nordic Congresses of General Practice and to evaluate determinants for these publication rates. Design Prospective study. Setting MEDLINE (PubMed) and Google Scholar were searched for relevant publications from 1 January 2009 up until 31 August 2014. Methods Abstracts accepted for oral or poster presentation were identified from the original congress booklets from the Nordic Congresses of General Practice in 2009 and 2011. Based on PubMed and Google Scholar searches, we subsequently identified full journal publications within a 36-month follow-up from both congresses. In cases of doubt, the first author was contacted directly. Main outcome measures Full journal publication within 36 months after the congress. Results A total of 200 abstracts were analyzed. Of these, 85 (42.5%) were identified with a full publication within 36 months after the congress. More abstracts from the 2011 congress were published compared to the 2009 congress odds ratio (OR) 1.97, 95% confidence interval (CI) (1.10; 3.50). Abstracts accepted for oral presentation were more often published OR 1.94, 95% CI (1.08; 3.50) than accepted poster abstracts. In the multivariate analysis, a university affiliation for both first and last author increased the probability for publication OR 4.23, 95% CI (1.71; 10.42), as well as more than two authors. An optimal number, based on the highest OR, seems to be 3–4 authors with OR 2.43, 95% CI (1.07; 5.54). Qualitative studies were published at the same frequency as quantitative studies OR 1.36, 95% CI (0.57; 3.24). Conclusion Less than half of the abstracts accepted for oral or poster presentation at two consecutive Nordic Congresses of General Practice were published as full text articles within 36 months. Key points Congress abstracts accepted for Nordic Congress of General Practice are not indexed in international search databases. Less than half of the abstracts accepted for oral or poster presentation at two consecutive Nordic Congresses of General Practice were published as full text articles within 36 months. Future congress committees could address this aspect in order to increase the visibility of and accessibility to research within the field of general practice. PMID:28277049

General practitioners' use of caries-preventive agents in adult patients versus pediatric patients: findings from the dental practice-based research network.

PubMed

Riley, Joseph L; Gordan, Valeria V; Rindal, D Brad; Fellows, Jeffrey L; Williams, O Dale; Ritchie, Lloyd K; Gilbert, Gregg H

2010-06-01

In this study, the authors tested the frequency of dentists' recommendations for and use of caries-preventive agents for children as compared with adults. The authors surveyed 467 general dentists in the Dental Practice-Based Research Network who practice within the United States and treat both pediatric and adult patients. They asked dentists to identify the percentage of their patients for whom they had administered or recommended dental sealants, in-office and at-home fluoride, chlorhexidine rinse and xylitol gum. Dentists were less likely to provide adult patients than pediatric patients with in-office caries-preventive agents. However, the rate at which they recommended at-home preventive regimens for the two groups of patients was similar. Dentists with a conservative approach to caries treatment were the most likely to use and recommend the use of caries-preventive agents at similar rates in adults as in children. In addition, dentists in practices with a greater number of patients who had dental insurance were significantly more likely to provide in-office fluoride or sealants to adult patients than to pediatric patients. General dentists use in-office caries-preventive agents more commonly with their pediatric patients than with their adult patients. General dentists should consider providing additional in-office caries-preventive agents for their adult patients who are at increased risk of experiencing dental caries.

Evidence-Based Practice: A Matrix for Predicting Phonological Generalization

ERIC Educational Resources Information Center

Gierut, Judith A.; Hulse, Lauren E.

2010-01-01

This paper describes a matrix for clinical use in the selection of phonological treatment targets to induce generalization, and in the identification of probe sounds to monitor during the course of intervention. The matrix appeals to a set of factors that have been shown to promote phonological generalization in the research literature, including…

Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults' perceptions of this initiative.

PubMed

Jones, Leah Ffion; Ricketts, Ellie; Town, Katy; Rugman, Claire; Lecky, Donna; Folkard, Kate; Nardone, Anthony; Hartney, Thomas Nathan; McNulty, Cliodna

2017-07-01

Opportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013-2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines. To determine young adults' opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice. Qualitative interviews were conducted in a general practice setting in England between March and June 2013. Thirty interviews were conducted with nine male and 21 female patients aged 16-24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework. Participants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation. General practice staff should facilitate patients' preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way. © British Journal of General Practice 2017.

Assessing the quality of radiographic processing in general dental practice.

PubMed

Thornley, P H; Stewardson, D A; Rout, P G J; Burke, F J T

2006-05-13

To determine if a commercial device (Vischeck) for monitoring film processing quality was a practical option in general dental practice, and to assess processing quality among a group of GDPs in the West Midlands with this device. Clinical evaluation. General dental practice, UK, 2004. Ten GDP volunteers from a practice based research group processed Vischeck strips (a) when chemicals were changed, (b) one week later, and (c) immediately before the next change of chemicals. These were compared with strips processed under ideal conditions. Additionally, a series of duplicate radiographs were produced and processed together with Vischeck strips in progressively more dilute developer solutions to compare the change in radiograph quality assessed clinically with that derived from the Vischeck. The Vischeck strips suggested that at the time chosen for change of processing chemicals, eight dentists had been processing films well beyond the point indicated for replacement. Solutions were changed after a wide range of time periods and number of films processed. The calibration of the Vischeck strip correlated closely to a clinical assessment of acceptable film quality. Vischeck strips are a useful aid to monitoring processing quality in automatic developers in general dental practice. Most of this group of GDPs were using chemicals beyond the point at which diagnostic yield would be affected.

National Service Frameworks and UK general practitioners: street-level bureaucrats at work?

PubMed

Checkland, Kath

2004-11-01

This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well-established sociological perspectives of deprofessionalisation and proletarianisation, this paper takes a view of general practice as work, and uses the ideas of Lipsky to analyse practice-level responses to some of these changes. In addition to evidence-based clinical guidelines, National Service Frameworks, introduced by the UK government in 1997, also specify detailed models of service provision that health care providers are expected to follow. As part of a larger study examining the impact of National Service Frameworks in general practice, the response of three practices to the first four NSFs were explored. The failure of NSFs to make a significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as 'street-level bureaucrats' is discussed and used as a framework within which to view these findings.

Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care-associated infection rates in a cohort of acute care general hospitals.

PubMed

Halpin, Helen Ann; McMenamin, Sara B; Simon, Lisa Payne; Jacobsen, Diane; Vanneman, Megan; Shortell, Stephen; Milstein, Arnold

2013-04-01

In 2008, hospitals were selected to participate in the California Healthcare-Associated Infection Prevention Initiative (CHAIPI). This research evaluates the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of health care-associated infection (HAI) rates. Statewide computer-assisted telephone surveys of California's general acute care hospitals were conducted in 2008 and 2010 (response rates, 80% and 76%, respectively). Difference-in-difference analyses were used to compare changes in process and HAI rate outcomes in CHAIPI hospitals (n = 34) and non-CHAIPI hospitals (n = 149) that responded to both waves of the survey. Compared with non-CHAIPI hospitals, CHAIPI hospitals demonstrated greater improvements between 2008 and 2010 in adoption (P = .021) and implementation (P = .012) of written evidence-based practices for overall patient safety and prevention of HAIs and in assessing their compliance (P = .033) with these practices. However, there were no significant differences in the changes in HAI rates between CHAIPI and non-CHAIPI hospitals over this time period. Participation in the CHAIPI collaborative was associated with significant improvements in evidence-based patient safety practices in hospitals. However, determining how evidence-based practices translate into changes in HAI rates may take more time. Our results suggest that all hospitals be offered the opportunity to participate in an active learning collaborative to improve patient safety. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Organisational determinants of production and efficiency in general practice: a population-based study.

PubMed

Olsen, Kim Rose; Gyrd-Hansen, Dorte; Sørensen, Torben Højmark; Kristensen, Troels; Vedsted, Peter; Street, Andrew

2013-04-01

Shortage of general practitioners (GPs) and an increased political focus on primary care have enforced the interest in efficiency analysis in the Danish primary care sector. This paper assesses the association between organisational factors of general practices and production and efficiency. We assume that production and efficiency can be modelled using a behavioural production function. We apply the Battese and Coelli (Empir Econ 20:325-332, 1995) estimator to accomplish a decomposition of exogenous variables to determine the production frontier and variables determining the individual GPs distance to this frontier. Two different measures of practice outputs (number of office visits and total production) were applied and the results compared. The results indicate that nurses do not substitute GPs in the production. The production function exhibited constant returns to scale. The mean level of efficiency was between 0.79 and 0.84, and list size was the most important determinant of variation in efficiency levels. Nurses are currently undertaking other tasks than GPs, and larger practices do not lead to increased production per GP. However, a relative increase in list size increased the efficiency. This indicates that organisational changes aiming to increase capacity in general practice should be carefully designed and tested.

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 Activity-Based Approach to Achieving Theoretical and Practical Consensus in Pedagogy of N. F. Talyzina

ERIC Educational Resources Information Center

Chapaev, Nikolay K.; Akimova, Olga B.; Selivanov, Andrey V.; Shaforostova, Tatiana V.

2016-01-01

The relevance of the problem under study is based on the necessity to solve the permanent problem of the unity of theory and practice in the content of students' cognitive activity in the modern conditions. The purpose of the article is to analyze and to generalize the main concepts of pedagogy by N.F. Talyzina for implementation of the…

General practice--a post-modern specialty?

PubMed Central

Mathers, N; Rowland, S

1997-01-01

The 'modern' view of the world is based on the premise that we can discover the essential truth of the world using scientific method. The assumption is made that knowledge so acquired has been 'uncontaminated' by the mind of the investigator. Post-modern theory, however, is concerned with the process of knowing and how our minds are part of the process, i.e. our perceptions of reality and the relationships between different concepts are important influences on our ways of knowing. The values of post-modern theory are those of uncertainty, many different voices and experiences of reality and multifaceted descriptions of truth. These values are closer to our experience of general practice than the 'modern' values of scientific rationalism and should be reflected in a new curriculum for general practice. PMID:9167325

Educational Economics: Some Practical Thoughts.

ERIC Educational Resources Information Center

Schmidt, Gene L.; Bartalo, Donald B.

1984-01-01

Presents a practical viewpoint of the economic necessities of funding education and a general model for restoring economic stability. This involves a fixed "Basic Education Budget" not subject to voter approval, an "Index for Fixed School Costs" based on socioeconomic status of the community, and increased community…

21 CFR 184.1449 - Manganese citrate.

Code of Federal Regulations, 2012 CFR

2012-04-01

... than current good manufacturing practice. The affirmation of this ingredient as generally recognized as safe (GRAS) as a direct human food ingredient is based upon the following current good manufacturing... good manufacturing practice: baked goods as defined in § 170.3(n)(1) of this chapter; nonalcoholic...

21 CFR 184.1449 - Manganese citrate.

Code of Federal Regulations, 2010 CFR

2010-04-01

... than current good manufacturing practice. The affirmation of this ingredient as generally recognized as safe (GRAS) as a direct human food ingredient is based upon the following current good manufacturing... good manufacturing practice: baked goods as defined in § 170.3(n)(1) of this chapter; nonalcoholic...

21 CFR 184.1449 - Manganese citrate.

Code of Federal Regulations, 2011 CFR

2011-04-01

... than current good manufacturing practice. The affirmation of this ingredient as generally recognized as safe (GRAS) as a direct human food ingredient is based upon the following current good manufacturing... good manufacturing practice: baked goods as defined in § 170.3(n)(1) of this chapter; nonalcoholic...

21 CFR 184.1449 - Manganese citrate.

Code of Federal Regulations, 2013 CFR

2013-04-01

... than current good manufacturing practice. The affirmation of this ingredient as generally recognized as safe (GRAS) as a direct human food ingredient is based upon the following current good manufacturing... good manufacturing practice: baked goods as defined in § 170.3(n)(1) of this chapter; nonalcoholic...

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

General Dentists’ Use of Isolation Techniques During Root Canal Treatment: from the National Dental Practice-Based Research Network

PubMed Central

Lawson, Nathaniel C.; Gilbert, Gregg H.; Funkhouser, Ellen; Eleazer, Paul D.; Benjamin, Paul L.; Worley, Donald C.

2015-01-01

Introduction A preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified use of all isolation techniques, including RD use. Methods Network practitioners completed a questionnaire about isolation techniques used during RCT. Network Enrollment Questionnaire data provided practitioner characteristics. Results 1,490 of 1,716 eligible GDs participated (87%); 697 (47%) reported always using a RD. This percentage varied by tooth type. These GDs were more likely to always use a RD: do not own a private practice; perform less than 10 RCT/month; have postgraduate training. Conclusions Most GDs do not use a RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics. PMID:26015159

The National Children's Study: Recruitment Outcomes Using the Provider-Based Recruitment Approach.

PubMed

Hale, Daniel E; Wyatt, Sharon B; Buka, Stephen; Cherry, Debra; Cislo, Kendall K; Dudley, Donald J; McElfish, Pearl Anna; Norman, Gwendolyn S; Reynolds, Simone A; Siega-Riz, Anna Maria; Wadlinger, Sandra; Walker, Cheryl K; Robbins, James M

2016-06-01

In 2009, the National Children's Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment using a birth-rate probability sample. In 2010, the NCS Program Office launched 3 additional recruitment approaches. We tested whether provider-based recruitment could improve recruitment outcomes compared with household-based recruitment. The NCS aimed to recruit 18- to 49-year-old women who were pregnant or at risk for becoming pregnant who lived in designated geographic segments within primary sampling units, generally counties. Using provider-based recruitment, 10 study centers engaged providers to enroll eligible participants at their practice. Recruitment models used different levels of provider engagement (full, intermediate, information-only). The percentage of eligible women per county ranged from 1.5% to 57.3%. Across the centers, 3371 potential participants were approached for screening, 3459 (92%) were screened and 1479 were eligible (43%). Of those 1181 (80.0%) gave consent and 1008 (94%) were retained until delivery. Recruited participants were generally representative of the county population. Provider-based recruitment was successful in recruiting NCS participants. Challenges included time-intensity of engaging the clinical practices, differential willingness of providers to participate, and necessary reliance on providers for participant identification. The vast majority of practices cooperated to some degree. Recruitment from obstetric practices is an effective means of obtaining a representative sample. Copyright © 2016 by the American Academy of Pediatrics.

The National Children’s Study: Recruitment Outcomes Using the Provider-Based Recruitment Approach

PubMed Central

Wyatt, Sharon B.; Buka, Stephen; Cherry, Debra; Cislo, Kendall K.; Dudley, Donald J.; McElfish, Pearl Anna; Norman, Gwendolyn S.; Reynolds, Simone A.; Siega-Riz, Anna Maria; Wadlinger, Sandra; Walker, Cheryl K.; Robbins, James M.

2016-01-01

OBJECTIVE: In 2009, the National Children’s Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment using a birth-rate probability sample. In 2010, the NCS Program Office launched 3 additional recruitment approaches. We tested whether provider-based recruitment could improve recruitment outcomes compared with household-based recruitment. METHODS: The NCS aimed to recruit 18- to 49-year-old women who were pregnant or at risk for becoming pregnant who lived in designated geographic segments within primary sampling units, generally counties. Using provider-based recruitment, 10 study centers engaged providers to enroll eligible participants at their practice. Recruitment models used different levels of provider engagement (full, intermediate, information-only). RESULTS: The percentage of eligible women per county ranged from 1.5% to 57.3%. Across the centers, 3371 potential participants were approached for screening, 3459 (92%) were screened and 1479 were eligible (43%). Of those 1181 (80.0%) gave consent and 1008 (94%) were retained until delivery. Recruited participants were generally representative of the county population. CONCLUSIONS: Provider-based recruitment was successful in recruiting NCS participants. Challenges included time-intensity of engaging the clinical practices, differential willingness of providers to participate, and necessary reliance on providers for participant identification. The vast majority of practices cooperated to some degree. Recruitment from obstetric practices is an effective means of obtaining a representative sample. PMID:27251870

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

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

PubMed

Reeve, Joanne; Blakeman, Tom; Freeman, George K; Green, Larry A; James, Paul A; Lucassen, Peter; Martin, Carmel M; Sturmberg, Joachim P; van Weel, Chris

2013-08-07

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? 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. 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.

Integrating Clinical Practice Guidelines into Daily Practice: Impact of an Interactive Workshop on Drafting of a Written Action Plan for Asthma Patients

ERIC Educational Resources Information Center

Labelle, Martin; Beaulieu, Michele; Renzi, Paolo; Rahme, Elham; Thivierge, Robert L.

2004-01-01

Introduction: Written action plans (WAPs) are instructions that enable asthmatics to manage their condition appropriately and are recommended by current asthma clinical practice guidelines (CPGs). However, general practitioners (GPs) rarely draft WAPs for their patients. An interactive, case-based workshop for asthma, combined with an objective…

Knowledge, practices and expectations of preventive care: a qualitative study of patients attending government general outpatient clinics in Hong Kong.

PubMed

Tam, Denise Y S; Lo, Yvonne Y C; Tsui, Wendy

2018-05-09

Evidence-based preventive care recommendations have been well established, but studies have persistently reported gaps between these recommendations and general practitioners' practices in providing preventive care. Many studies have explored factors that affect the delivery of preventive care from the perspectives of the practitioners, but relatively few have evaluated the patients' point of view. The purpose of this study was to explore patients' understanding of preventive care, the actions they were taking in terms of preventive health and their expectations from family doctors in providing preventive care. A qualitative study was conducted based on one-on-one in-depth interviews. Twenty-eight patients without chronic illnesses were purposively recruited from government general outpatient clinics in Hong Kong. The interviews took place between November 2013 and February 2014. The participants' knowledge of preventive care was limited, and their preventive practices were mostly restricted to healthy lifestyle practices. They rarely obtained individualised preventive care advice from doctors. Screening investigations were initiated after symptoms had already occurred, and the decision of what to check was arbitrary. Few of the participants knew what they wanted from their doctors in terms of preventive care. These findings show significant gaps between evidence-based preventive recommendations and patients' current knowledge and practice, and show the need for a wider spectrum of preventive care education and reliable sources to provide individualised and affordable preventive assessment and screening services. Most importantly, primary care providers must take a more proactive role to provide preventive services.

Implementing portfolio in postgraduate general practice training. Benefits and recommendations.

PubMed

Alotaibi, Fawaz S

2012-10-01

This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.

Aggregation, Validation, and Generalization of Qualitative Data - Methodological and Practical Research Strategies Illustrated by the Research Process of an empirically Based Typology.

PubMed

Weis, Daniel; Willems, Helmut

2017-06-01

The article deals with the question of how aggregated data which allow for generalizable insights can be generated from single-case based qualitative investigations. Thereby, two central challenges of qualitative social research are outlined: First, researchers must ensure that the single-case data can be aggregated and condensed so that new collective structures can be detected. Second, they must apply methods and practices to allow for the generalization of the results beyond the specific study. In the following, we demonstrate how and under what conditions these challenges can be addressed in research practice. To this end, the research process of the construction of an empirically based typology is described. A qualitative study, conducted within the framework of the Luxembourg Youth Report, is used to illustrate this process. Specifically, strategies are presented which increase the likelihood of generalizability or transferability of the results, while also highlighting their limitations.

Collecting Information About a CAM Practitioner’s Practice: A Preliminary Report of a Self-Interview Methodology

PubMed Central

Elder, William G.; Purdy, Hunter; Bentley, Andrew

2009-01-01

To prepare allopathic providers to advise patients about complementary and alternative medicine (CAM) therapies, the University of Kentucky CAM curriculum integration project has identified and trained CAM practitioners to coteach, precept, and demonstrate their respective practices. This project is interested in integrating CAM practitioners as teachers into this university and has formed a multidisciplinary committee for advice. The committee has recognized the importance of increased understanding of CAM practices to enhance communication within itself and to decide to which CAM practices students should receive exposure. This article reports our attempt to create a CAM practice description, based on questions general to CAM practice and specific to a particular approach. Because there is limited existing systematic research on CAM practice characteristics, these questions may interest researchers conducting qualitative studies, especially those seeking an example of questions to ask CAM practitioners. We also believe this practice description will be of general interest. PMID:19890441

[Prevalence of chronic fatigue syndrome in 4 family practices in Leiden].

PubMed

Versluis, R G; de Waal, M W; Opmeer, C; Petri, H; Springer, M P

1997-08-02

To determine the prevalence of chronic fatigue syndrome (CFS) in general practice. Descriptive. General practice and primary health care centres in Leyden region, the Netherlands. RNUH-LEO is a computerized database which contains the anonymous patient information of one general practice (with two practitioners) and four primary health care centres. The fourteen participating general practitioners were asked what International Classification of Primary Care (ICPC) code they used to indicate a patient with chronic fatigue or with CFS. With these codes and with the code for depression patients were selected from the database. It then was determined whether these patients met the criteria of CFS by Holmes et al. The general practitioners used 10 codes. Including the code for depression a total of 601 patients were preselected from a total of 23,000 patients in the database. Based on the information from the patients' records in the database, 42 of the preselected patients were selected who might fulfill the Holmes' criteria of CFS. According to the patients' own general practitioner, 25 of the 42 patients would fulfil the Holmes' criteria. The men:women ratio was 1:5. The prevalence of CFS in the population surveyed was estimated to be at least 1.1 per 1,000 patients.

Primary care in an era of hospital bed reduction: what can we infer from QOF and PBC?

PubMed

Checkland, Kath; Harrison, Stephen

2010-12-01

The Quality and Outcomes Framework (QOF) has been efficiently and effectively incorporated into practice routines. One possible negative effect of this has been a move towards a more biomedical form of practice.There has been patchy but real engagement with practice-based commissioning (PBC), with significant moves in some areas towards GPs acting collectively to improve services across the health economy, including engaging in performance management of each others' practice.Together, responses to QOF and PBC suggest that GPs may be willing and able to act both individually and collectively to try to mitigate the negative impacts of future spending reductions. General practice will be under a great deal of pressure in the next few years. Understanding the impact of past policy changes is essential if we are to ensure that the core values of general practice are maintained.

Clinical placements in general practice: relationships between practice nurses and tertiary institutions.

PubMed

Peters, Kathleen; Halcomb, Elizabeth J; McInnes, Susan

2013-05-01

As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and models of clinical placement. This paper uses qualitative research methods to explore the perspectives of 12 Australian general practice nurses who have experience in facilitating undergraduate clinical placements about the relationships between HEIs and nurses. Findings are presented in the following three themes: (1) Appropriate preparation for placement: They don't know what primary health really means, (2) Seeking greater consultation in the organisation of clinical placements: they've got to do it one way for everyone, and (3) Uncertainty and lack of support: I had no contact with the university. Clinical placements in general practice can be an innovative strategy providing non-traditional, yet high quality, teaching and learning experiences for undergraduate nursing students. To optimise the quality of these placements, however, it is essential that HEIs provide appropriate support to the practice nurses mentoring these students. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cross-sectional study to examine evidence-based practice skills and behaviors of physical therapy graduates: is there a knowledge-to-practice gap?

PubMed

Manns, Patricia J; Norton, Amy V; Darrah, Johanna

2015-04-01

Curricula changes in physical therapist education programs in Canada emphasize evidence-based practice skills, including literature retrieval and evaluation. Do graduates use these skills in practice? The aim of this study was to evaluate the use of research information in the clinical decision making of therapists with different years of experience and evidence-based practice preparation. Perceptions about evidence-based practice were explored qualitatively. A cross-sectional study with 4 graduating cohorts was conducted. Eighty physical therapists representing 4 different graduating cohorts participated in interviews focused on 2 clinical scenarios. Participants had varying years of clinical experience (range=1-15 years) and academic knowledge of evidence-based practice skills. Therapists discussed the effectiveness of interventions related to the scenarios and identified the sources of information used to reach decisions. Participants also answered general questions related to evidence-based practice knowledge. Recent graduates demonstrated better knowledge of evidence-based practice skills compared with therapists with 6 to 15 years of clinical experience. However, all groups used clinical experience most frequently as their source of information for clinical decisions. Research evidence was infrequently included in decision making. This study used a convenience sample of therapists who agreed to volunteer for the study. The results suggest a knowledge-to-practice gap; graduates are not using the new skills to inform their practice. Tailoring academic evidence-based activities more to the time constraints of clinical practice may help students to be more successful in applying evidence in practice. Academic programs need to do more to create and nurture environments in both academic and clinical settings to ensure students practice using evidence-based practice skills across settings. © 2015 American Physical Therapy Association.

Patient empowerment, an additional characteristic of the European definitions of general practice/family medicine.

PubMed

Mola, Ernesto

2013-06-01

Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.

The effect of family and peer communication on college students' communication with dating partners about HIV and AIDS.

PubMed

Powell, Heather L; Segrin, Chris

2004-01-01

As family and peers are primary socializing agents in the lives of young adults, a social learning based model of communication about HIV/AIDS among dating partners was developed and tested, examining the role of interactions with family and peers in this type of communication. Specifically, the model describes relationships between general communication, communication about sexuality, and communication about HIV/AIDS with parents, peers, and dating partners. Participants were 153 young adult couples who completed measures of their communication practices, as well as their communication with family and peers. Communication practices in the family of origin appear to influence both general communication and communication about HIV/AIDS with dating partners. Communication practices with peers influenced general communication, communication about sexuality, and communication about HIV/AIDS with dating partners. Participants and their dating partners exhibited relative agreement about their general communication practices and their communication about HIV/AIDS, but showed less agreement in reports of their communication about sexuality. Implications for understanding the role of family and peer interactions in communication about HIV/AIDS with dating partners are discussed.

Recruitment strategies for a clinical trial of community-based water therapy for osteoarthritis.

PubMed

Davey, Rachel; Edwards, Sarah Matthes; Cochrane, Tom

2003-04-01

This study compares the efficiency of two methods of recruitment into a randomised controlled trial examining the cost-effectiveness of water therapy for elderly people with lower limb osteoarthritis. The direct cost of recruiting patients via general practice was 27.66 Pounds per patient (1.1 personnel hours/patient). The cost per recruited patient from a local newspaper article was 2.72 Pounds (0.2 personnel hours/patient). The cost differential between the two recruitment methods was largely owing to poor administration practices, difficulties in accessing patient information, and difficulties in contacting patients from the general practice computer database.

Distorted Representations of the "Capability Approach" in Australian School Education

ERIC Educational Resources Information Center

Skourdoumbis, Andrew

2015-01-01

Recently, curriculum developments in Australia have seen the incorporation of functionalist "general capabilities" as essential markers of schooling, meaning that any pedagogical expression of classroom-based practice, including subsequent instruction, should entail the identification and development of operational general capabilities.…

Predicting the scope of practice of family physicians.

PubMed

Wong, Eric; Stewart, Moira

2010-06-01

To identify factors that are associated with the scope of practice of FPs and GPs who have office-based practices. Secondary univariable and multivariable analyses of cross-sectional data from the 2001 National Family Physician Workforce Survey conducted by the College of Family Physicians of Canada. Canada. General community of FPs and GPs who spent most of their clinical time in office settings. Demographic characteristics and scope of practice score (SPS), which was the number of 12 selected medical services provided by office-based FPs and GPs. The multivariable model explained 35.1% of the variation in the SPS among participants. Geographic factors of provincial division and whether or not the population served was rural explained 30.5% of the variation in the SPS. Male physician sex, younger physician age, being in group practice, greater access to hospital beds, less access to specialists, main practice setting of an academic teaching unit, mixed method physician payment, additional structured postresidency training, and greater number of different types of allied health professionals in the main practice setting were also associated with higher SPSs. Geographic factors were the strongest determinants of scope of practice; physician-related factors, availability of health care resources to the main practice setting, and practice organization factors were weaker determinants. It is important to understand how and why geographic factors influence scope of practice, and whether a broad scope of practice independent of population needs benefits the population. This study supports primary care renewal efforts that use mixed payment systems, incorporate allied health care professionals into family and general practices, and foster group practices.

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

Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database.

PubMed

Aabenhus, Rune; Hansen, Malene Plejdrup; Siersma, Volkert; Bjerrum, Lars

2017-06-01

To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice. Retrospective cohort register-based study including the Danish National Prescription Register. Population-based study of routine electronic antibiotic prescriptions from Danish general practice. All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013). Number of prescriptions per clinical indication. Number of antibiotic prescriptions per 1000 inhabitants by age and gender. Logistic regression analysis estimated the association between patient and provider factors and missing clinical indications on antibiotic prescriptions. A total of 2.381.083 systemic antibiotic prescriptions were issued by Danish general practitioners in the study period. We identified three main clinical entities: urinary tract infections (n = 506.634), respiratory tract infections (n = 456.354) and unspecified infections (n = 416.354). Women were more exposed to antibiotics than men. Antibiotic use was high in children under 5 years and even higher in elderly people. In 32% of the issued prescriptions, the clinical indication was missing. This was mainly associated with antibiotic types. We found that a prescription for a urinary tract agent without a specific clinical indication was uncommon. Clinical indications from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation and optimisation of the system is preferable.

Is a practice-based rural research network feasible in Europe?

PubMed

Klemenc-Ketis, Zalika; Kurpas, Donata; Tsiligianni, Ioanna; Petrazzuoli, Ferdinando; Jacquet, Jean-Pierre; Buono, Nicola; Lopez-Abuin, Jose; Lionis, Christos

2015-01-01

Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience.

Differences in diagnostic activity in general practice and findings for individuals invited to the danish screening programme for colorectal cancer: a population-based cohort study.

PubMed

Juul, Jakob Søgaard; Andersen, Berit; Laurberg, Søren; Carlsen, Anders Helles; Olesen, Frede; Vedsted, Peter

2018-06-22

To investigate the diagnostic activity in general practice and the cumulative incidence of colorectal cancer (CRC) in individuals invited to the Danish national screening programme for CRC. A historical population-based cohort study. The Danish CRC screening programme and general practice. The 376,198 individuals invited to the Danish CRC screening programme from 1 March to 31 December 2014. The diagnostic activity (consultations and haemoglobin measures) in general practice in the year preceding the screening invitation and the cumulated incidence of CRC in the year following the screening invitation. Screening participants had significantly higher diagnostic activity than non-participants. Individuals with a positive faecal immunochemical test (FIT) had higher diagnostic activity compared to individuals with a negative FIT, and a small increase in the months leading up to the invitation. Individuals with a screen-detected CRC had lower diagnostic activity than individuals with no CRC. In total, 308 (25.3%) of CRCs diagnosed in the invited population were diagnosed outside the screening programme. Non-participants with CRC more often had low socio-economic status, high comorbidity and stage IV CRC than participants with CRC. There was a tendency that participants and those with a positive FIT had a higher diagnostic activity the year before the screening. This was not seen for those with CRC detected through screening. CRC must still be diagnosed in general practice in the invited population and non-participants are of special interest as they have higher risk of late stage CRC. Key Points Current awareness:Individuals with colorectal cancer (CRC) in screening may be symptomatic and CRC may still occur outside screening in the invited population. Most important points:The majority of individuals with CRC in screening cannot be expected to be diagnosed on symptomatic presentation in general practice GPs have to be aware that CRC still occurs outside screening in the invited population Non-participants with CRC are often deprived and have late stage CRC.

Untitled Document

Science.gov Websites

practices of modeling, generalization, and justification. Narrative examples from education research Science (NCISLA) (1995-2004) POWERFUL PRACTICES IN MATHEMATICS AND SCIENCE A research-based multimedia product that distills key ideas from a significant body of research. Comprised of two CD-s and a 40-page

10 CFR 603.110 - Use of TIAs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... performers to develop and use new business practices and disseminate best practices throughout the technology... ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS General § 603.110 Use of TIAs. The ultimate goal for using a TIA is to broaden the technology base available to meet DOE mission...

Reducing Adolescents' Perceived Barriers to Treatment and Increasing Help-Seeking Intentions: Effects of Classroom Presentations by General Practitioners

ERIC Educational Resources Information Center

Wilson, Coralie Joy; Deane, Frank P.; Marshall, Kellie L.; Dalley, Andrew

2008-01-01

The "Building Bridges to General Practice" (BBGP) program is an outreach initiative. It aims to reduce young peoples' perceived knowledge- and belief-based barriers to engaging in treatment and to increase their behavioral intentions to consult a general medical practitioner (GP) for physical and psychological problems. By increasing…

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

e-Learning competency for practice nurses: an evaluation report.

PubMed

Heartfield, Marie; Morello, Andrea; Harris, Melanie; Lawn, Sharon; Pols, Vincenza; Stapleton, Carolyn; Battersby, Malcolm

2013-01-01

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.

Preference for practice: a Danish study on young doctors' choice of general practice using a discrete choice experiment.

PubMed

Pedersen, Line Bjørnskov; Gyrd-Hansen, Dorte

2014-07-01

This study examines the preferences of general practitioners (GPs) in training for organizational characteristics in general practice with focus on aspects that can mitigate problems with GP shortages. A discrete choice experiment was used to investigate preferences for the attributes practice type, number of GPs in general practice, collaboration with other practices, change in weekly working hours (administrative versus patient related), and change in yearly surplus. In May 2011, all doctors actively engaged in the family medicine program in Denmark were invited to participate in a web-based survey. A total of 485 GPs in training responded to the questionnaire, resulting in a response rate of 56%. A mixed logit model showed that GPs in training prefer to work in smaller shared practices (2 GPs). This stands in contrast to the preferences of current GPs. Hence, a generational change in the GP population is likely to introduce more productive practice forms, and problems with GP shortages are likely to be mitigated over the coming years. Results further showed that a majority of the respondents are willing to work in larger shared practices (with 3-4 GPs) if they receive an increase in surplus (approximately 50,000 DKK/6,719 EUR per year) and that they may be willing to take in more patient-related work if the increase in surplus is sufficient (approximately 200,000 DKK/26,875 EUR per year for 5 extra hours per week). Monetary incentives may therefore be an effective tool for further improving productivity.

System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model.

PubMed

Bowie, Paul; Price, Julie; Hepworth, Neil; Dinwoodie, Mark; McKay, John

2015-11-27

To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. A retrospective database analysis. General practices in the UK and Ireland. 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the 'postanalytical test stage' (n=702, 43.8%), followed closely by 'communication outcomes issues' (n=628, 39.1%). Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Understanding patient choices for attending sexually transmitted infection testing services: a qualitative study

PubMed Central

Pollard, Alex; Miners, Alec; Richardson, Daniel; Fisher, Martin; Cairns, John; Smith, Helen

2012-01-01

Objectives To establish which aspects of sexually transmitted infection (STI) testing services are important to STI testing service users. Methods 10 focus groups consisting of previous or existing users of STI testing services were conducted in community settings in the south east of England. Groups were quota sampled based on age, gender and sexual orientation. Data were analysed using Framework Analysis. Results 65 respondents (58% men) participated. Perceived expertise of staff was the key reason for attendance at genitourinary medicine services rather than general practice. Although some respondents voiced a willingness to test for STIs within general practice, the apparent limited range of tests available in general practice and the perceived lack of expertise around sexual health appeared to discourage attendance at general practice. The decision of where to test for STIs was also influenced by past experience of testing, existing relationships with general practice, method of receiving test results and whether the patient had other medical conditions such as HIV. Conclusions No one type of STI testing service is suitable for all patients. This is recognised by policymakers, and it now requires commissioners and providers to make services outside of genitourinary medicine clinics more acceptable and attractive to patients, in particular to address the perceived lack of expertise and limited range of STIs tests available at alternative testing sites. PMID:22628665

Evidence-based nursing practice: both state of the art in general and specific to pressure sores.

PubMed

Buss, I C; Halfens, R J; Abu-Saad, H H; Kok, G

1999-01-01

The importance of research-based practice in nursing has been frequently stressed, and a number of nursing studies have been conducted whose results enable nursing to improve knowledge and practice. This study reports a literature review in which the current status of knowledge and research utilization with regard to pressure sores is described. This review first gives an overview of studies on knowledge utilization in general and shows that the spontaneous diffusion of knowledge is inappropriate. Furthermore, an overview of planned research utilization activities focusing on pressure sore prevention and treatment in nursing is presented. The results of these studies show that planned research utilization activities performed in individual organizations lead to positive outcomes in almost all cases. Therefore, it could be concluded that implementing planned research utilization activities in individual health care institutions seems to be an effective strategy to decrease pressure sore incidence and prevalence rates.

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Describing Agency Needs 970.1100-1 Performance... practicable, performance-based contracting methods in its management and operating contracts. The Office of...-based contracting concepts and methodologies that may be generally applied to management and operating...

The Survey Questionnaire

ERIC Educational Resources Information Center

Ritter, Lois A. Ed.; Sue, Valerie M., Ed.

2007-01-01

Internet-based surveys are still relatively new, and researchers are just beginning to articulate best practices for questionnaire design. Online questionnaire design has generally been guided by the principles applying to other self-administered instruments, such as paper-based questionnaires. Web-based questionnaires, however, have the potential…

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

Prior, Maria; Elouafkaoui, Paula; Elders, Andrew; Young, Linda; Duncan, Eilidh M; Newlands, Rumana; Clarkson, Jan E; Ramsay, Craig R

2014-04-24

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. 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. 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. Current Controlled Trials ISRCTN49204710.

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

Abortion training at multiple sites: an unexpected curriculum for teaching systems-based practice.

PubMed

Herbitter, Cara; Kumar, Vanita; Karasz, Alison; Gold, Marji

2010-04-01

In 1999, the Accreditation Council for Graduate Medical Education endorsed systems-based practice as one of six general competencies. The objective is to explore the paradigm of teaching residents systems-based practice during a women's health rotation that included abortion training in multiple settings. During a routine women's health rotation, residents from two urban family medicine residency programs received early abortion training at a high-volume abortion clinic and their continuity clinic. Thirty-min semistructured interviews were conducted with all 26 residents who rotated between July 2005 and August 2006. Transcripts were analyzed using thematic codes. Through exposure to different healthcare delivery systems, residents learned about systems-based practice, including understanding the failure of the larger system to meet patients' reproductive healthcare needs, differences between two systems, and potential systems barriers they might face as providers. Abortion training in multiple settings may serve as a paradigm for teaching systems-based practice during other rotations that include training in multiple sites.

A novel task-oriented optimal design for P300-based brain-computer interfaces.

PubMed

Zhou, Zongtan; Yin, Erwei; Liu, Yang; Jiang, Jun; Hu, Dewen

2014-10-01

Objective. The number of items of a P300-based brain-computer interface (BCI) should be adjustable in accordance with the requirements of the specific tasks. To address this issue, we propose a novel task-oriented optimal approach aimed at increasing the performance of general P300 BCIs with different numbers of items. Approach. First, we proposed a stimulus presentation with variable dimensions (VD) paradigm as a generalization of the conventional single-character (SC) and row-column (RC) stimulus paradigms. Furthermore, an embedding design approach was employed for any given number of items. Finally, based on the score-P model of each subject, the VD flash pattern was selected by a linear interpolation approach for a certain task. Main results. The results indicate that the optimal BCI design consistently outperforms the conventional approaches, i.e., the SC and RC paradigms. Specifically, there is significant improvement in the practical information transfer rate for a large number of items. Significance. The results suggest that the proposed optimal approach would provide useful guidance in the practical design of general P300-based BCIs.

A novel task-oriented optimal design for P300-based brain-computer interfaces

NASA Astrophysics Data System (ADS)

Zhou, Zongtan; Yin, Erwei; Liu, Yang; Jiang, Jun; Hu, Dewen

2014-10-01

Objective. The number of items of a P300-based brain-computer interface (BCI) should be adjustable in accordance with the requirements of the specific tasks. To address this issue, we propose a novel task-oriented optimal approach aimed at increasing the performance of general P300 BCIs with different numbers of items. Approach. First, we proposed a stimulus presentation with variable dimensions (VD) paradigm as a generalization of the conventional single-character (SC) and row-column (RC) stimulus paradigms. Furthermore, an embedding design approach was employed for any given number of items. Finally, based on the score-P model of each subject, the VD flash pattern was selected by a linear interpolation approach for a certain task. Main results. The results indicate that the optimal BCI design consistently outperforms the conventional approaches, i.e., the SC and RC paradigms. Specifically, there is significant improvement in the practical information transfer rate for a large number of items. Significance. The results suggest that the proposed optimal approach would provide useful guidance in the practical design of general P300-based BCIs.

Strategies to promote practice nurse capacity to deliver evidence-based care: An example from sexual healthcare.

PubMed

Dadich, Ann; Abbott, Penny; Hosseinzadeh, Hassan

2015-01-01

Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice. A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare - namely, a clinical aide and online training. The perceived impact of both resources was determined by views on relevance and design - particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues. This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare. Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited. Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

The Art of Leadership: A Study of Administrative Practices in Florida's Schools of the Arts

ERIC Educational Resources Information Center

Perry, Kevin Gardner

2012-01-01

The purpose of this exploratory study was to identify common practices of school-of-the-arts administrators and to determine if these commonalities differ from the practices of effective school leaders in general. A sample of administrators (n = 92) completed a 3-part Likert survey based on the 21 attributes identified in the balanced leadership…

Human papillomavirus vaccination in Auckland: reducing ethnic and socioeconomic inequities.

PubMed

Poole, Tracey; Goodyear-Smith, Felicity; Petousis-Harris, Helen; Desmond, Natalie; Exeter, Daniel; Pointon, Leah; Jayasinha, Ranmalie

2012-12-17

The New Zealand HPV publicly funded immunisation programme commenced in September 2008. Delivery through a school based programme was anticipated to result in higher coverage rates and reduced inequalities compared to vaccination delivered through other settings. The programme provided for on-going vaccination of girls in year 8 with an initial catch-up programme through general practices for young women born after 1 January 1990 until the end of 2010. To assess the uptake of the funded HPV vaccine through school based vaccination programmes in secondary schools and general practices in 2009, and the factors associated with coverage by database matching. Retrospective quantitative analysis of secondary anonymised data School-Based Vaccination Service and National Immunisation Register databases of female students from secondary schools in Auckland District Health Board catchment area. Data included student and school demographic and other variables. Binary logistic regression was used to estimate odds ratios and significance for univariables. Multivariable logistic regression estimated strength of association between individual factors and initiation and completion, adjusted for all other factors. The programme achieved overall coverage of 71.5%, with Pacific girls highest at 88% and Maori at 78%. Girls higher socioeconomic status were more likely be vaccinated in general practice. School-based vaccination service targeted at ethic sub-populations provided equity for the Maori and Pacific student who achieved high levels of vaccination. Copyright © 2012 Elsevier Ltd. All rights reserved.

Improving software maintenance through measurement

NASA Technical Reports Server (NTRS)

Rombach, H. Dieter; Ulery, Bradford T.

1989-01-01

A practical approach to improving software maintenance through measurements is presented. This approach is based on general models for measurement and improvement. Both models, their integration, and practical guidelines for transferring them into industrial maintenance settings are presented. Several examples of applications of the approach to real-world maintenance environments are discussed.

Multicomponent Training of Teachers of Students with Severe Disabilities

ERIC Educational Resources Information Center

Brown, Phillip; Stephenson, Jennifer; Carter, Mark

2014-01-01

Over the last decade, the obligation of general and special educators to utilize evidence-based instructional practices has become more prominent. Research increasingly suggests the failure of didactic teacher training alone to ensure implementation with fidelity of these practices by teachers in their classrooms. Multicomponent training (MCT)…

Teachers' Perceptions of Their Own Instructional Effectiveness

ERIC Educational Resources Information Center

Satterwhite, Zarinaha N.

2013-01-01

The focus on measuring student growth based on teacher effectiveness has presented new challenges for an urban school in Massachusetts. The purpose of this general interpretive qualitative study was to examine the instructional practices of a group of middle school teachers, the practices they perceived to be effective for ensuring student…

Evidence Valued and Used by Health Promotion Practitioners

ERIC Educational Resources Information Center

Li, V.; Carter, S. M.; Rychetnik, L.

2015-01-01

The use of evidence has become a foundational part of health promotion practice. Although there is a general consensus that adopting an evidence-based approach is necessary for practice, disagreement remains about what types of evidence practitioners should use to guide their work. An empirical understanding of how practitioners conceptualize and…

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

PubMed

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

2008-01-25

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. 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. 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. 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.

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

The brave new world of older patients: preparing general practice training for an ageing population.

PubMed

Bonney, Andrew; Phillipson, Lyn; Jones, Sandra C; Hall, Julie; Sharma, Rashmi

2015-11-01

Develop and pilot test evidence-based resources for general practice training practices to enhance older patients' (65+ years) interactions with General Practice Registrars (GPRs). In Australia, general practice trainees, referred to as GPRs, see fewer older patients and patients with chronic conditions than doctors who have completed their specialist GP training. This reduces learning opportunities for GPRs in the management of these important patient groups. Therefore, developing effective strategies to improve GPR-older patient interaction is critical to primary care training, to meet the current and future needs of an ageing population. Adopting a social marketing approach, GPR practice resources were developed to address knowledge and attitudinal barriers at the practice and patient level to improve older patient comfort, and willingness to engage, with GPR care. Two focus groups with older patients (n=18) and interviews with staff of training practices (n=12) were utilised to pre-test resources. Amended resources were pilot tested and evaluated in a naturalistic GPR training practice setting using a structured patient questionnaire (n=44). Pilot evaluation suggests improved comfort and willingness of older patients to interact with GPRs. In all, 54% of survey participants indicated they would be more likely to make an appointment with a Registrar in the future as a result of exposure to the resources. In all, 40% of patients would feel comfortable having a GPR manage a complex or chronic condition, which compares favourably with 28% of similarly aged patients in previous research. The use of tailored, engaging and informative GPR resources for older patients and practice staff may be an important contributor to addressing the growing problem of ensuring GPRs are adequately engaged in treating older patients. The adoption of a social marketing framework was instrumental in enhancing the acceptance and effectiveness of this intervention.

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

Information in general medical practices: the information processing model.

PubMed

Crowe, Sarah; Tully, Mary P; Cantrill, Judith A

2010-04-01

The need for effective communication and handling of secondary care information in general practices is paramount. To explore practice processes on receiving secondary care correspondence in a way that integrates the information needs and perceptions of practice staff both clinical and administrative. Qualitative study using semi-structured interviews with a wide range of practice staff (n = 36) in nine practices in the Northwest of England. Analysis was based on the framework approach using N-Vivo software and involved transcription, familiarization, coding, charting, mapping and interpretation. The 'information processing model' was developed to describe the six stages involved in practice processing of secondary care information. These included the amendment or updating of practice records whilst simultaneously or separately actioning secondary care recommendations, using either a 'one-step' or 'two-step' approach, respectively. Many factors were found to influence each stage and impact on the continuum of patient care. The primary purpose of processing secondary care information is to support patient care; this study raises the profile of information flow and usage within practices as an issue requiring further consideration.

Pressure damage prevention: basing practice on evidence.

PubMed

Parker, K; Morgan, L; Clayton, J; Gerrish, K; Nolan, M

As part of an initiative to develop evidence-based practice at the Northern General Hospital, Sheffield, a three-part project was undertaken. The aims were to identify barriers to using research in nursing, establish a baseline of nurses' knowledge and its influence on their practice in one essential area of nursing care--pressure damage prevention--and develop a strategy for change which took account of the findings from the first two parts of the project. In this article, the authors describe the second part of the project which examined nursing knowledge and practice with reference to the management of pressure damage prevention. The findings are discussed and the authors recommend that nurses integrate into their practice evidence from sources such as systematic reviews.

Perceptions of primary care staff on a regional data quality intervention in Australian general practice: a qualitative study.

PubMed

Ghosh, Abhijeet; McCarthy, Sandra; Halcomb, Elizabeth

2016-04-26

Technological advances in clinical data capturing and storage systems have led to recent attempts at disease surveillance and region specific population health planning through regularly collected primary care administrative clinical data. However the accuracy and comprehensiveness of primary care health records remain questionable. We aimed to explore the perceptions and experiences of general practice staff in maintaining accurate patient health data within clinical software used in primary care settings of regional NSW. Focus groups were conducted with general practitioners, practice nurses and practice administrative staff from 17 practices in the Illawarra-Shoalhaven region of the state of New South Wales (NSW) in Australia that had participated in the Sentinel Practices Data Sourcing (SPDS) project - a general practice based chronic disease surveillance and data quality improvement study. A total of 25 respondents that included 12 general practitioners (GPs) and 13 practice staff participated in the 6 focus groups. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis of the data was undertaken. Five key themes emerged from the data. Firstly, the theme of resourcing data management raised issues of time constraints, the lack of a dedicated data management role and the importance of multidisciplinary involvement, including a data champion. The need for incentives was identified as being important to motivate ongoing commitment to maintaining data quality. However, quality of software packages, including coding issues and software limitations and information technology skills were seen as key barriers. The final theme provided insight into the lessons learnt from the project and the increased awareness of the importance of data quality amongst practice staff. The move towards electronic methods of maintaining general practice patient records offers significant potential benefits in terms of both patient care and monitoring of health status and health needs within the community. However, this study has reinforced the importance of human factors in the maintenance of such datasets. To achieve optimal benefits of electronic health and medical records for patient care and for population health planning purposes, it is extremely essential to address the barriers that clinicians and other staff face in maintaining complete and correct primary care patient electronic health and medical information.

The Contributions of Applied Behavior Analysis and Behavior Theory to Innovative Research and Practice Cultures in Social Work.

PubMed

Briggs, Harold Eugene; Sharkey, Caroline; Briggs, Adam Christopher

2016-01-01

In this article the authors tie the emergence of an empirical practice research culture, which enabled the rise in evidence-based practice in social work to the introduction of applied behavior analysis and behavioral theory to social work practice and research. The authors chronicle the: (1) scientific foundations of social work, (2) influence and push by corporatized university cultures for higher scholarship productivity among faculty, (3) significance of theory in general, (4) importance of behavioral theory in particular as a major trigger of the growth in research on effective social work practice approaches, and (5) commonalities between applied behavior analysis and evidence-based practice. The authors conclude with implications for addressing the dual challenges of building an enhanced research culture in schools of social work and the scholarship of transferring practice research to adoption in real world practice settings.

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.

PubMed

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

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses. Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%-100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation. Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care. © 2017 John Wiley & Sons Ltd.

Information demands of occupational health physicians and their attitude towards evidence-based medicine.

PubMed

Schaafsma, Frederieke; Hulshof, Carel; van Dijk, Frank; Verbeek, Jos

2004-08-01

This study assessed the extent and nature of information demands among occupational health physicians and their attitude towards the application of evidence-based medicine in occupational health. A questionnaire survey was carried out among a random sample of 159 physicians practicing occupational medicine in The Netherlands. The questionnaire investigated the type and number of questions encountered in daily practice, the actions taken in response, the physicians' experience in using scientific databases on the Internet, and their attitude towards evidence-based medicine. The occupational health physicians' questions concerned medical, legal, and rehabilitation topics in particular. In pursuing answers to their questions, they generally chose to contact colleagues. Scientific databases were not consulted very often, although, in general, the attitude towards evidence-based medicine was positive. In addition to known barriers for practicing evidence-based medicine, occupational health physicians perceive a lack of scientific evidence in their field. The extensiveness of the field of knowledge in occupational health care was not regarded as an obstacle to their application of evidence-based medicine. Occupational health physicians have a demand for information on a broad range of topics, and, in most cases, their attitude towards evidence-based medicine is fairly positive. Besides education and training in evidence-based medicine, access to the Internet and the presence of a good knowledge infrastructure would help occupational health physicians use evidence-based medicine.

Generalized Buneman Pruning for Inferring the Most Parsimonious Multi-state Phylogeny

NASA Astrophysics Data System (ADS)

Misra, Navodit; Blelloch, Guy; Ravi, R.; Schwartz, Russell

Accurate reconstruction of phylogenies remains a key challenge in evolutionary biology. Most biologically plausible formulations of the problem are formally NP-hard, with no known efficient solution. The standard in practice are fast heuristic methods that are empirically known to work very well in general, but can yield results arbitrarily far from optimal. Practical exact methods, which yield exponential worst-case running times but generally much better times in practice, provide an important alternative. We report progress in this direction by introducing a provably optimal method for the weighted multi-state maximum parsimony phylogeny problem. The method is based on generalizing the notion of the Buneman graph, a construction key to efficient exact methods for binary sequences, so as to apply to sequences with arbitrary finite numbers of states with arbitrary state transition weights. We implement an integer linear programming (ILP) method for the multi-state problem using this generalized Buneman graph and demonstrate that the resulting method is able to solve data sets that are intractable by prior exact methods in run times comparable with popular heuristics. Our work provides the first method for provably optimal maximum parsimony phylogeny inference that is practical for multi-state data sets of more than a few characters.

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

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.

Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial.

PubMed

Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming; Maindal, Helle Terkildsen; Petersen, Karin Dam; Jensen, Martin Bach

2013-10-20

Evidence-based clinical practice guidelines may improve treatment quality, but the uptake of guideline recommendations is often incomplete and slow. Recently new low back pain guidelines are being launched in Denmark. The guidelines are considered to reduce personal and public costs. The aim of this study is to evaluate whether a complex, multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy. In a two-armed cluster randomised trial, 100 general practices (clusters) and 2,700 patients aged 18 to 65 years from the North Denmark region will be included. Practices are randomly allocated 1:1 to a simple or a complex implementation strategy. Intervention practices will receive a complex implementation strategy, including guideline facilitator visits, stratification tools, and quality reports on low back pain treatment. Primary outcome is referral to secondary care. Secondary outcomes are pain, physical function, health-related quality of life, patient satisfaction with care and treatment outcome, employment status, and sick leave. Primary and secondary outcomes pertain to the patient level. Assessments of outcomes are blinded and follow the intention-to-treat principle. Additionally, a process assessment will evaluate the degree to which the intervention elements will be delivered as planned, as well as measure changes in beliefs and behaviours among general practitioners and patients. This study provides knowledge concerning the process and effect of an intervention to implement low back pain guidelines in general practice, and will provide insight on essential elements to include in future implementation strategies in general practice. Registered as NCT01699256 on ClinicalTrials.gov.

Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider.

PubMed

Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna

2014-01-01

Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

Project PEGS! Practices in Effective Guidance Strategies: Interactive CD-ROM Series for Educators To Practice Positive Behavior Management Skills, October 1, 1999-December 30, 2002. Final Performance Report.

ERIC Educational Resources Information Center

Quirk, Constance A.

This final report describes the activities and outcomes of a federally funded project designed to produce and field-test two computer-based interactive CD-ROMs: "PEGS! for Preschool" and "PEGS! for Secondary School". These programs, in a game format, provide beginning general and special educators with independent practice in…

Does Practical Work Really Motivate? A Study of the Affective Value of Practical Work in Secondary School Science

ERIC Educational Resources Information Center

Abrahams, Ian

2009-01-01

The present paper reports on a study that examined whether practical work can be said to have affective outcomes, and if so in what sense. The term "affective" is used here to refer to the emotions, or feelings, engendered amongst pupils towards school science in general, or one of the sciences in particular. The study is based on 25 multi-site…

Clinical indications for antibiotic use in Danish general practice: results from a nationwide electronic prescription database

PubMed Central

Aabenhus, Rune; Hansen, Malene Plejdrup; Siersma, Volkert; Bjerrum, Lars

2017-01-01

Objective To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice. Design Retrospective cohort register-based study including the Danish National Prescription Register. Setting Population-based study of routine electronic antibiotic prescriptions from Danish general practice. Subjects All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013). Main outcome measures Number of prescriptions per clinical indication. Number of antibiotic prescriptions per 1000 inhabitants by age and gender. Logistic regression analysis estimated the association between patient and provider factors and missing clinical indications on antibiotic prescriptions. Results A total of 2.381.083 systemic antibiotic prescriptions were issued by Danish general practitioners in the study period. We identified three main clinical entities: urinary tract infections (n = 506.634), respiratory tract infections (n = 456.354) and unspecified infections (n = 416.354). Women were more exposed to antibiotics than men. Antibiotic use was high in children under 5 years and even higher in elderly people. In 32% of the issued prescriptions, the clinical indication was missing. This was mainly associated with antibiotic types. We found that a prescription for a urinary tract agent without a specific clinical indication was uncommon. Conclusion Clinical indications from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation and optimisation of the system is preferable. PMID:28585886

An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial.

PubMed

Hayek, Adina; Joshi, Rohina; Usherwood, Tim; Webster, Ruth; Kaur, Baldeep; Saini, Bandana; Armour, Carol; Krass, Ines; Laba, Tracey-Lea; Reid, Christopher; Shiel, Louise; Hespe, Charlotte; Hersch, Fred; Jan, Stephen; Lo, Serigne; Peiris, David; Rodgers, Anthony; Patel, Anushka

2016-09-23

Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general practice quality improvement tool incorporating clinical decision support and audit/feedback capabilities; availability of a range of CVD polypills (fixed-dose combinations of two blood pressure lowering agents, a statin ± aspirin) for prescription when appropriate; and access to a pharmacy-based program to support long-term medication adherence and lifestyle modification. Following a systematic development process, the intervention will be evaluated in a pragmatic cluster randomized controlled trial including 70 general practices for a median period of 18 months. The 35 general practices in the intervention group will work with a nominated partner pharmacy, whereas those in the control group will provide usual care without access to the intervention tools. The primary outcome is the proportion of patients at high CVD risk who were inadequately treated at baseline who achieve target blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels at the study end. The outcomes will be analyzed using data from electronic medical records, utilizing a validated extraction tool. Detailed process and economic evaluations will also be performed. The study intends to establish evidence about an intervention that combines technological innovation with team collaboration between patients, pharmacists, and general practitioners (GPs) for CVD prevention. Australian New Zealand Clinical Trials Registry ACTRN12616000233426.

Developing a general ward nursing dashboard.

PubMed

Russell, Margot; Hogg, Maggie; Leach, Stuart; Penman, Mags; Friel, Susan

2014-12-15

The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice.

Atlas 1.1 Implementation Guide: Moving from Theory into Practice

DTIC Science & Technology

2018-01-16

Math /Science/General Engienering...six proficiency areas based on the Helix interview data, as shown in Figure 6 below. Figure 6. Proficiency Areas for Systems Engineers 1. Math ...the problem domain and solution Math / Science / General Engineering System’s Domain & Opera:onal Context Systems Engineering

Improving General Chemistry Course Performance through Online Homework-Based Metacognitive Training

ERIC Educational Resources Information Center

Casselman, Brock L.; Atwood, Charles H.

2017-01-01

In a first-semester general chemistry course, metacognitive training was implemented as part of an online homework system. Students completed weekly quizzes and multiple practice tests to regularly assess their abilities on the chemistry principles. Before taking these assessments, students predicted their score, receiving feedback after…

Generalized Structured Component Analysis with Latent Interactions

ERIC Educational Resources Information Center

Hwang, Heungsun; Ho, Moon-Ho Ringo; Lee, Jonathan

2010-01-01

Generalized structured component analysis (GSCA) is a component-based approach to structural equation modeling. In practice, researchers may often be interested in examining the interaction effects of latent variables. However, GSCA has been geared only for the specification and testing of the main effects of variables. Thus, an extension of GSCA…

75 FR 22540 - Review of Arbitration Awards; Miscellaneous and General Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... the Authority's existing practice for calculating the date for filing timely exceptions, so that the... general rules regarding calculating filing periods; and Sec. 2429.22 to specify that the rules set forth..., investment, productivity, innovation, or on the ability of United States-based companies to compete with...

Regularized Generalized Structured Component Analysis

ERIC Educational Resources Information Center

Hwang, Heungsun

2009-01-01

Generalized structured component analysis (GSCA) has been proposed as a component-based approach to structural equation modeling. In practice, GSCA may suffer from multi-collinearity, i.e., high correlations among exogenous variables. GSCA has yet no remedy for this problem. Thus, a regularized extension of GSCA is proposed that integrates a ridge…

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

Are paediatric operations evidence based? A prospective analysis of general surgery practice in a teaching paediatric hospital.

PubMed

Zani-Ruttenstock, Elke; Zani, Augusto; Bullman, Emma; Lapidus-Krol, Eveline; Pierro, Agostino

2015-01-01

Paediatric surgical practice should be based upon solid scientific evidence. A study in 1998 (Baraldini et al., Pediatr Surg Int) indicated that only a quarter of paediatric operations were supported by the then gold standard of evidence based medicine (EBM) which was defined by randomized controlled trials (RCTs). The aim of the current study was to re-evaluate paediatric surgical practice 16 years after the previous study in a larger cohort of patients. A prospective observational study was performed in a tertiary level teaching hospital for children. The study was approved by the local research ethics board. All diagnostic and therapeutic procedures requiring a general anaesthetic carried out over a 4-week period (24 Feb 2014-22 Mar 2014) under the general surgery service or involving a general paediatric surgeon were included in the study. Pubmed and EMBASE were used to search in the literature for the highest level of evidence supporting the recorded procedures. Evidence was classified according to the Oxford Centre for Evidence Based Medicine (OCEBM) 2009 system as well as according to the classification used by Baraldini et al. Results was compared using Χ (2) test. P < 0.05 was considered statistically significant. During the study period, 126 operations (36 different types) were performed on 118 patients. According to the OCEBM classification, 62 procedures (49 %) were supported by systematic reviews of multiple homogeneous RCTs (level 1a), 13 (10 %) by individual RCTs (level 1b), 5 (4 %) by systematic reviews of cohort studies (level 2a), 11 (9 %) by individual cohort studies, 1 (1 %) by systematic review of case-control studies (level 3a), 14 (11 %) by case-control studies (level 3b), 9 (7 %) by case series (type 4) and 11 procedures (9 %) were based on expert opinion or deemed self-evident interventions (type 5). High level of evidence (OCEBM level 1a or 1b or level I according to Baraldini et al. PSI 1998) supported 75 (60 %) operations in the current study compared to 18 (26 %) in the study of 1998 (P < 0.0001). The present study shows that nowadays a remarkable number of paediatric surgical procedures are supported by high level of evidence. Despite this improvement in evidence-based paediatric surgical practice, more than a third of the procedures still lack sufficient evidence-based literature support. More RCTs are warranted to support and direct paediatric surgery practice according to the principals of EBM.

Failure of physicians to recognize functional disability in ambulatory patients.

PubMed

Calkins, D R; Rubenstein, L V; Cleary, P D; Davies, A R; Jette, A M; Fink, A; Kosecoff, J; Young, R T; Brook, R H; Delbanco, T L

1991-03-15

To assess the ability of internists to identify functional disabilities reported by their patients. Comparison of responses by physicians and a random sample of their patients to a 12-item questionnaire about physical and social function. A hospital-based internal medicine group practice in Boston, Massachusetts, and selected office-based internal medicine practices in Los Angeles, California. Five staff physicians, three general internal medicine fellows, and 34 internal medicine residents in the hospital-based practice and 178 of their patients. Seventy-six physicians in the office-based practices and 230 of their patients. Physicians underestimated or failed to recognize 66% of disabilities reported by patients. Patient-reported disabilities were underestimated or unrecognized more often in the hospital-based practice than in the office-based practices (75% compared with 60%, P less than 0.05). Physicians overstated functional impairment in 21% of paired responses in which patients reported no disability. Physicians often underestimate or fail to recognize functional disabilities that are reported by their patients. They overstate functional impairment to a lesser degree. Because these discrepancies may adversely affect patient care and well-being, medical educators and clinicians should pay more attention to the assessment of patient function.

What should we mean by empirical validation in hypnotherapy: evidence-based practice in clinical hypnosis.

PubMed

Alladin, Assen; Sabatini, Linda; Amundson, Jon K

2007-04-01

This paper briefly surveys the trend of and controversy surrounding empirical validation in psychotherapy. Empirical validation of hypnotherapy has paralleled the practice of validation in psychotherapy and the professionalization of clinical psychology, in general. This evolution in determining what counts as evidence for bona fide clinical practice has gone from theory-driven clinical approaches in the 1960s and 1970s through critical attempts at categorization of empirically supported therapies in the 1990s on to the concept of evidence-based practice in 2006. Implications of this progression in professional psychology are discussed in the light of hypnosis's current quest for validation and empirical accreditation.

Generalization bounds of ERM-based learning processes for continuous-time Markov chains.

PubMed

Zhang, Chao; Tao, Dacheng

2012-12-01

Many existing results on statistical learning theory are based on the assumption that samples are independently and identically distributed (i.i.d.). However, the assumption of i.i.d. samples is not suitable for practical application to problems in which samples are time dependent. In this paper, we are mainly concerned with the empirical risk minimization (ERM) based learning process for time-dependent samples drawn from a continuous-time Markov chain. This learning process covers many kinds of practical applications, e.g., the prediction for a time series and the estimation of channel state information. Thus, it is significant to study its theoretical properties including the generalization bound, the asymptotic convergence, and the rate of convergence. It is noteworthy that, since samples are time dependent in this learning process, the concerns of this paper cannot (at least straightforwardly) be addressed by existing methods developed under the sample i.i.d. assumption. We first develop a deviation inequality for a sequence of time-dependent samples drawn from a continuous-time Markov chain and present a symmetrization inequality for such a sequence. By using the resultant deviation inequality and symmetrization inequality, we then obtain the generalization bounds of the ERM-based learning process for time-dependent samples drawn from a continuous-time Markov chain. Finally, based on the resultant generalization bounds, we analyze the asymptotic convergence and the rate of convergence of the learning process.

Moral Education in the Schools. Some Practical Suggestions.

ERIC Educational Resources Information Center

Beck, Clive

This document contains practical suggestions for moral education which, although tentative, are based to a considerable extent on classroom experimentation. There are three main sections. The first suggests a series of mini-courses to be incorporated in the school curriculum. It deals with personal and social values in general, human relations,…

Plato, Pascal, and the Dynamics of Personal Knowledge

ERIC Educational Resources Information Center

Otte, Michael Friedrich; Campos, Tania M. M.; Abido, Alexandre S.

2013-01-01

Educational practices are to be based on proven scientific knowledge, not least because the function science has to perform in human culture consists of unifying practical skills and general beliefs, the episteme and the techne (Amsterdamski, 1975, pp. 43-44). Now, modern societies first of all presuppose regular and standardized ways of…

Community-based oral health promotion practices targeted at children and adolescents in Finland--developing an assessment tool.

PubMed

Blomqvist, Pia; Ojala, Ellinoora; Kettunen, Tarja; Poskiparta, Marita; Kasila, Kirsti

2014-06-01

To develop an assessment tool for evaluating oral health promotion practices and to evaluate community-based oral health promotion practices targeted at children and adolescents with this tool. A theoretical framework about health promotion planning, implementation and evaluation was made on the basis of a literature review. Then, information about Finnish community-based oral health promotion practices (n=12) targeted at children and adolescents was collected using semi-structured interviews. Also, related documents, for example action plans and reports, were collected when available. Next, an assessment tool based on the theoretical framework was developed, and the recorded and transcribed interview data and other documents were evaluated with this tool. The assessment tool proved to be practical: it pointed out the strengths and weaknesses of the practices. The tool revealed strengths in the implementation and deficiencies in the planning and evaluation of oral health promotion practices. One-quarter of the 12 practices assessed could be considered 'good practices'. There is a need to improve the planning and evaluation of oral health promotion practices. The assessment tool developed in this study might be useful for practitioners both in the field of oral health promotion and general health promotion. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effectiveness of pharmacovigilance training of general practitioners: a retrospective cohort study in the Netherlands comparing two methods.

PubMed

Gerritsen, Roald; Faddegon, Hans; Dijkers, Fred; van Grootheest, Kees; van Puijenbroek, Eugène

2011-09-01

Spontaneous reporting is a cornerstone of pharmacovigilance. Unfamiliarity with the reporting of suspected adverse drug reactions (ADRs) is a major factor leading to not reporting these events. Medical education may promote more effective reporting. Numerous changes have been implemented in medical education over the last decade, with a shift in training methods from those aimed predominantly at the transfer of knowledge towards those that are more practice based and skill oriented. It is conceivable that these changes have an impact on pharmacovigilance training in vocational training programmes. Therefore, this study compares the effectiveness of a skill-oriented, practice-based pharmacovigilance training method, with a traditional, lecture-based pharmacovigilance training method in the vocational training of general practitioners (GPs). The traditional, lecture-based method is common practice in the Netherlands. The purpose of this study was to establish whether the use of a practice-based, skill-oriented method in pharmacovigilance training during GP traineeship leads to an increase of reported ADRs after completion of this traineeship, compared with a lecture-based method. We also investigated whether the applied training method has an impact on the documentation level of the reports and on the number of unlabelled events reported. A retrospective cohort study. The number of ADR reports submitted to the Netherlands Pharmacovigilance Centre Lareb (between January 2006 and October 2010) after completion of GP vocational training was compared between the two groups. Documentation level of the reports and the number of labelled/unlabelled events reported were also compared. The practice-based cohort reported 32 times after completion of training (124 subjects, 6.8 reports per 1000 months of follow-up; total follow-up of 4704 months). The lecture-based cohort reported 12 times after training (135 subjects, 2.1 reports per 1000 months of follow-up; total follow-up of 5824 months) [odds ratio 2.9; 95% CI 1.4, 6.1]. Reports from GPs with practice-based training had a better documentation grade than those from GPs with lecture-based training, and more often concerned unlabelled events. The practice-based method resulted in significantly more and better-documented reports and more often concerned unlabelled events than the lecture-based method. This effect persisted and did not appear to diminish over time.

Nondiabetic retinal pathology - prevalence in diabetic retinopathy screening.

PubMed

Nielsen, Nathan; Jackson, Claire; Spurling, Geoffrey; Cranstoun, Peter

2011-07-01

To determine the prevalence of photographic signs of nondiabetic retinal pathology in Australian general practice patients with diabetes. Three hundred and seven patients with diabetes underwent retinal photography at two general practices, one of which was an indigenous health centre. The images were assessed for signs of pathology by an ophthalmologist. Signs of nondiabetic retinal pathology were detected in 31% of subjects with adequate photographs. Features suspicious of glaucoma were detected in 7.7% of subjects. Other abnormalities detected included signs of age related macular degeneration (1.9%), epiretinal membranes (2.4%), vascular pathology (9.6%), chorioretinal lesions (2.9%), and congenital disc anomalies (2.9%). Indigenous Australian patients were more likely to have signs of retinal pathology and glaucoma. Signs of nondiabetic retinal pathology were frequently encountered. In high risk groups, general practice based diabetic retinopathy screening may reduce the incidence of preventable visual impairment, beyond the benefits of detection of diabetic retinopathy alone.

[Possibilities and limitations of telemedicine in general practitioner practices].

PubMed

van den Berg, N; Meinke, C; Hoffmann, W

2009-09-01

According to the AGnES concept (general-practitioner-supporting, community-based, e-health-assisted systemic intervention), general practitioners (GPs) can delegate certain components of medical care in the context of home visits by qualified AGnES employees. Within the framework of six AGnES projects, different telemedical applications have been implemented. Telemedical monitoring of patients was implemented to analyse the feasibility and acceptance within GP practices. One hundred sixty-two patients used a telemedical monitoring system (e.g. scale/sphygmomanometer and intraocular pressure measurement system). Regarding communication in cases of acutely necessary GP consultations, telephone calls and videoconferences between the GP and the AGnES employee were analysed. Unscheduled telephone calls or videoconferences were necessary for only a few home visits; the reasons included pain, anomalous values, and medication problems. The main result of the analysis was that implementation of telemedicine in GP practices is feasible and is accepted both by patients and GPs.

Escaping the healthcare leadership cul-de-sac.

PubMed

Edmonstone, John Duncan

2017-02-06

Purpose This paper aims to propose that healthcare is dominated by a managerialist ideology, powerfully shaped by business schools and embodied in the Masters in Business Administration. It suggests that there may be unconscious collusion between universities, healthcare employers and student leaders and managers. Design/methodology/approach Based on a review of relevant literature, the paper examines critiques of managerialism generally and explores the assumptions behind leadership development. It draws upon work which suggests that leading in healthcare organisations is fundamentally different and proposes that leadership development should be more practice-based. Findings The way forward for higher education institutions is to include work- or practice-based approaches alongside academic approaches. Practical implications The paper suggests that there is a challenge for higher education institutions to adopt and integrate practice-based development methods into their programme designs. Originality/value The paper provides a challenge to the future role of higher education institutions in developing leadership in healthcare.

Are general and strategic measures of organizational context and leadership associated with knowledge and attitudes toward evidence-based practices in public behavioral health settings? A cross-sectional observational study.

PubMed

Powell, Byron J; Mandell, David S; Hadley, Trevor R; Rubin, Ronnie M; Evans, Arthur C; Hurford, Matthew O; Beidas, Rinad S

2017-05-12

Examining the role of modifiable barriers and facilitators is a necessary step toward developing effective implementation strategies. This study examines whether both general (organizational culture, organizational climate, and transformational leadership) and strategic (implementation climate and implementation leadership) organizational-level factors predict therapist-level determinants of implementation (knowledge of and attitudes toward evidence-based practices). Within the context of a system-wide effort to increase the use of evidence-based practices (EBPs) and recovery-oriented care, we conducted an observational, cross-sectional study of 19 child-serving agencies in the City of Philadelphia, including 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Organizational variables included characteristics such as EBP initiative participation, program size, and proportion of independent contractor therapists; general factors such as organizational culture and climate (Organizational Social Context Measurement System) and transformational leadership (Multifactor Leadership Questionnaire); and strategic factors such as implementation climate (Implementation Climate Scale) and implementation leadership (Implementation Leadership Scale). Therapist-level variables included demographics, attitudes toward EBPs (Evidence-Based Practice Attitudes Scale), and knowledge of EBPs (Knowledge of Evidence-Based Services Questionnaire). We used linear mixed-effects regression models to estimate the associations between the predictor (organizational characteristics, general and strategic factors) and dependent (knowledge of and attitudes toward EBPs) variables. Several variables were associated with therapists' knowledge of EBPs. Clinicians in organizations with more proficient cultures or higher levels of transformational leadership (idealized influence) had greater knowledge of EBPs; conversely, clinicians in organizations with more resistant cultures, more functional organizational climates, and implementation climates characterized by higher levels of financial reward for EBPs had less knowledge of EBPs. A number of organizational factors were associated with the therapists' attitudes toward EBPs. For example, more engaged organizational cultures, implementation climates characterized by higher levels of educational support, and more proactive implementation leadership were all associated with more positive attitudes toward EBPs. This study provides evidence for the importance of both general and strategic organizational determinants as predictors of knowledge of and attitudes toward EBPs. The findings highlight the need for longitudinal and mixed-methods studies that examine the influence of organizational factors on implementation.

Pharmacist consultations in general practice clinics: the Pharmacists in Practice Study (PIPS).

PubMed

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2014-01-01

Medication-related problems (MRPs) are a concern in primary care settings. Pharmacists based in the community or community pharmacies are able to identify, resolve and prevent MRPs; however, the lack of a formal partnership with physicians and poor access to patients' medical records are limitations. In Australia, delivery of pharmacist services within general practice clinics is rare. To evaluate the effectiveness of consultations by pharmacists based within primary care medical practices. A prospective, before-after intervention study was conducted at two primary health care (general practice) clinics in Melbourne, Australia. Participants were clinic patients who had risk-factors for MRPs (e.g. polypharmacy). Patients received a consultation with the pharmacist in a private consulting room at the clinic or in their home. The pharmacist reviewed the patient's medication regimen and adherence, with full access to their medical record, provided patient education, and produced a report for the general practitioner. The primary outcome was the number of MRPs identified by the pharmacist, and the number that remained unresolved 6 months after the pharmacist consultation. Secondary outcomes included medication adherence, health service use, and patient satisfaction. Eighty-two patients were recruited and 62 (75.6%) completed the study. The median number of MRPs per patient identified by the practice pharmacist was 2 (interquartile range [IQR] 1, 4). Six months after review, this fell to 0 (IQR 0, 1), P < 0.001. The proportion of patients who were adherent to their medications improved significantly, according to both the Morisky (44.1% versus 62.7%, P = 0.023) and the Tool for Adherence Behaviour Screening (TABS) (35.6% versus 57.6%, P = 0.019) scales. There was no significant effect on health service use. Patients were highly satisfied with the pharmacist consultations. Consultations undertaken by pharmacists located within primary health care clinics were effective in identifying and resolving MRPs. The consultations were well received by patients and were associated with improvements in medication adherence. Copyright © 2014 Elsevier Inc. All rights reserved.

Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress.

PubMed

Cousins, Rosanna; Donnell, Christine

2012-04-01

Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

Food parenting practices and child dietary behavior. Prospective relations and the moderating role of general parenting.

PubMed

Sleddens, Ester F C; Kremers, Stef P J; Stafleu, Annette; Dagnelie, Pieter C; De Vries, Nanne K; Thijs, Carel

2014-08-01

Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened beverage; and healthy: water and fruit intake). Furthermore, we tested the moderating role of general parenting on this relationship. Within the KOALA Birth Cohort Study, in the Netherlands, questionnaire data were collected at 6 and 8 years (N = 1654). Correlations were computed to assess the association between food parenting practices and general parenting (i.e., nurturance, behavioral control, structure, coercive control, and overprotection). Linear regression models were fitted to assess whether food parenting practices predict dietary behavior. Instrumental and emotional feeding, and pressure to eat were found to have associations with undesirable child dietary behavior (increased unhealthy intake/decreased healthy intake), whereas associations were in the desirable direction for covert control, encouragement and restriction. Moderation analyses were performed by evaluating interactions with general parenting. The associations of encouragement and covert control with desirable child dietary behaviors were found to be stronger for children who were reared in a positive parenting context. Future research should assess the influence of contextual parenting factors moderating the relationships between food parenting and child dietary behavior as the basis for the development of more effective family-based interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

PubMed Central

Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

2015-01-01

Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from <1.0% of clinical teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve this. PMID:26009536

The 2013 ACR Commission on Human Resources workforce survey.

PubMed

Bluth, Edward I; Truong, Hang; Nsiah, Eugene; Hughes, Danny; Short, Bradley W

2013-10-01

The ACR Commission on Human Resources conducts an annual electronic survey during the first quarter of the year to better understand the present workforce situation for radiologists. We used the Practice of Radiology Environment Database (PRED) to identify 2,067 practice leaders and asked them to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leaders or their designates to report the number of radiologists they currently employ or supervise, the number hired in 2012, and the number they plan to hire in 2013 and 2016. The leaders were also asked to report the subspecialty area that was used as the main reason for hiring that physician. Of the 2,067 practice leaders surveyed, 22% responded, a figure corresponding to 23% of all practicing radiologists in the United States. These results showed that 54% of radiologists are in private practice and 46% are employed by various other entities. The current workforce consists of 21% general radiologists and 79% subspecialists. The largest areas of subspecialty include general interventionalists, neuroradiologists, and body imagers. In 2012, 1,407 radiologists were hired. The greatest number of radiologists hired involved general interventional radiologists, followed by general radiologists, body imagers, and those specializing in musculoskeletal radiology, neuroradiology, and breast imaging. In 2013, 1,526 job opportunities were projected and in 2016, 1,434 job opportunities. In 2013, the most sought-after individuals will be general radiologists, general interventionalists, breast imagers, neuroradiologists, musculoskeletal radiologists, and body imagers. Based on the data collected from the responding practices, the demand for hiring radiologists in 2013 will be similar to 2012. Each of the 1,200 residents who complete their training programs each year should have a position available, but the job may not necessarily be in the subspecialty, geographic area, or type of practice that the individual desires. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings.

PubMed

Gilbert, Gregg H; Gordan, Valeria V; Korelitz, James J; Fellows, Jeffrey L; Meyerowitz, Cyril; Oates, Thomas W; Rindal, D Brad; Gregory, Randall J

2015-01-22

Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics. Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), three were "common" (molar endodontics; implants; non-surgical periodontics), and five were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.

[Administration: practices, myths and ideologies].

PubMed

Spinelli, Hugo

2017-01-01

Administration in the social field is examined based on an analysis of its practices, the rationalist myth and its ideological dimensions. In this way, the article discusses the most frequently utilized concepts (administration, management, gerencia, gestión) and their etymologies; the limitations of teaching administration; the complexity of a practice marked by the dimensions of science, art and the social game; and the ideological question underlying the great thought factory that the general theory of administration has been since the start of the 19th century. The article reflects upon the need to construct a theory based in practice contextualized in the global south that goes beyond the classic frames of reference and, above all, to transform administration into a problem to be discussed outside of the knowledge that recognizes it as a technical practice.

Blended care vs. usual care in the treatment of depressive symptoms and disorders in general practice [BLENDING]: study protocol of a non-inferiority randomized trial.

PubMed

Massoudi, Btissame; Blanker, Marco H; van Valen, Evelien; Wouters, Hans; Bockting, Claudi L H; Burger, Huibert

2017-06-13

The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. This trial will show whether blended care might be an appropriate treatment strategy for patients with depressive symptoms and depressive disorder in general practice. Netherlands Trial Register: NTR4757; 25 August 2014. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757 . (Archived by WebCite® at http://www.webcitation.org/6mnXNMGef ).

Structured data quality reports to improve EHR data quality.

PubMed

Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

2015-12-01

To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (p<0.01) over 12 months, but was not sufficient to comply with RACGP standards. Improvement was greatest with allergies. There was no significant change in duplicate records. SDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Bidirectional associations between activity-related parenting practices, and child physical activity, sedentary screen-based behavior and body mass index: a longitudinal analysis.

PubMed

Sleddens, Ester F C; Gubbels, Jessica S; Kremers, Stef P J; van der Plas, Eline; Thijs, Carel

2017-07-06

It has been generally assumed that activity-related parenting practices influence children's activity behavior and weight status. However, vice versa parents may also change their parenting behaviors in response to their perceptions of their child's activity behavior and weight status. This study examined the bidirectional relationships between activity-related parenting practices, and physical activity, sedentary screen-based behavior, and body mass index (BMI) between children's age of 5 and 7 years. Three scales of the Activity-related Parenting Questionnaire (i.e. 'restriction of sedentary behavior', 'stimulation of physical activity', and 'monitoring of physical activity') were completed by 1694 parents of the Dutch KOALA Birth Cohort Study at the child's age of around 5 and again around age 7. Physical activity, sedentary screen-based behavior and BMI were measured at both ages as well. Linear regression models were used to estimate the bidirectional associations between each parenting practice and the child's physical activity levels, sedentary screen-based behavior and BMI z-scores. Several parenting practices at age 5 predicted child physical activity, sedentary screen-based behavior, and BMI z-scores at age 7. Restriction of sedentary behavior positively predicted child BMI and sedentary screen-based behavior, whereas this practice negatively predicted child physical activity. In addition, stimulation of physical activity at age 5 was significantly associated with higher levels of child physical activity at age 7. The following child factors at age 5 predicted parenting practices at age 7: Child physical activity positively predicted parental stimulation of physical activity and monitoring activities. Sedentary screen-based behavior was associated with lower parental stimulation to be active. Findings generally revealed that parents and children mutually influence each other's behavior. A reinforcing feedback loop was present between parental stimulation of physical activity and child physical activity. Bidirectional parent-child interaction should be considered in future research in order to properly inform parenting-related intervention programs aimed at preventing or treating childhood overweight or obesity. System dynamic methods to explore the existence of reinforcing or balancing loops are needed in this regard.

Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis.

PubMed

Hansen, Pernille Libach; Hjertholm, Peter; Vedsted, Peter

2015-08-01

Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n = 19,209) and matched references (n = 192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV = 3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a "diagnostic time window" and a potential for earlier diagnosis of CRC based on clinical signs and symptoms. © 2015 UICC.

General practitioners as educators in adolescent health: a training evaluation.

PubMed

Van de Mortel, Thea; Bird, Jennifer; Chown, Peter; Trigger, Robert; Ahern, Christine

2016-03-22

General practitioners play an important role in the primary care of adolescents in both community and clinical settings. Yet studies show that GPs can lack confidence, skills and knowledge in adolescent health. This study evaluates the effectiveness of an innovative training intervention on medical participants' knowledge and confidence as adolescent health educators in a school setting. 15 general practitioners, 12 general practice registrars and 18 medical students participated in an adolescent health education workshop followed by field experience in health education sessions in secondary schools. The mixed method design included a pre and post intervention survey and focus group interviews. Mean scores on the Confidence to Teach scale increased significantly (3.34 ± 0.51 to 4.09 ± 0.33) (p < .001) as did confidence to communicate with adolescents (3.64 ± 0.48 to 4.19 ± 0.33) (p < .001). Mean knowledge scores increased significantly (7.00 ± 1.22 to 8.98 ± 1.11) (p < .001). Participants highlighted the value of learning about adolescent health issues and generic teaching skills especially lesson planning and design, practicing experiential teaching strategies and finding the 'sweet spot' when communicating with adolescents. Some participants reported that these skills would transfer to the practice setting. An applied training intervention that uses evidence-based, experiential teaching strategies and focuses on developing knowledge and practical teaching skills appropriate for the health education of adolescents can enhance knowledge and confidence to engage in community-based adolescent health education.

A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice.

PubMed

Duncombe, Daphne C

2018-03-01

To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to <35 years age group (45.9%). Of nurses surveyed, 72.1% had never tried to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best method for successfully incorporating evidence-based practice into nursing practice in The Bahamas. © 2017 John Wiley & Sons Ltd.

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

Improving Reading and Social Studies Learning for Secondary Students with Reading Disabilities

ERIC Educational Resources Information Center

Capin, Philip; Vaughn, Sharon

2017-01-01

This article describes evidence-based practices that beginning special education teachers can readily implement in special or general education settings that promote reading and content outcomes for students with disabilities as well as general education students. We describe two approaches: (a) Promoting Adolescents' Comprehension of Text (PACT),…

Design and Implementation of a Studio-Based General Chemistry Course

ERIC Educational Resources Information Center

Gottfried, Amy C.; Sweeder, Ryan D.; Bartolin, Jeffrey M.; Hessler, Jessica A.; Reynolds, Benjamin P.; Stewart, Ian C.; Coppola, Brian P.; Holl, Mark Banaszak M.

2007-01-01

The design and implementation of a new value-added general chemistry course, which could use the studio instructional method to incorporate the existing educational research is reviewed. These teaching methods and activities were woven into the course to provide the students with ways of learning chemical concepts and practicing scientific…

Accommodating the Special Learner in Secondary General Music Classes

ERIC Educational Resources Information Center

VanWeelden, Kimberly

2011-01-01

It can be challenging to know which accommodations for special learners can be used within the various secondary general music class settings. Fortunately, there have been several recent music education and therapy articles based on special education practices that have addressed techniques for working with students with special needs in music.…

Dominant Personality Types in Public Accounting: Selection Bias or Indoctrinated?

ERIC Educational Resources Information Center

Burton, Hughlene; Daugherty, Brian; Dickins, Denise; Schisler, Dan

2016-01-01

Prior studies concerning the personality type and preferences of accountants generally draw conclusions based upon the reports of either practicing accountants, or accounting students, at a single point in time. So while much is known about the personality type of accountants in general, left unexplored is the question of whether public…

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units.

PubMed

Day, T; Wainwright, S P; Wilson-Barnett, J

2001-09-01

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.

Conceptual Framework for Trait-Based Ecological Risk Assessment for Wildlife Populations Exposed to Pesticides

EPA Science Inventory

Between screening level risk assessments and complex ecological models, a need exists for practical identification of risk based on general information about species, chemicals, and exposure scenarios. Several studies have identified demographic, biological, and toxicological fa...

Computerized general practice based networks yield comparable performance with sentinel data in monitoring epidemiological time-course of influenza-like illness and acute respiratory illness.

PubMed

Truyers, Carla; Lesaffre, Emmanuel; Bartholomeeusen, Stefaan; Aertgeerts, Bert; Snacken, René; Brochier, Bernard; Yane, Fernande; Buntinx, Frank

2010-03-22

Computerized morbidity registration networks might serve as early warning systems in a time where natural epidemics such as the H1N1 flu can easily spread from one region to another. In this contribution we examine whether general practice based broad-spectrum computerized morbidity registration networks have the potential to act as a valid surveillance instrument of frequently occurring diseases. We compare general practice based computerized data assessing the frequency of influenza-like illness (ILI) and acute respiratory infections (ARI) with data from a well established case-specific sentinel network, the European Influenza Surveillance Scheme (EISS). The overall frequency and trends of weekly ILI and ARI data are compared using both networks. Detection of influenza-like illness and acute respiratory illness occurs equally fast in EISS and the computerized network. The overall frequency data for ARI are the same for both networks, the overall trends are similar, but the increases and decreases in frequency do not occur in exactly the same weeks. For ILI, the overall rate was slightly higher for the computerized network population, especially before the increase of ILI, the overall trend was almost identical and the increases and decreases occur in the same weeks for both networks. Computerized morbidity registration networks are a valid tool for monitoring frequent occurring respiratory diseases and the detection of sudden outbreaks.

Health professionals responding to men for safety (HERMES): feasibility of a general practice training intervention to improve the response to male patients who have experienced or perpetrated domestic violence and abuse.

PubMed

Williamson, Emma; Jones, Sue K; Ferrari, Giulia; Debbonaire, Thangam; Feder, Gene; Hester, Marianne

2015-05-01

To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England. Research suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services. The intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies. Results show a significant increase in clinicians' self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians' confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.

Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

PubMed Central

Reeve, Joanne; Dowrick, Christopher F; Freeman, George K; Gunn, Jane; Mair, Frances; May, Carl; Mercer, Stewart; Palmer, Victoria; Howe, Amanda; Irving, Greg; Shiner, Alice; Watson, Jessica

2013-01-01

Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. Design Qualitative study in General Practice. Setting UK primary care. Main outcome measures A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. Design and setting Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. Participants UK based GPs (interview and surveys); European GP trainees (focus groups). Results Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. Conclusions We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role. PMID:24475347

WestREN: a description of an Irish academic general practice research network

PubMed Central

2010-01-01

Background Primary care research networks have been established internationally since the 1960s to enable diverse practitioners to engage in and develop research and education and implement research evidence. The newly established Western Research and Education Network (WestREN) is one such network consisting of a collaboration between the Discipline of General Practice at NUI Galway and 71 West of Ireland general practices. In September 2009 all member practices were issued with a questionnaire with two objectives: to describe the structure and characteristics of the member practices and to compare the results to the national profile of Irish general practice. Methods A postal survey was used followed by one written and one email reminder. Results A response rate of 73% (52/71) was achieved after two reminders. Half of practices were in a rural location, one quarter located in an urban setting and another quarter in a mixed location. Ninety-four per cent of general practitioners practice from purpose-built or adapted premises with under 6% of practices being attached to the general practitioner's residence. Over 96% of general practitioners use appointment systems with 58% using appointment only. All practices surveyed were computerised, with 80% describing their practices as 'fully computerised'. Almost 60% of general practitioners are coding chronic diagnoses with 20% coding individual consultations. Twenty-five per cent of general practitioners were single-handed with the majority of practices having at least two general practitioners, and a mean number of general practitioners of 2.4. Ninety-two per cent of practices employed a practice nurse with 30% employing more than one nurse. Compared to the national profile, WestREN practices appear somewhat larger, and more likely to be purpose-built and in rural areas. National trends apparent between 1982 and 1992, such as increasing computerisation and practice nurse availability, appear to be continuing. Conclusions WestREN is a new university-affiliated general practice research network in Ireland. Survey of its initial membership confirms WestREN practices to be broadly representative of the national profile and has provided us with valuable information on the current and changing structure of Irish general practice. PMID:20925958

The Role of Program Consistency in a Summer Therapeutic Camp for Students with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Quinn, Colleen; Nowosielski, Ashley; Kitchen, Tom; Belfiore, Phillip J.

2014-01-01

Although evidenced-based practices, delivered with procedural integrity are increasingly common in the field of autism, generalizing those practices to less traditional settings is not. The present study, conducted at a summer therapeutic camp used a single subject multiple baseline across participants research design to evaluate the effects of…

An Inquiry-Based Approach to Critical Literacy: Pedagogical Nuances of a Second Grade Classroom

ERIC Educational Resources Information Center

Beach, Pamela; Cleovoulou, Yiola

2014-01-01

This case study explores the pedagogy and practices of an elementary school teacher who combines inquiry pedagogy and critical literacy. The authors gathered data for this analysis by conducting two interviews with a classroom teacher and observing classroom practices 12 times over a 6 month period. Through a general inductive approach to…

Effectiveness of students worksheet based on mastery learning in genetics subject

NASA Astrophysics Data System (ADS)

Megahati, R. R. P.; Yanti, F.; Susanti, D.

2018-05-01

Genetics is one of the subjects that must be followed by students in Biology education department. Generally, students do not like the genetics subject because of genetics concepts difficult to understand and the unavailability of a practical students worksheet. Consequently, the complete learning process (mastery learning) is not fulfilled and low students learning outcomes. The aim of this study develops student worksheet based on mastery learning that practical in genetics subject. This research is a research and development using 4-D models. The data analysis technique used is the descriptive analysis that describes the results of the practicalities of students worksheets based on mastery learning by students and lecturer of the genetic subject. The result is the student worksheet based on mastery learning on genetics subject are to the criteria of 80,33% and 80,14%, which means that the students worksheet practical used by lecturer and students. Student’s worksheet based on mastery learning effective because it can increase the activity and student learning outcomes.

Compatibility of scientific research and specialty training in General Practice. A cross-sectional study

PubMed Central

Kötter, Thomas; Carmienke, Solveig; Herrmann, Wolfram J.

2014-01-01

Objective: In many departments of General Practice (GP) in Germany, young doctors who are trainees also work as researchers. Often these trainees work part time at the university and part time as a trainee in clinical practice. However, little is known about the situation of the actors involved. The aim of the study was to investigate the perspectives of GP trainees, heads of departments and GP trainers regarding the combination of research and GP training. Methods: We conducted a web-based survey with the heads of all German departments of General Practice, GP trainees who also conduct research and their GP trainers. The questionnaires consisted of open and closed questions. The results were analyzed using descriptive statistics and qualitative methods. Results: 28 heads of GP departments and 20 GP trainees responded. The trainees were mostly very satisfied with their situation as a trainee. However, the trainees considered the combination of research and GP training as difficult. The respondents name as problems the coordination of multiple jobs and the lack of credibility given to research in General Practice. They name as solutions research-enabling training programs and uniform requirements in training regarding research. Conclusion: The combination of GP training and scientific research activity is perceived as difficult. However, well-organized and designed programs can improve the quality of the combination. PMID:25228933

Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study.

PubMed

van Dijk, Christel E; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, Dinny H

2016-02-01

In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. In 86.6% of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

7 CFR 1468.30 - Appeals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... allocations; (2) Eligible conservation practices; (3) Payment rates, and cost-share percentages; (4) Science-based formulas and factor values; (5) Soils mapping and information; and (6) Other matters of general...

7 CFR 1468.30 - Appeals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... allocations; (2) Eligible conservation practices; (3) Payment rates, and cost-share percentages; (4) Science-based formulas and factor values; (5) Soils mapping and information; and (6) Other matters of general...

7 CFR 1468.30 - Appeals.

Code of Federal Regulations, 2012 CFR

2012-01-01

... allocations; (2) Eligible conservation practices; (3) Payment rates, and cost-share percentages; (4) Science-based formulas and factor values; (5) Soils mapping and information; and (6) Other matters of general...

7 CFR 1468.30 - Appeals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... allocations; (2) Eligible conservation practices; (3) Payment rates, and cost-share percentages; (4) Science-based formulas and factor values; (5) Soils mapping and information; and (6) Other matters of general...

The education of attention as explanation of variability of practice effects: learning the final approach phase in a flight simulator.

PubMed

Huet, Michaël; Jacobs, David M; Camachon, Cyril; Missenard, Olivier; Gray, Rob; Montagne, Gilles

2011-12-01

The present study reports two experiments in which a total of 20 participants without prior flight experience practiced the final approach phase in a fixed-base simulator. All participants received self-controlled concurrent feedback during 180 practice trials. Experiment 1 shows that participants learn more quickly under variable practice conditions than under constant practice conditions. This finding is attributed to the education of attention to the more useful informational variables: Variability of practice reduces the usefulness of initially used informational variables, which leads to a quicker change in variable use, and hence to a larger improvement in performance. In the practice phase of Experiment 2 variability was selectively applied to some experimental factors but not to others. Participants tended to converge toward the variables that were useful in the specific conditions that they encountered during practice. This indicates that an explanation for variability of practice effects in terms of the education of attention is a useful alternative to traditional explanations based on the notion of the generalized motor program and to explanations based on the notions of noise and local minima.

Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2017.

PubMed

Wieland, Mark L; Szostek, Jason H; Wingo, Majken T; Post, Jason A; Mauck, Karen F

2018-02-26

Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature. Copyright © 2018 Elsevier Inc. All rights reserved.

Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis

PubMed Central

Rice, Nigel; Dixon, Paul; Lloyd, David C E F; Roberts, David

2000-01-01

Objective To develop a weighted capitation formula for setting target allocations for prescribing expenditures for health authorities and primary care groups in England. Design Regression analysis relating prescribing costs to the demographic, morbidity, and mortality composition of practice lists. Setting 8500 general practices in England. Subjects Data from the 1991 census were attributed to practice lists on the basis of the place of residence of the practice population. Main outcome measures Variation in age, sex, and temporary resident originated prescribing units (ASTRO(97)-PUs) adjusted net ingredient cost of general practices in England for 1997-8 modelled for the impact of health and social needs after controlling for differences in supply. Results A needs gradient based on the four variables: permanent sickness, percentage of dependants in no carer households, percentage of students, and percentage of births on practice lists. These, together with supply characteristics, explained 41% of variation in prescribing costs per ASTRO(97)-PU adjusted capita across practices. The latter alone explained about 35% of variation in total costs per head across practices. Conclusions The model has good statistical specification and contains intuitively plausible needs drivers of prescribing expenditure. Together with adjustments made for differences in ASTRO(97)-PUs the model is capable of explaining 62% (35%+0.65% (41%)) of variation in prescribing expenditure at practice level. The results of the study have formed the basis for setting target budgets for 1999-2000 allocations for prescribing expenditure for health authorities and primary care groups. PMID:10650026

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…

Pharmaceutical trials in general practice: the first 100 protocols. An audit by the clinical research ethics committee of the Royal College of General Practitioners.

PubMed Central

Wise, P.; Drury, M.

1996-01-01

OBJECTIVE: To assess the outcome of 100 general practice based, multicentre research projects submitted to the ethics committee of the Royal College of General Practitioners by pharmaceutical companies or their agents between 1984 and 1989. DESIGN: Analysis of consecutive submitted protocols for stated objectives, study design, and outcomes; detailed review of committee minutes and correspondence in relation to amendment and approval; assessment of final reports submitted at conclusion of studies. SUBJECTS: 82 finally approved protocols, embracing 34,523 proposed trial subjects and 1195 proposed general practice investigators. MAIN OUTCOME MEASURES: Success at enrolling subjects and investigators; commencement and completion data; validity of final report's assessment of efficacy, safety, tolerability, and acceptability; and method of use and dissemination of findings. RESULTS: 18 studies were not approved and 45 had to be amended. Randomised controlled trials comprised 46 of the original submissions. Remuneration considerations, inadequate information or consent sheets, pregnancy safety, the need to discontinue existing therapy, and suboptimal scientific content were major reasons for rejecting studies or asking for amendments. Of the 82 approved studies 8 were not started. Shortfalls of investigators (of 39%) and trial subjects (of 37%) and an overall 23% withdrawal rate were responsible for a significant incidence of inconclusive results. Within the six year follow up interval, only 19 of the studies had been formally published. CONCLUSIONS: This audit identified substantial ethical concerns in the process of approving multicentre general practice pharmaceutical research. PMID:8939118

[From evidence-based medicine to value-based medicine].

PubMed

Zhang, Shao-dan; Liang, Yuan-bo; Li, Si-zhen

2006-11-01

Evidence base medicine (EBM) is based on objective evidence, which provides best available knowledge for physicians to scientifically make medical and therapeutic decisions for the care of all individual patients in order to improve the effectiveness of treatment and to prolong the life of patients. EBM has made a significant progress in clinical practice. But medical therapies cannot always bring a better life quality and clinically, patients' preference should be always taken into account. Value-based medicine medicine (VBM) is the practice of medicine that emphasizes the value received from an intervention. It takes evidence-based data to a higher level by combining the parameters of patient-perceived value with the cost of an intervention. The fundamental instrument of VBM is cost-utility analysis. VBM will provide a better practice model to evaluate the therapeutic package and cost effectiveness for individual and general health care.

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

A state survey of Child Advocacy Center therapists' attitudes toward treatment manuals and evidence-based practice.

PubMed

Staudt, Marlys; Williams-Hayes, Mona

2011-01-01

The objective of this descriptive study was to examine Child Advocacy Center therapists' attitudes toward treatment manuals and evidence-based practices and to gather information about the treatments they use most frequently. An online survey was sent to 30 therapists employed by 15 Child Advocacy Centers in a southeastern state. The response rate was 70%. The respondents generally had positive attitudes toward the use of treatment manuals and the implementation of evidence-based practices. The treatment utilized most frequently was trauma focused cognitive-behavioral therapy. More outcome research of Child Advocacy Center services is needed, and information about how children and parents perceive the acceptability and outcomes of Child Advocacy Center services can be used to enhance services.

Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention.

PubMed

Lewis, Natalia V; Larkins, Cath; Stanley, Nicky; Szilassy, Eszter; Turner, William; Drinkwater, Jessica; Feder, Gene S

2017-03-04

Children's exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures. We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants' knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence. Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children's social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants' suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children. The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians' knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.

Developing a new syndromic surveillance system for the London 2012 Olympic and Paralympic Games.

PubMed

Harcourt, S E; Fletcher, J; Loveridge, P; Bains, A; Morbey, R; Yeates, A; McCloskey, B; Smyth, B; Ibbotson, S; Smith, G E; Elliot, A J

2012-12-01

Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.

What does locality commissioning in Avon offer? Retrospective descriptive evaluation.

PubMed Central

Hine, C. E.; Bachmann, M. O.

1997-01-01

OBJECTIVE: To describe the impact, direct costs of, and participants' attitudes to the first two years and eight months of locality commissioning in Avon. DESIGN: Retrospective description of programme. SETTING: Thirteen localities in Avon Health Authority area, covering 982000 population and 147 general practices. METHODS: Postal questionnaire survey of 147 general practitioners (one per practice); interviews with and questionnaire survey of 13 lead general practitioners and 13 so called link staff from the health authority. MAIN OUTCOME MEASURES: Locality initiatives, perceived influence, general practitioners' attitudes, management costs. RESULTS: Twenty initiatives were identified that had changed services to patients, and another nine were planned. The commonest initiatives concerned primary mental health care (seven), nurse specialists for primary care of chronic diseases (three), referral and clinical practice guidelines (seven), and access to hospital outpatient departments (one, with two others planned). Localities were more likely to have influenced the authority, trust managers, and consultants than social services, community health councils, and voluntary organisations. Activity varied between localities, lead general practitioners estimating that 120/147 (82%) of practices had been involved in locality meetings (range 44-100% in different localities). The authority had spent 6 p per capita on running the scheme, and the total time used by general practitioners for locality commissioning was estimated at 1.5 whole time equivalents. CONCLUSION: Locality commissioning has selectively changes services with limited extra funding and without delegation of hospital and community health service budgets. General practitioners wanted more policy and financial support. Further development should be based on evidence of costs, benefits, and limitations of locality commissioning schemes. PMID:9154029

Pediatric skin care: what do nurses really know?

PubMed

Drake, Jennifer; Redfern, Wendi S; Sherburne, Eileen; Nugent, Melodee L; Simpson, Pippa

2012-10-01

The purpose of this study was to explore pediatric nurses' knowledge of pressure ulcer prevention, investigate their beliefs and practices, and identify the barriers and facilitators to providing evidence-based pressure ulcer preventive practices. An exploratory, descriptive, and cross-sectional survey was taken of registered nurses in a freestanding children's hospital. Nurses have adequate knowledge of general pressure ulcer prevention; however, they struggle with individualization. Further, analysis revealed that nursing knowledge did not always correlate with nursing practice. Nurses require education on individualized interventions and access to user-friendly, interactive, and comprehensive resources, including unit-based champions and order sets. © 2012, Wiley Periodicals, Inc.

RISQy business (Relationships, Incentives, Supports, and Quality): evolution of the British Columbia Model of Primary Care (patient-centered medical home).

PubMed

MacCarthy, Dan; Hollander, Marcus J

2014-01-01

In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committee's approach to primary care was to respond to an operational problem--the decline of family practice in British Columbia--with an operational solution--assist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a "soft power" approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians. There are many similarities between the British Columbian approach to primary care and the US patient-centered medical home.

Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency.

PubMed

Ramanathan, Rajesh; Duane, Therese M; Kaplan, Brian J; Farquhar, Doris; Kasirajan, Vigneshwar; Ferrada, Paula

2015-01-01

To describe and evaluate a root cause analysis (RCA)-based educational curriculum for quality improvement (QI) practice-based learning and implementation in general surgery residency. A QI curriculum was designed using RCA and spaced-learning approaches to education. The program included a didactic session about the RCA methodology. Resident teams comprising multiple postgraduate years then selected a personal complication, completed an RCA, and presented the findings to the Department of Surgery. Mixed methods consisting of quantitative assessment of performance and qualitative feedback about the program were used to assess the value, strengths, and limitations of the program. Urban tertiary academic medical center. General surgery residents, faculty, and medical students. An RCA was completed by 4 resident teams for the following 4 adverse outcomes: postoperative neck hematoma, suboptimal massive transfusion for trauma, venous thromboembolism, and decubitus ulcer complications. Quantitative peer assessment of their performance revealed proficiency in selecting an appropriate case, defining the central problem, identifying root causes, and proposing solutions. During the qualitative feedback assessment, residents noted value of the course, with the greatest limitation being time constraints and equal participation. An RCA-based curriculum can provide general surgery residents with QI exposure and training that they value. Barriers to successful implementation include time restrictions and equal participation from all involved members. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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.

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.

Narrative medicine in surgical education.

PubMed

Pearson, A Scott; McTigue, Michael P; Tarpley, John L

2008-01-01

Narrative medicine is a patient-centered approach to the practice of medicine that rescues the patients' stories and integrates what is important to them into decisions regarding their health care. Our hypothesis is that narrative understanding enhances the patient-provider relationship and contributes to optimizing patient care. We propose to use written narrative reflection to capture and measure the general competencies of systems-based practice, practice-based learning, communication skills, and professionalism. DEVELOPMENT/METHODS: The development of this narrative-based project is based on a pilot study that we conducted at our institution with third-year surgical clerkship students. In the pilot, students produced in-depth narrative write-ups on a patient they had had the opportunity to "know." We plan a similar approach for surgical resident education. After a brief discussion of narrative medicine during our scheduled didactic conference, the residents are asked to initiate a written narrative reflection on a patient of their choosing. The narratives will be collected 1 week later. Our plan is to repeat this assessment quarterly so that 4 narratives will be generated annually from internship through the chief resident year. The narratives will be analyzed for content and recurring themes that capture the resident's communication skills, professionalism, as well as self-critique (practice-based learning) and value attributed to health-care teams (systems-based practice). After completion of the narratives, a 5-point Likert response survey will be given to the residents to assess their experience and the perceived value of written reflection. The written narratives will become part of the resident's ongoing portfolio. IMPLEMENTATION/EXPERIENCE TO DATE: Feedback from the medical student pilot study was favorable. When asked in a follow-up questionnaire, most students reported the experience to be valuable and recommended the use of narrative reflection in medical education. To assess the feasibility of this approach in surgical residency, we introduced the concept of narrative reflection to our residents during surgery grand rounds. Thirty-three narratives were collected 1 week later. CONCLUSION/NEXT STEPS: This preliminary experience suggests that acquisition of resident-authored narrative reflection is feasible during surgical residency. Use of this narrative-based approach in surgical resident education has the potential to capture and measure the general competencies of systems-based practice, practice-based learning, communication skills, and professionalism.

Revisiting a neglected construct: parenting styles in a child-feeding context.

PubMed

Hughes, Sheryl O; Power, Thomas G; Orlet Fisher, Jennifer; Mueller, Stephen; Nicklas, Theresa A

2005-02-01

The extent to which general parenting represents feeding styles in ethnically diverse populations is not well documented. Existing measures of child feeding have focused almost exclusively on specific behaviors of European-American parents. A valid and reliable instrument was developed to identify feeding styles in parents of low-income minority preschoolers. Two hundred thirty-one parents (130 Hispanic; 101 African-American) completed questionnaires on feeding practices and parenting styles. Based on self-reported feeding behavior, parents were assigned to four feeding styles (authoritarian, n=84; authoritative, n=34; indulgent, n=80; and uninvolved, n=33). Convergent validity was evaluated by relating feeding styles to independent measures of general parenting and authoritarian feeding practices. Authoritarian feeding styles were associated with higher levels of general parental control and authoritarian feeding practices. Alternatively, authoritative feeding styles were associated with higher levels of general parental responsiveness. Among the two permissive feeding styles, Hispanic parents were more likely to be indulgent, whereas African-American parents were more likely to be uninvolved. Further, differences were found among the feeding styles on an independent measure of child's body mass index.

General practitioners in Styria - who is willing to take part in research projects and why? : A survey by the Institute of General Practice and Health Services Research.

PubMed

Poggenburg, Stephanie; Reinisch, Manuel; Höfler, Reinhild; Stigler, Florian; Avian, Alexander; Siebenhofer, Andrea

2017-11-01

Increasing recognition of general practice is reflected in the growing number of university institutes devoted to the subject and Health Services Research (HSR) is flourishing as a result. In May 2015 the Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, initiated a survey of Styrian GPs. The aim of the survey was to determine the willingness to take part in HSR projects, to collect sociodemographic data from GPs who were interested and to identify factors affecting participation in research projects. Of the 1015 GPs who received the questionnaire, 142 (14%) responded and 135 (13%) were included in the analysis. Overall 106 (10%) GPs indicated their willingness to take part in research projects. Factors inhibiting participation were lack of time, administrative workload, and lack of assistance. Overall, 10% of Styrian GPs were willing to participate in research projects. Knowledge about the circumstances under which family doctors are prepared to participate in HSR projects will help in the planning of future projects.

Rated casemix of general practitioner referrals to practice counsellors and clinical psychologists: A retrospective survey of a year's caseload.

PubMed

Cape, John; Parham, Alan

2001-06-01

Although evidence-based guidelines are beginning to be produced as to which psychological therapies might be appropriate for which patients, little is known about how general medical practitioners (GPs) in practice distribute referrals between different psychological therapy services. In a retrospective survey, 19 practice counsellors and 10 clinical psychologists from the same geographical area rated a year's caseload of GP referrals using identical data collection methods. Rated casemix was found to be broadly similar, although practice counsellors rated relationship and bereavement problems as more common in their caseloads (totalling 986 patients), and clinical psychologists rated panic disorder, phobias, and obsessive-compulsive problems as more common in their caseloads (totalling 320 patients). Depression and anxiety reactions were the most common problems rated in both groups, but the clinical psychologist cases of depression were rated as more severe and complex. Where differences were found, they may have reflected the different ways that counsellors and clinical psychologists conceptualize cases rather than actual differences in casemix. The results are discussed in relation to evidence-based guideline recommendations about cases appropriate to be seen by practice counsellors and by clinical psychologists in primary and secondary care, and the need to adapt such guidance to local services and skills of practitioners.

Rated casemix of general practitioner referrals to practice counsellors and clinical psychologists: a retrospective survey of a year's caseload.

PubMed

Cape, J; Parham, A

2001-06-01

Although evidence-based guidelines are beginning to be produced as to which psychological therapies might be appropriate for which patients, little is known about how general medical practitioners (GPs) in practice distribute referrals between different psychological therapy services. In a retrospective survey, 19 practice counsellors and 10 clinical psychologists from the same geographical area rated a year's caseload of GP referrals using identical data collection methods. Rated casemix was found to be broadly similar, although practice counsellors rated relationship and bereavement problems as more common in their caseloads (totalling 986 patients), and clinical psychologists rated panic disorder, phobias, and obsessive-compulsive problems as more common in their caseloads (totalling 320 patients). Depression and anxiety reactions were the most common problems rated in both groups, but the clinical psychologist cases of depression were rated as more severe and complex. Where differences were found, they may have reflected the different ways that counsellors and clinical psychologists conceptualize cases rather than actual differences in casemix. The results are discussed in relation to evidence-based guideline recommendations about cases appropriate to be seen by practice counsellors and by clinical psychologists in primary and secondary care, and the need to adapt such guidance to local services and skills of practitioners.

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

Electro-encephalogram based brain-computer interface: improved performance by mental practice and concentration skills.

PubMed

Mahmoudi, Babak; Erfanian, Abbas

2006-11-01

Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.

Un/doing Gender? a Case Study of School Policy and Practice in Zambia

NASA Astrophysics Data System (ADS)

Bajaj, Monisha

2009-11-01

This article explores an attempt to disrupt gender inequality in a unique, low-cost private school in Ndola, Zambia. It examines deliberate school policies aimed at "undoing gender" or fostering greater gender equity. These include efforts to maintain gender parity at all levels of the school and the requirement that both young men and women carry out cleaning tasks generally viewed as "women's work". Observations, interviews, student diaries and surveys from this school and from government schools provide the basis for a comparison, indicating how the former strives to interrupt the transmission of gender inequalities as well as how students respond to these practices. The findings suggest that the pedagogical practices deployed by this school have generally succeeded in destabilising norms of gender subordination and gender-based violence, though the replicability of these practices is interrogated given broader questions about the country's public resources and political will.

The place of practical wisdom in science education: what can be learned from Aristotelian ethics and a virtue-based theory of knowledge

NASA Astrophysics Data System (ADS)

Salloum, Sara

2017-06-01

This conceptual paper aims to characterize science teachers' practical knowledge utilizing a virtue-based theory of knowledge and the Aristotelian notion of phronesis/practical wisdom. The article argues that a greater understanding of the concept of phronesis and its relevance to science education would enrich our understandings of teacher knowledge, its development, and consequently models of teacher education. Views of teacher knowledge presented in this paper are informed by philosophical literature that questions normative views of knowledge and argues for a virtue-based epistemology rather than a belief-based one. The paper first outlines general features of phronesis/practical wisdom. Later, a virtue-based view of knowledge is described. A virtue-based view binds knowledge with moral concepts and suggests that knowledge development is motivated by intellectual virtues such as intellectual sobriety, perseverance, fairness, and humility. A virtue-based theory of knowledge gives prominence to the virtue of phronesis/practical wisdom, whose primary function is to mediate among virtues and theoretical knowledge into a line of action that serves human goods. The role of phronesis and its relevance to teaching science are explained accordingly. I also discuss differences among various characterizations of practical knowledge in science education and a virtue-based characterization. Finally, implications and further questions for teacher education are presented.

The Use of Office-Based Sedation and General Anesthesia by Board Certified Pediatric Dentists Practicing in the United States

PubMed Central

Olabi, Nassim F.; Jones, James E.; Saxen, Mark A.; Sanders, Brian J.; Walker, LaQuia A.; Weddell, James A.; Schrader, Stuart M.; Tomlin, Angela M.

2012-01-01

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available. PMID:22428969

The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

PubMed

Olabi, Nassim F; Jones, James E; Saxen, Mark A; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Schrader, Stuart M; Tomlin, Angela M

2012-01-01

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

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.

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

Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork.

PubMed

Zwarenstein, Merrick; Reeves, Scott

2006-01-01

Knowledge-translation interventions and interprofessional education and collaboration interventions all aim at improving health care processes and outcomes. Knowledge-translation interventions attempt to increase evidence-based practice by a single professional group and thus may fail to take into account barriers from difficulties in interprofessional relations. Interprofessional education and collaboration interventions aim to improve interprofessional relations, which may in turn facilitate the work of knowledge translation and thus evidence-based practice. We summarize systematic review work on the effects of interventions for interprofessional education and collaboration. The current evidence base contains mainly descriptive studies of these interventions. Knowledge is limited regarding the impact on care and outcomes and the extent to which the interventions increase the practice of evidence-based care. Rigorous multimethod research studies are needed to develop and strengthen the current evidence base in this field. We describe a Health Canada-funded randomized trial in which quantitative and qualitative data will be gathered in 20 general internal medicine units located at 5 Toronto, Ontario, teaching hospitals. The project examines the impact of interprofessional education and collaboration interventions on interprofessional relationships, health care processes (including evidence-based practice), and patient outcomes. Routes are suggested by which interprofessional education and collaboration interventions might affect knowledge translation and evidence-based practice.

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.

Data Generation in the Discovery Sciences--Learning from the Practices in an Advanced Research Laboratory

ERIC Educational Resources Information Center

Roth, Wolff-Michael

2013-01-01

General scientific literacy includes understanding the grounds on which scientific claims are based. The measurements scientists make and the data that they produce from them generally constitute these grounds. However, the nature of data generation has received relatively little attention from those interested in teaching science through inquiry.…

Psychometric Assessment and Reporting Practices: Incongruence between Theory and Practice

ERIC Educational Resources Information Center

Slaney, Kathleen L.; Tkatchouk, Masha; Gabriel, Stephanie M.; Maraun, Michael D.

2009-01-01

The aim of the current study is twofold: (a) to investigate the rates at which researchers assess and report on the psychometric properties of the measures they use in their research and (b) to examine whether or not researchers appear to be generally employing sound/unsound rationales when it comes to how they conduct test evaluations. Based on a…

Practical Action Programs in Education: Highlights of the Third National Conference on General Systems Education.

ERIC Educational Resources Information Center

Southern Connecticut State Coll., New Haven. Center for Interdisciplinary Creativity.

In this collection of papers Harold G. Cassidy outlines the conceptual framework for the conference which is based on a systems approach to development of practical action programs in education. A basic model is presented as a basis for shifting from the post-crisis to the pre-crisis approach to curriculum development and educational…

PreK-6 Teachers' Beliefs about Inclusive Practices in the United States and South Korea: Cross Cultural Perspectives

ERIC Educational Resources Information Center

Jeong, Hyunjeong

2013-01-01

The educational practice known as inclusion, which is based on values of equal opportunity and diversity, enables students with disabilities to attend the same general education classes as typically developing peers. Inclusion is a legal requirement in the United States and South Korea, but factors facilitating inclusion likely differ across…

An evaluation of a training placement in general practice for paramedic practitioner students: improving patient-centred care through greater interprofessional understanding and supporting the development of autonomous practitioners.

PubMed

Ruston, Annmarie; Tavabie, Abdol

2011-01-01

To report the extent to which the placement of paramedic practitioner students (PPSs) in accredited general practice (GP) training practices supported their development as autonomous, patient-centred practitioners and fostered interprofessional learning. A case study method was used. Sources of data included semi-structured telephone interviews (eight PPSs, eight GP trainers), an online end of placement survey and placement and assessment documentation. Interview data were transcribed and analysed using the constant comparative method. Accredited training practices in South East England. All respondents were positive that the placement provided a high-quality interprofessional learning environment which provided PPSs with learning opportunities based on assessed need, the support of experienced trainers and access to a wide range of patients and learning situations. The placement enabled PPSs to acquire the appropriate skills, knowledge and understanding to act as autonomous, patient-centred practitioners. The placement provides a sound model for expanding the skills of paramedic practitioners in order to meet the increasing demands for patient-centred, community based health care. It provided them with the skills to treat patients closer to home rather than automatically transporting them to hospital.

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.

A Case-Based Learning Model in Orthodontics.

ERIC Educational Resources Information Center

Engel, Francoise E.; Hendricson, William D.

1994-01-01

A case-based, student-centered instructional model designed to mimic orthodontic problem solving and decision making in dental general practice is described. Small groups of students analyze case data, then record and discuss their diagnoses and treatments. Students and instructors rated the seminars positively, and students reported improved…

Epistemic lenses and virtues, beyond evidence-based medicine.

PubMed

Murphy, Mark E

2018-06-01

This editorial is based on the keynote by Dr Mark Murphy, Department of General Practice, Royal College of Surgeons, Ireland, at the Health Libraries Group conference, Keele University on 13-15 June 2018. https://bit.ly/2rubsIR#HLG2018. © 2018 Health Libraries Group.

Use of buprenorphine for addiction treatment: perspectives of addiction specialists and general psychiatrists.

PubMed

Thomas, Cindy Parks; Reif, Sharon; Haq, Sayeda; Wallack, Stanley S; Hoyt, Alexander; Ritter, Grant A

2008-08-01

In 2002 buprenorphine (Suboxone or Subutex) was approved by the U.S. Food and Drug Administration for office-based treatment of opioid addiction. The goal of office-based pharmacotherapy is to bring more opiate-dependent people into treatment and to have more physicians address this problem. This study examined prescribing practices for buprenorphine, including facilitators and barriers, and the organizational settings that facilitate its being incorporated into treatment. Addiction specialists and other psychiatrists in four market areas were surveyed by mail and Internet in fall 2005 to examine prescribing practices for buprenorphine. Respondents included 271 addiction specialists (72% response rate) and 224 psychiatrists who were not listed as addiction specialists but who had patients with addictions in their practice (57% response rate). Three years after approval of buprenorphine for office-based addiction treatment, nearly 90% of addiction specialists had been approved to prescribe it and two-thirds treated patients with buprenorphine. However, fewer than 10% of non-addiction specialist psychiatrists prescribed it. Regression-adjusted factors predicting prescribing of buprenorphine included support of training and use of buprenorphine by the physician's main affiliated organization, less time in general psychiatry compared with addictions treatment, more time in group practice rather than solo, ten or more opiate-dependent patients, belief that drugs play a large role in addiction treatment, and patient demand. Office-based pharmacotherapy offers a promising path to improved access to addictions treatment, but prescribing has expanded little beyond the addiction specialist community.

A feasibility study for a clinical decision support system prompting HIV testing.

PubMed

Chadwick, D R; Hall, C; Rae, C; Rayment, Ml; Branch, M; Littlewood, J; Sullivan, A

2017-07-01

Levels of undiagnosed HIV infection and late presentation remain high globally despite attempts to increase testing. The objective of this study was to evaluate a risk-based prototype application to prompt HIV testing when patients undergo routine blood tests. Two computer physician order entry (CPOE) systems were modified using the application to prompt health care workers (HCWs) to add an HIV test when other tests selected suggested that the patient was at higher risk of HIV infection. The application was applied for a 3-month period in two areas, in a large London hospital and in general practices in Teesside/North Yorkshire. At the end of the evaluation period, HCWs were interviewed to assess the usability and acceptability of the prompt. Numbers of HIV tests ordered in the general practice areas were also compared before and after the prompt's introduction. The system was found to be both useable and generally acceptable to hospital doctors, general practitioners and nurse practitioners, with little evidence of prompt/alert fatigue. The issue of the prompt appearing late in the patient consultation did lead to some difficulties, particularly around discussion of the test and consent. In the general practices, around 1 in 10 prompts were accepted and there was a 6% increase in testing rates over the 3-month study period (P = 0.169). Using a CPOE-based clinical decision support application to prompt HIV testing appears both feasible and acceptable to HCWs. Refining the application to provide more accurate risk stratification is likely to make it more effective. © 2016 British HIV Association.

Design and methods of a strategic outcome study for chronic kidney disease: Frontier of Renal Outcome Modifications in Japan.

PubMed

Yamagata, Kunihiro; Makino, Hirofumi; Akizawa, Tadao; Iseki, Kunitoshi; Itoh, Sadayoshi; Kimura, Kenjiro; Koya, Daisuke; Narita, Ichiei; Mitarai, Tetsuya; Miyazaki, Masanobu; Tsubakihara, Yoshiharu; Watanabe, Tsuyoshi; Wada, Takashi; Sakai, Osamu

2010-04-01

The continuous increase in the number of people requiring dialysis is a major clinical and socioeconomical issue in Japan and other countries. This study was designed to encourage chronic kidney disease (CKD) patients to consult a physician, enhance cooperation between nephrologists and general practices, and prevent the progression of kidney disease. Subjects comprise CKD patients aged between 40 and 74 years consulting a general physician, and patients in CKD stage 3 with proteinuria and diabetes or hypertension. This trial is a stratified open cluster-randomized study with two intervention groups: group A (weak intervention) and group B (strong intervention). We have recruited 49 local medical associations (clusters) in 15 different prefectures, which were classified into four regions (strata) based on the level of increase rate of dialysis patients. The patients in group A clusters were instructed initially to undergo treatment in accordance with the current CKD treatment guide, whereas patients in group B clusters were not only instructed in the same fashion but also received support from an information technology (IT)-based system designed to help achieve the goals of CKD treatment, consultation support centers, and consultations by dietitians visiting the local general practice offices. We assessed the rates of continued consultation, collaboration between general practitioners and nephrologists, and progression of CKD (as expressed by CKD stage). Through this study, filling the evidence-practice gap by facilitating effective communication and supporting general physicians and nephrologists, we will establish a CKD care system and decrease the number of advanced-stage CKD patients.

Evidence-based care of older people with suspected cognitive impairment in general practice: protocol for the IRIS cluster randomised trial.

PubMed

McKenzie, Joanne E; French, Simon D; O'Connor, Denise A; Mortimer, Duncan S; Browning, Colette J; Russell, Grant M; Grimshaw, Jeremy M; Eccles, Martin P; Francis, Jill J; Michie, Susan; Murphy, Kerry; Kossenas, Fiona; Green, Sally E

2013-08-19

Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers. This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs' (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial). The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs' detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation. Australian New Zealand Clinical Trials Registry: ACTRN12611001032943 (date registered 28 September, 2011).

Characteristic-based algorithms for flows in thermo-chemical nonequilibrium

NASA Technical Reports Server (NTRS)

Walters, Robert W.; Cinnella, Pasquale; Slack, David C.; Halt, David

1990-01-01

A generalized finite-rate chemistry algorithm with Steger-Warming, Van Leer, and Roe characteristic-based flux splittings is presented in three-dimensional generalized coordinates for the Navier-Stokes equations. Attention is placed on convergence to steady-state solutions with fully coupled chemistry. Time integration schemes including explicit m-stage Runge-Kutta, implicit approximate-factorization, relaxation and LU decomposition are investigated and compared in terms of residual reduction per unit of CPU time. Practical issues such as code vectorization and memory usage on modern supercomputers are discussed.

Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research.

PubMed

Brownson, Ross C; Fielding, Jonathan E; Green, Lawrence W

2018-04-01

Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and its application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan, deliver, and evaluate the preventive dose of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. Although there is general agreement among practitioners and scientists on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when, and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity building will foster more effective public health practice.

Building capacity for evidence-based public health: Reconciling the pulls of practice and the push of research

PubMed Central

Fielding, Jonathan E.; Green, Lawrence W.

2018-01-01

Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan deliver and evaluate the “preventive dose” of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. While there is general agreement on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity-building will foster more effective public health practice. PMID:29166243

Engaging participants in a complex intervention trial in Australian General Practice

PubMed Central

Perkins, David; Harris, Mark F; Tan, Jocelyn; Christl, Bettina; Taggart, Jane; Fanaian, Mahnaz

2008-01-01

Background The paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian General Practice. Methods Reflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention. Results Recruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection. Conclusion There needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks. Trial Registration Current Controlled Trials ACTRN12605000788673 PMID:18700984

[The practice guideline 'Pregnancy and puerperium' (first revision) from the Dutch College of General Practitioners; a response from the perspective of gynaecology].

PubMed

Heringa, M P

2004-01-10

The major benefit of the revised version of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium is the formal starting point of professional equality of midwives and general practitioners as care providers in antenatal and postpartum care. This thorough evidence-based practice guideline is behind the most recent developments in this field. Scientific evidence on vertical HIV transmission favours screening all pregnant women and not just the selective procedure proposed in this guideline. The restrictive attitude towards routine ultrasound screening during pregnancy hardly seems in line with scientific evidence and the public demand. On the other hand the guideline is very progressive as far as the care of women with thyroid disorders is concerned even though evidence on this subject is meagre. Most importantly the transition of antenatal care from the current almost conveyor belt-like procedure to an efficient but individually-adapted care process was not addressed.

Does attitude matter in computer use in Australian general practice? A zero-inflated Poisson regression analysis.

PubMed

Khan, Asaduzzaman; Western, Mark

The purpose of this study was to explore factors that facilitate or hinder effective use of computers in Australian general medical practice. This study is based on data extracted from a national telephone survey of 480 general practitioners (GPs) across Australia. Clinical functions performed by GPs using computers were examined using a zero-inflated Poisson (ZIP) regression modelling. About 17% of GPs were not using computer for any clinical function, while 18% reported using computers for all clinical functions. The ZIP model showed that computer anxiety was negatively associated with effective computer use, while practitioners' belief about usefulness of computers was positively associated with effective computer use. Being a female GP or working in partnership or group practice increased the odds of effectively using computers for clinical functions. To fully capitalise on the benefits of computer technology, GPs need to be convinced that this technology is useful and can make a difference.

The effectiveness of competency-based education in equipping primary health care workers to manage chronic disease in Australian general practice settings.

PubMed

Glasgow, Nicholas J; Wells, Robert; Butler, James; Gear, Anna

2008-04-21

To review the literature on the effectiveness of competency-based education (CBE) as a means of equipping the Australian general practice workforce to deliver optimal chronic disease outcomes to articulate policy options for the Australian context. Systematic review of the literature (1991-2005) using a narrative approach followed by analysis of the findings using the actors/context/ processes/content framework of Buse et al. Few high-quality studies were identified. National policy options include incorporating clear statements about education and training, research and evaluation in any policy document targeting chronic disease; and provision of funding to enhance general practice teaching facilities and/or facilitate the development of supportive coordinating and administrative structures for training practices. Designers of CBE should consider five key questions: Are the educational objectives of the CBE clearly aligned with the chronic disease or workforce-related outcomes of interest? Is the design of the CBE sound? Have similar educational programs targeting the same outcomes been identified and every attempt made to maximise synergies between programs? Are the educational designers fully aware of and working within the existing complexity of the training environment? Are all involved in the program actively managing the process of change? Policy options range from those relatively simple and achievable to more complex and difficult. The full report is available at http://www.anu.edu.au/aphcri/Domain/Workforce/final_25_glasgow.pdf.

Impact of introducing near patient testing for standard investigations in general practice.

PubMed Central

Rink, E; Hilton, S; Szczepura, A; Fletcher, J; Sibbald, B; Davies, C; Freeling, P; Stilwell, J

1993-01-01

OBJECTIVE--To assess the clinical and economic impact of surgery based near patient testing in general practice for six commonly used biochemical and bacteriological tests. DESIGN--After four months' monitoring, equipment for two bacteriological and four biochemical tests was introduced without cost into 12 practices using a crossover design. Structured request forms were used to monitor laboratory investigations. SETTING--12 general practices in west midlands and south west Thames with list sizes above 9000. MAIN OUTCOME MEASURES--Investigation rates per 1000 consultations. Changes from baseline rates. Reasons for requesting investigations and provisional diagnoses. Cost per test and sensitivity of costs to rate of use. RESULTS--Investigation rates for the six tests rose by 16.5% (from 78.6/1000 consultations to 91.6/1000) when equipment was available in the surgery and reverted to baseline rates when it was withdrawn. The average weekly number of tests when equipment was available ranged from 0.5 to 10.5 (mean 9.0). Cholesterol tests were used as an addition to laboratory testing, usually for screening. Midstream urine analysis was often done in the surgery instead of in the laboratory, although 30% of samples were tested by both methods. Doctors' reasons for investigation and conditions tested were largely unaffected by availability of surgery tests. Costs for surgery tests were higher for all tests except midstream urine. CONCLUSIONS--Availability of surgery based testing increased the number of tests performed. It was cost effective only for midstream urine analysis. PMID:8219952

Academic Primer Series: Eight Key Papers about Education Theory.

PubMed

Gottlieb, Michael; Boysen-Osborn, Megan; Chan, Teresa M; Krzyzaniak, Sara M; Pineda, Nicolas; Spector, Jordan; Sherbino, Jonathan

2017-02-01

Many teachers adopt instructional methods based on assumptions of best practices without attention to or knowledge of supporting education theory. Familiarity with a variety of theories informs education that is efficient, strategic, and evidence-based. As part of the Academic Life in Emergency Medicine Faculty Incubator Program, a list of key education theories for junior faculty was developed. A list of key papers on theories relevant to medical education was generated using an expert panel, a virtual community of practice synthetic discussion, and a social media call for resources. A three-round, Delphi-informed voting methodology including novice and expert educators produced a rank order of the top papers. These educators identified 34 unique papers. Eleven papers described the general use of education theory, while 23 papers focused on a specific theory. The top three papers on general education theories and top five papers on specific education theory were selected and summarized. The relevance of each paper for junior faculty and faculty developers is also presented. This paper presents a reading list of key papers for junior faculty in medical education roles. Three papers about general education theories and five papers about specific educational theories are identified and annotated. These papers may help provide foundational knowledge in education theory to inform junior faculty teaching practice.

Diffusion of laparoscopic cholecystectomy among general surgeons in the United States.

PubMed

Escarce, J J; Bloom, B S; Hillman, A L; Shea, J A; Schwartz, J S

1995-03-01

Introduced in 1989, laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examine the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than three fourths of adopters identified the desire to keep up with the state-of-the-art and improved patient outcomes as very or extremely important reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generally was consistent with expected utility maximization in an uncertain new technological environment. Of particular interest, fee-for-service payment and more competitive practice settings and markets were associated with earlier adoption. These findings suggest that the "technological imperative" and surgeons' perception of the relative clinical and financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Policies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product innovations in health care.

Academic Primer Series: Eight Key Papers about Education Theory

PubMed Central

Gottlieb, Michael; Boysen-Osborn, Megan; Chan, Teresa M.; Krzyzaniak, Sara M.; Pineda, Nicolas; Spector, Jordan; Sherbino, Jonathan

2017-01-01

Introduction Many teachers adopt instructional methods based on assumptions of best practices without attention to or knowledge of supporting education theory. Familiarity with a variety of theories informs education that is efficient, strategic, and evidence-based. As part of the Academic Life in Emergency Medicine Faculty Incubator Program, a list of key education theories for junior faculty was developed. Methods A list of key papers on theories relevant to medical education was generated using an expert panel, a virtual community of practice synthetic discussion, and a social media call for resources. A three-round, Delphi-informed voting methodology including novice and expert educators produced a rank order of the top papers. Results These educators identified 34 unique papers. Eleven papers described the general use of education theory, while 23 papers focused on a specific theory. The top three papers on general education theories and top five papers on specific education theory were selected and summarized. The relevance of each paper for junior faculty and faculty developers is also presented. Conclusion This paper presents a reading list of key papers for junior faculty in medical education roles. Three papers about general education theories and five papers about specific educational theories are identified and annotated. These papers may help provide foundational knowledge in education theory to inform junior faculty teaching practice. PMID:28210367

Can self-care health books affect amount of contact with the primary health care team? A randomized controlled trial in general practice.

PubMed

Platts, Amanda; Mitton, Rosly; Boniface, David; Friedli, Karin

2005-09-01

To investigate the effects of two differently styled self-care health books in general practice on the frequency and duration of patients' consultations and their views of the books. Random allocation of patients to either a descriptive or a decision-tree based self-care health book, or a no-book control condition. Three- and 12-months follow-up by postal questionnaire and monitoring of consultations. A large general practice in the South East of England. A total of 1967 volunteer, adult patients who attended the practice in 2001 participated. Demographics; health problems; use of health services; use and perceptions of the trial book; frequency and duration of consultations. Response rates to postal questionnaires at 3 and 12 months were 80% and 74%. In all, 48% consulted their allocated book, compared with 25% who consulted any healthcare book in the Control group. Those reporting health problems were more likely to have consulted their allocated book; 60% reported that the allocated book made them more likely to deal with a problem themselves and 40% reported themselves less likely to consult the practice. However, there were no differences in consultation rates or durations of consultations between the three groups. Handing out of self-care health books may provide qualitative benefits for patients but is unlikely to reduce attendance at the GP practice.

An exploration of equitable science teaching practices for students with learning disabilities

NASA Astrophysics Data System (ADS)

Morales, Marlene

In this study, a mixed methods approach was used to gather descriptive exploratory information regarding the teaching of science to middle grades students with learning disabilities within a general education classroom. The purpose of this study was to examine teachers' beliefs and their practices concerning providing equitable opportunities for students with learning disabilities in a general education science classroom. Equitable science teaching practices take into account each student's differences and uses those differences to inform instructional decisions and tailor teaching practices based on the student's individualized learning needs. Students with learning disabilities are similar to their non-disabled peers; however, they need some differentiation in instruction to perform to their highest potential achievement levels (Finson, Ormsbee, & Jensen, 2011). In the quantitative phase, the purpose of the study was to identify patterns in the beliefs of middle grades science teachers about the inclusion of students with learning disabilities in the general education classroom. In the qualitative phase, the purpose of the study was to present examples of instruction in the classrooms of science education reform-oriented middle grades science teachers. The quantitative phase of the study collected data from 274 sixth through eighth grade teachers in the State of Florida during the 2007--2008 school year using The Teaching Science to Students with Learning Disabilities Inventory. Overall, the quantitative findings revealed that middle grades science teachers held positive beliefs about the inclusion of students with learning disabilities in the general education science classroom. The qualitative phase collected data from multiple sources (interviews, classroom observations, and artifacts) to develop two case studies of reform-oriented middle grades science teachers who were expected to provide equitable science teaching practices. Based on their responses to The Teaching Science to Students with Learning Disabilities Inventory, the case study teachers demonstrated characteristics of successful teachers of diverse learners developed by Lynch (2000). Overall, the qualitative findings revealed that the case study teachers were unsure how to provide equitable science teaching practices to all students, particularly to students with learning disabilities. They provided students with a variety of learning experiences that entailed high expectations for all; however, these experiences were similar for all students. Had the teachers fully implemented equitable science teaching practices, students would have had multiple options for taking in the information and making sense of it in each lesson. Teaching that includes using a variety of validated practices that take into account students' individualized learning needs can promote aspects of equitable science teaching practices. Finally, this study provides implications for teacher education programs and professional development programs. As teachers implement science education reform efforts related to equitable science teaching practices, both teacher education programs and professional development programs should include opportunities for teachers to reflect on their beliefs about how students with learning disabilities learn and provide them with a variety of validated teaching practices that will assist them in teaching students with learning disabilities in the general education classroom while implementing science reform efforts.

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.

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

Practical applications of the geographic coordinate data base in Arkansas

Treesearch

Mickie Warwick; Don C. Bragg

2005-01-01

Though not intended for these applications, the General Land Office (GLO) survey notes are a primary source of historical, ecological, and cultural information, making it imperative that their spatial coordinates be as reliable as possible. The Geographic Coordinate Data Base (GCDB) is a statistically-based coordinate fitting program that uses the GLO notes and other...

Science and Sentiment: Grinnell's Fact-Based Philosophy of Biodiversity Conservation.

PubMed

Shavit, Ayelet; Griesemer, James R

2018-06-01

At the beginning of the twentieth century, the biologist Joseph Grinnell made a distinction between science and sentiment for producing fact-based generalizations on how to conserve biodiversity. We are inspired by Grinnellian science, which successfully produced a century-long impact on studying and conserving biodiversity that runs orthogonal to some familiar philosophical distinctions such as fact versus value, emotion versus reason and basic versus applied science. According to Grinnell, unlike sentiment-based generalizations, a fact-based generalization traces its diverse commitments and thus becomes tractable for its audience. We argue that foregrounding tractability better explains Grinnell's practice in the context of his time as well as in the context of current discourse among scientists over the political "biases" of biodiversity research and its problem of "reproducibility."

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.

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model.

PubMed

Schulte, Timothy J; Isley, Elayne; Link, Nancy; Shealy, Craig N; Winfrey, LaPearl Logan

2004-10-01

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace. Copyright 2004 Wiley Periodicals, Inc.

Travel medicine and general practice: a suitable case for audit?

PubMed Central

Sloan, D S

1993-01-01

Travel medicine becomes more important with the continual expansion of international travel and the increased popularity of exotic holiday destinations. In the United Kingdom general practitioners provide the bulk of travel health advice and immunisation and there is growing interest in providing these services. While their armamentarium has been expanded with attractive but expensive new vaccines, the need for health service advice has never been more vital, with the risks of HIV infection and drug resistant malaria. Advantages of a general practice based travel medicine service include maintaining continuity of care for the patient, but a disadvantage might be that the general practitioner sees too few patients to acquire enough skill in the subject. Furthermore, there may be a conflict of interest between time devoted to the "vaccination ritual" and giving health advice. Overall there seems to be a case for both audit and support by the health authorities. Images p616-a PMID:8401022

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

PubMed

Gavartina, Amina; Zaroti, Stavria; Szecsenyi, Joachim; Miksch, Antje; Ose, Dominik; Campbell, Stephen M; Goetz, Katja

2013-08-05

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. 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. 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. 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.

[Factors associated with investment in an office medicine project by general practice residents].

PubMed

Munck, Stéphane; Massin, Sophie; Hofliger, Philippe; Darmon, David

2015-01-01

To identify thefactors associated with investment in an office medicine project by French general practice (GP) residents. We conducted a national survey using a web-based self-administered questionnaire and analyzed the data collected by multiple logistic regressions. The dependent variable was "an office medicine project" The explanatory variables were both individual (socio-demographic and linked to training trajectories) and contextual (related to the available training programmes and the regional medical demography). The response rate was 48.5%. Out of the 1,695 residents of the study sample, 315 (18.6%) already had a project to setup an office practice during their third cycle ofmedical studies. The main factors associated with this project were (p < 0.05): to receive strong academic support, to live in a rural or semi-rural area, to work as a GP locum, to perform residency training in the same city as the medical training and to perform residency training in a region with a high percentage of GPs 55years and older. This study showed that a project to setup an office practice was influenced by both individual and contextualfactors. Special attention should be paid to the means and content of training to ensure better supportfor residents, which could make office general practice more attractive.

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.

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.

Knowledge and attitudes towards evidence-based medicine of mentors in general practice can be influenced by using medical students as academic detailers.

PubMed

Vrdoljak, Davorka; Petric, Dragomir; Diminić Lisica, Ines; Kranjčević, Ksenija; Došen Janković, Sanja; Delija, Ita; Puljak, Livia

2015-01-01

Regular use of evidence-based medicine (EBM) among general practitioners (GP) is insufficient. To analyse whether knowledge and attitudes about EBM can be improved among mentors in general practice by involving sixth-year medical students as academic detailers. An interventional non-randomized before-and-after study included 98 GPs (49 in the intervention group of mentors and 49 controls) and 174 medical students attending family medicine clinical rotations. A telephone survey on knowledge and attitudes towards EBM was conducted among participating physicians before, and six months after the rotation. During the rotation, each mentor chose two cases from real life, and the students' task was to form an answerable clinical question, find the evidence-based answer and to write a brief report. The mentor reviewed the report and discussed it with the student. Students' EBM detailing intervention led to significant improvement in knowledge and attitudes about EBM in the intervention group of mentors in general practice compared to control GPs (relative increase in knowledge was 20 ± 46.9% vs 6 ± 12.1%, respectively; P = 0.042). Among participants with Ph.D. or specialization in family medicine, the observed effects of the intervention were similar as in the total sample, and statistically significant, but not in the group of participants with neither scientific degree nor specialization in family medicine. Knowledge and attitudes of GP mentors towards EBM can be improved by involving medical students as academic detailers. Further studies should explore the effectiveness of this method among GPs that are not mentors, and who do not have a specialization or research degree.

General practice and specialist palliative care teams: an exploration of their working relationship from the perspective of clinical staff working in New Zealand.

PubMed

Keane, Barry; Bellamy, Gary; Gott, Merryn

2017-01-01

With the future focus on palliative and end-of-life care provision in the community, the role of the general practice team and their relationship with specialist palliative care providers is key to responding effectively to the projected increase in palliative care need. Studies have highlighted the potential to improve co-ordination and minimise fragmentation of care for people living with palliative care need through a partnership between generalist services and specialist palliative care. However, to date, the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. The aim of this study was to explore how general practice and specialist palliative care team (SPCT) members view their relationship in terms of partnership working. Five focus group discussions with general practices and SPCT members (n = 35) were conducted in 2012 in two different regions of New Zealand and analysed using a general inductive approach. The findings indicate that participants' understanding of partnership working was informed by their identity as a generalist or specialist, their existing rules of engagement and the approach they took towards sustaining the partnership. Considerable commitment to partnership working was shown by all participating teams. However, their working relationship was based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. Tensions between the cultures of 'generalism' and 'specialism' also provided challenges for those endeavouring to meet palliative care need collaboratively in the community. Further research is required to better understand the factors associated with successful partnership working between general practices and specialist palliative care in order to develop robust strategies to support a more sustainable model of community palliative care. © 2015 John Wiley & Sons Ltd.

General practitioners' and students' experiences with feedback during a six-week clerkship in general practice: a qualitative study.

PubMed

Gran, Sarah Frandsen; Brænd, Anja Maria; Lindbæk, Morten; Frich, Jan C

2016-06-01

Feedback may be scarce and unsystematic during students' clerkship periods. We wanted to explore general practitioners' (GPs) and medical students' experiences with giving and receiving supervision and feedback during a clerkship in general practice, with a focus on their experiences with using a structured tool (StudentPEP) to facilitate feedback and supervision. Qualitative study. Teachers and students from a six-week clerkship in general practice for fifth year medical students were interviewed in two student and two teacher focus groups. 21 GPs and nine medical students. We found that GPs first supported students' development in the familiarization phase by exploring the students' expectations and competency level. When mutual trust had been established through the familiarization phase GPs encouraged students to conduct their own consultations while being available for supervision and feedback. Both students and GPs emphasized that good feedback promoting students' professional development was timely, constructive, supportive, and focused on ways to improve. Among the challenges GPs mentioned were giving feedback on behavioral issues such as body language and insensitive use of electronic devices during consultations or if the student was very insecure, passive, and reluctant to take action or lacked social or language skills. While some GPs experienced StudentPEP as time-consuming and unnecessary, others argued that the tool promoted feedback and learning through mandatory observations and structured questions. Mutual trust builds a learning environment in which supervision and feedback may be given during students' clerkship in general practice. Structured tools may promote feedback, reflection and learning. Key Points Observing the teacher and being supervised are essential components of Medical students' learning during general practice clerkships. Teachers and students build mutual trust in the familiarization phase. Good feedback is based on observations, is timely, encouraging, and instructive. StudentPEP may create an arena for structured feedback and reflection.

Participant Diversity in Special Education Research: Parent-Implemented Behavior Interventions for Children with Autism

ERIC Educational Resources Information Center

Robertson, Rachel E.; Sobeck, Emily E.; Wynkoop, Kaylee; Schwartz, Rachel

2017-01-01

Evidence-based practices for children with disabilities have empirical support for their effectiveness; however, the demographics of participants making up the evidence base are generally unknown, leaving generalizability of the evidence unclear. This study presents a systematic literature review of participant racial and socioeconomic…

16 CFR 1608.2 - Form of separate guaranty.

Code of Federal Regulations, 2010 CFR

2010-01-01

...: Name Address (b) Form for guaranty based on guaranty. Based upon a guaranty received, the undersigned... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Form of separate guaranty. 1608.2 Section... GENERAL RULES AND REGULATIONS UNDER THE FLAMMABLE FABRICS ACT § 1608.2 Form of separate guaranty. The...

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative

PubMed Central

Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

2015-01-01

Quality problem Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Initial assessment Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼30% were estimated to have suboptimal management according to Public Health Observatory analyses. Choice of solution An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. Implementation A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Evaluation Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. Lessons learned An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. PMID:25525148

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative.

PubMed

Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

2015-02-01

Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼ 30% were estimated to have suboptimal management according to Public Health Observatory analyses. An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼ 2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Themes and methods of research presented at European General Practice Research Network conferences.

PubMed

Kruschinski, Carsten; Lange, Maaike; Lionis, Christos; van Weel, Chris; Hummers-Pradier, Eva

2010-08-01

The World Organization of Family Doctors (Wonca) defined core characteristics of general practice and general practitioners' competencies. It is unclear to which extent research has addressed these issues so far. To determine themes and research methods of general practice research as reflected by presentations at the European General Practice Research Network (EGPRN) meetings. Descriptive and retrospective study. All abstracts presented at each of the 14 EGPRN conferences between June 2001 and October 2007 were analysed for content and study design/methodology. Categories for content were developed inductively; a predefined hierarchical scheme was used for study designs. A total of N=614 abstracts were classified. The main research topics were related to GP/health service issues (n=232), clinical (n=148) and patient-related themes (n=118). Original data (n=558) were mainly derived from cross-sectional designs (38.7%). Intervention studies (11.0%), longitudinal designs including case-control and cohort studies (13.3%) as well as instrumental research (2.2%) were less common. More than one-fourth of all original studies were qualitative studies (27.6%). Stratified analysis revealed that cross-sectional designs were less frequent in the second half of conferences. Analysis by country showed that, in contrast to different quantitative designs, the proportion of qualitative studies was comparable. To test effectiveness of diagnostic and therapeutic interventions under primary care conditions, a higher proportion of experimental studies would be preferable. This could increase the acceptance of general practitioners' specific approaches and provide clear guidance on approaches and procedures, especially in health care systems not predominantly based on primary care.

Voluntary Guidelines for Methamphetamine Laboratory Cleanup - Document

EPA Pesticide Factsheets

provides technical guidance for state and local personnel responsible for meth lab cleanup, based on an extensive review of the best available science and practices, and addresses general cleanup activities, specific items/materials, sampling.

[Dialogues on risks and health resources in general practice].

PubMed

Hollnagel, Hanne; Malterud, Kirsti

2002-11-04

The healing and preventive forces related to individuals' health resources and self-assessed knowledge have hitherto been underestimated in medicine. In this article, we draw attention to ethical and epistemological challenges in relation to values, communication, knowledge, and autonomy that are embedded in the prevailing risk-oriented epidemiology. We have developed a theoretical model for a patient-centered, salutogenetic approach with the aim of a better balance between health resources and risk factors. We briefly present results of dialogues in the general practice consultation based on key questions about self-assessed health resources. We discuss pitfalls related to causality, group-based probabilities, medicalization, and informed consent, focusing on the clinical encounter with the individual patient. By introducing a salutogenetic perspective, we hope to shift attention towards the patient's resources and strengths. Communication can mediate oppression as well as empowerment.

Training in neurology.

PubMed

Aminoff, Michael J

2008-05-13

The training of clinical neurologists is undergoing profound change. Increasing subspecialization within neurology, the widening separation of clinical neurology from other branches of internal medicine, limitations of exposure to training in internal medicine, mandated restrictions in working hours, and attempts to shorten the training period are likely to have adverse effects on the next generation of clinical neurologists. Despite the need for a broad base in general medicine, discussed here, the exposure of neurology trainees to general medical disorders is diminishing. An emphasis on an algorithmic approach to patient management rather than on educating residents to use their reasoning faculties when applying new techniques and knowledge to clinical practice may adversely affect patient care. Neurologists require broad-based training in neurology, internal medicine, and psychiatry, to ensure excellence in clinical practice. It is time to question again whether they are receiving the training that they need.

A modified Delphi method toward multidisciplinary consensus on functional convalescence recommendations after abdominal surgery.

PubMed

van Vliet, Daphne C R; van der Meij, Eva; Bouwsma, Esther V A; Vonk Noordegraaf, Antonie; van den Heuvel, Baukje; Meijerink, Wilhelmus J H J; van Baal, W Marchien; Huirne, Judith A F; Anema, Johannes R

2016-12-01

Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients' insecurity, needlessly delayed recovery and prolonged sick leave. The aim of this study was to generate consensus-based multidisciplinary convalescence recommendations, including advice on return to work, applicable for both patients and physicians. Using a modified Delphi method among a multidisciplinary panel of 13 experts consisting of surgeons, occupational physicians and general practitioners, detailed recommendations were developed for graded resumption of 34 activities after uncomplicated laparoscopic cholecystectomy, laparoscopic and open appendectomy, laparoscopic and open colectomy and laparoscopic and open inguinal hernia repair. A sample of occupational physicians, general practitioners and surgeons assessed the recommendations on feasibility in daily practice. The response of this group of care providers was discussed with the experts in the final Delphi questionnaire round. Out of initially 56 activities, the expert panel selected 34 relevant activities for which convalescence recommendations were developed. After four Delphi rounds, consensus was reached for all of the 34 activities for all the surgical procedures. A sample of occupational physicians, general practitioners and surgeons regarded the recommendations as feasible in daily practice. Multidisciplinary convalescence recommendations regarding uncomplicated laparoscopic cholecystectomy, appendectomy (laparoscopic, open), colectomy (laparoscopic, open) and inguinal hernia repair (laparoscopic, open) were developed by a modified Delphi procedure. Further research is required to evaluate whether these recommendations are realistic and effective in daily practice.

Development of clinical practice guidelines.

PubMed

Hollon, Steven D; Areán, Patricia A; Craske, Michelle G; Crawford, Kermit A; Kivlahan, Daniel R; Magnavita, Jeffrey J; Ollendick, Thomas H; Sexton, Thomas L; Spring, Bonnie; Bufka, Lynn F; Galper, Daniel I; Kurtzman, Howard

2014-01-01

Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

A conceptual framework for transferring research to practice.

PubMed

Simpson, D Dwayne

2002-06-01

Systematic evaluations of efforts to transfer research-based interventions and procedures into general practice at community drug treatment programs have been limited. However, practical experiences as well as results from studies of technology transfer and organizational behavior in related fields provide a basis for proposing a heuristic model of key factors that influence this process. The successful completion of four stages of activity typically involved in program change (exposure, adoption, implementation, and practice of new interventions) appears to be influenced by several organizational considerations (e.g., institutional readiness for change, resources, and climate) as well as staff attributes. Assessment instruments for measuring organizational functioning (based on ratings aggregated for staff and patients in a program) are introduced, along with preliminary evidence for their validity. A better conceptual understanding of the process of program change and common barriers that may be encountered is needed for effectively transferring research to practice.

Substance and materiality? The archaeology of Talensi medicine shrines and medicinal practices.

PubMed

Insoll, Timothy

2011-08-01

Talensi materia medica is varied, encompassing plant, mineral, and animal substances. Healing, medicines, and medicinal practices and knowledge can be shrine-based and linked with ritual practices. This is explored utilising ethnographic data and from an archaeological perspective with reference to future possibilities for research both on Talensi medicine and, by implication, more generally through considering the archaeology of Talensi medicine preparation, use, storage, spread, and disposal. It is suggested that configuring the archaeology of medicine shrines and practices more broadly in terms of health would increase archaeological visibility and research potential.

Substance and materiality? The archaeology of Talensi medicine shrines and medicinal practices

PubMed Central

Insoll, Timothy

2011-01-01

Talensi materia medica is varied, encompassing plant, mineral, and animal substances. Healing, medicines, and medicinal practices and knowledge can be shrine-based and linked with ritual practices. This is explored utilising ethnographic data and from an archaeological perspective with reference to future possibilities for research both on Talensi medicine and, by implication, more generally through considering the archaeology of Talensi medicine preparation, use, storage, spread, and disposal. It is suggested that configuring the archaeology of medicine shrines and practices more broadly in terms of health would increase archaeological visibility and research potential. PMID:21810036

The relative clinical effectiveness and cost-effectiveness of three contrasting approaches to partner notification for curable sexually transmitted infections: a cluster randomised trial in primary care.

PubMed

Cassell, Jackie A; Dodds, Julie; Estcourt, Claudia; Llewellyn, Carrie; Lanza, Stefania; Richens, John; Smith, Helen; Symonds, Merle; Copas, Andrew; Roberts, Tracy; Walters, Kate; White, Peter; Lowndes, Catherine; Mistry, Hema; Rossello-Roig, Melcior; Smith, Hilary; Rait, Greta

2015-01-01

Partner notification is the process of providing support for, informing and treating sexual partners of individuals who have been diagnosed with sexually transmitted infections (STIs). It is traditionally undertaken by specialist sexual health services, and may involve informing a partner on a patient's behalf, with consent. With an increasing proportion of STIs diagnosed in general practice and other community settings, there is a growing need to understand the best way to provide partner notification for people diagnosed with a STI in this setting using a web-based referral system. We aimed to compare three different approaches to partner notification for people diagnosed with chlamydia within general practice. Cluster randomised controlled trial. General practices in England and, within these, patients tested for and diagnosed with genital chlamydia or other bacterial STIs in that setting using a web-based referral system. Three different approaches to partner notification: patient referral alone, or the additional offer of either provider referral or contract referral. (1) Number of main partners per index patient treated for chlamydia and/or gonorrhoea/non-specific urethritis/pelvic inflammatory disease; and (2) proportion of index patients testing negative for the relevant STI at 3 months. As testing rates for chlamydia were far lower than expected, we were unable to scale up the trial, which was concluded at pilot stage. We are not able to answer the original research question. We present the results of the work undertaken to improve recruitment to similar studies requiring opportunistic recruitment of young people in general practice. We were unable to standardise provider and contract referral separately; however, we also present results of qualitative work aimed at optimising these interventions. External recruitment may be required to facilitate the recruitment of young people to research in general practice, especially in sensitive areas, because of specific barriers experienced by general practice staff. Costs need to be taken into account together with feasibility considerations. Partner notification interventions for bacterial STIs may not be clearly separable into the three categories of patient, provider and contract referral. Future research is needed to operationalise the approaches of provider and contract partner notification if future trials are to provide generalisable information. Current Controlled Trials ISRCTN24160819. This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 5. See the NIHR Journals Library website for further project information.

[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.

Communicating Discovery-Based Research Results to the News: A Real-World Lesson in Science Communication for Undergraduate Students.

PubMed

Garcia, Julie Torruellas

2018-01-01

Communicating science effectively to the general public is a necessary skill that takes practice. Generally, undergraduate science majors are taught to communicate to other scientists but are not given formal training on how to communicate with a nonscientist. An opportunity to appear on a news segment can be used as a real-world lesson on science communication for your students. This article will describe how to contact a producer to get your class on a news segment, ideas for types of research that may be of interest to the media, and how to practice communicating the results effectively.

Native American health: traditional healing and culturally competent health care internet resources.

PubMed

Carlock, Danielle

2006-01-01

Health disparities between Native Americans and the general population of the United States are a major health concern. Traditional healing and culturally competent health care offer much promise in raising the health status of Native Americans. Traditional healing, although uniquely practiced by each indigenous culture, is generally a system of medicine based on the inseparability of mind, body, and spirit. Culturally competent health care, care that is congruent with the culture and language of the patient, is a growing initiative in western medicine. This article outlines Internet sites and online resources relevant to the study and practice of traditional healing and culturally competent health care.

Practice in Computer-Based Testing and Performance on the National Certification Examination for Nurse Anesthetists

ERIC Educational Resources Information Center

Dosch, Michael P.

2010-01-01

The general aim of the present retrospective study was to examine the test mode effect, that is, the difference in performance when tests are taken on computer (CBT), or by paper and pencil (PnP). The specific purpose was to examine the degree to which extensive practice in CBT in graduate students in nurse anesthesia would raise scores on a…

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

Evaluation of a practice-based intervention to improve the management of pediatric asthma.

PubMed

Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

2011-02-01

Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.

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.

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

An International Surgical Rotation as a Systems-Based Elective: The Botswana-University of Pennsylvania Surgical Experience.

PubMed

Cintolo-Gonzalez, Jessica A; Bedada, Alemayehu Ginbo; Morris, Jon; Azzie, Georges

2016-01-01

There is a growing need to address the global burden of surgical disease along with increasing interest in international surgical practice, necessitating an understanding of the challenges and issues that arise on a systems level when practicing abroad. This elective is a month-long rotation in which senior surgical residents participate in patient care as part of a surgical team in the main tertiary and teaching hospital in Gaborone, the capital city of Botswana. Clinical experience is combined with formal readings and educational sessions, with the attending surgeon supervising the program to develop a systems-based curriculum that contextualizes the clinical experience. A formal debriefing and written reflections by the residents at the conclusion of the rotation are used to qualitatively assess resident development and insight into systems-based international surgical practice. Princess Marina Hospital, Gaborone, Botswana. General surgery residents in their fourth clinical year of training. Our elective met important requirements outlined in the literature for foreign practice, including adequate supervision of the American trainees and care to not detract from local trainees' educational experience. Residents' debriefing and written reflections demonstrated an increased understanding of systems-based practice and awareness of issues important to successful international surgical practice and collaboration. Our global surgery elective with a focus on systems-based practice sensitizes residents to the challenges and issues they must be aware of when practicing internationally. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Pharmacologically inappropriate prescriptions for elderly patients in general practice: How common? Baseline data from The Prescription Peer Academic Detailing (Rx-PAD) study.

PubMed

Brekke, Mette; Rognstad, Sture; Straand, Jørund; Furu, Kari; Gjelstad, Svein; Bjørner, Trine; Dalen, Ingvild

2008-01-01

To assess Norwegian general practitioners' (GPs') level of potentially harmful drug prescribing for elderly patients. Prescription data for 12 months were retrospectively retrieved from the Norwegian Prescription Database (NorPD). Data were assessed in relation to 13 prescription quality indicators. General practice. A total of 454 GPs attending continuous medical education (CME) groups in Southern Norway, 85,836 patients >or=70 years who received any prescription from the GPs during the study period. Number of prescriptions assessed in relation to pharmacological inappropriateness based on a list of 13 explicit prescription quality indicators. Some 18.4% of the patients (66% females with mean age 79.8 years, 34% males with mean age 78.7 years) received one or more inappropriate prescriptions from their GP. An NSAID in a potentially harmful combination with another drug (7%) and a long-acting benzodiazepine (4.6%) were the most frequent inappropriate prescriptions made. Doctor characteristics associated with more inappropriate prescribing practice were old age and working single-handed with many elderly patients. The study reveals areas where GPs' prescribing practice for elderly patients can be improved and which can be targeted in educational interventions.

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.

Study Modules for Calculus-Based General Physics. [Includes Modules 24-26: Electric Potential; Ohm's Law; and Capacitors].

ERIC Educational Resources Information Center

Fuller, Robert G., Ed.; And Others

This is part of a series of 42 Calculus Based Physics (CBP) modules totaling about 1,000 pages. The modules include study guides, practice tests, and mastery tests for a full-year individualized course in calculus-based physics based on the Personalized System of Instruction (PSI). The units are not intended to be used without outside materials;…

Medical students' clinical performance in general practice - Triangulating assessments from patients, teachers and students.

PubMed

Braend, Anja Maria; Gran, Sarah Frandsen; Frich, Jan C; Lindbaek, Morten

2010-01-01

Formative assessment of medical students' clinical performance during general practice clerkship is necessary to learn consultation skills. Our aim was to triangulate feedback using patient questionnaires, written self-assessment and teachers' observation-based assessment, and to describe the content of this feedback. We developed StudentPEP, a 15-item version of EUROPEP, a tool for measuring patients' evaluation of quality in general practice. The teacher and student forms consisted of five StudentPEP-items and open-ended questions asking for approval and improvement needed on four aspects. Quantitative scores were analyzed statistically. Free-text comments were analyzed and categorized into 'specific and concrete' versus 'general and unspecific'. One hundred seventy-three students returned data from 2643 consultations. Mean patients' scores for 15 items were 4.3-4.8 on a five-point Likert scale. Mean teacher scores were 4.4 on five items, while students' mean self-assessments were 3.6-3.8. In an analysis of 380 consultations, students were more specific and concrete in their self-evaluation compared with teachers (p < 0.01). Patients scored students' performance high compared with students' self-assessments. Teachers' scores were in accordance with patients' scores. Teachers' written evaluations of students were often general. There is a potential for improving teachers' feedback in terms of more specific and concrete comments.

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.

Postfire management in forested public lands of the western USA

USGS Publications Warehouse

Beschta, R.L.; Rhodes, J.J.; Kauffman, J.B.; Gresswell, Robert E.; Minshall, G.W.; Frissell, C.A.; Perry, D.A.; Hauer, R.

2004-01-01

Forest ecosystems in the western United States evolved over many millennia in response to disturbances such as wildfires. Land use and management practices have altered these ecosystems, however, including fire regimes in some areas. Forest ecosystems are especially vulnerable to postfire management practices because such practices may influence forest dynamics and aquatic systems for decades to centuries. Thus, there is an increasing need to evaluate the effect of postfire treatments from the perspective of ecosystem recovery. We examined, via the published literature and our collective experience, the ecological effects of some common postfire treatments. Based on this examination, promising postfire restoration measures include retention of large trees, rehabilitation of firelines and roads, and, in some cases, planting of native species. The following practices are generally inconsistent with efforts to restore ecosystem functions after fire: seeding exotic species, livestock grazing, placement of physical structures in and near stream channels, ground-based postfire logging, removal of large trees, and road construction. Practices that adversely affect soil integrity, persistence or recovery of native species, riparian functions, or water quality generally impede ecological recovery after fire. Although research provides a basis for evaluating the efficacy of postfire treatments, there is a continuing need to increase our understanding of the effects of such treatments within the context of societal and ecological goals for forested public lands of the western United States.

On Displacement Height, from Classical to Practical Formulation: Stress, Turbulent Transport and Vorticity Considerations

NASA Astrophysics Data System (ADS)

Sogachev, Andrey; Kelly, Mark

2016-03-01

Displacement height ( d) is an important parameter in the simple modelling of wind speed and vertical fluxes above vegetative canopies, such as forests. Here we show that, aside from implicit definition through a (displaced) logarithmic profile, accepted formulations for d do not consistently predict flow properties above a forest. Turbulent transport can affect the displacement height, and is an integral part of what is called the roughness sublayer. We develop a more general approach for estimation of d, through production of turbulent kinetic energy and turbulent transport, and show how previous stress-based formulations for displacement height can be seen as simplified cases of a more general definition including turbulent transport. Further, we also give a simplified and practical form for d that is in agreement with the general approach, exploiting the concept of vortex thickness scale from mixing-layer theory. We assess the new and previous displacement height formulations by using flow statistics derived from the atmospheric boundary-layer Reynolds-averaged Navier-Stokes model SCADIS as well as from wind-tunnel observations, for different vegetation types and flow regimes in neutral conditions. The new formulations tend to produce smaller d than stress-based forms, falling closer to the classic logarithmically-defined displacement height. The new, more generally defined, displacement height appears to be more compatible with profiles of components of the turbulent kinetic energy budget, accounting for the combined effects of turbulent transport and shear production. The Coriolis force also plays a role, introducing wind-speed dependence into the behaviour of the roughness sublayer; this affects the turbulent transport, shear production, stress, and wind speed, as well as the displacement height, depending on the character of the forest. We further show how our practical (`mixing-layer') form for d matches the new turbulence-based relation, as well as correspondence to previous (stress-based) formulations.

Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial

PubMed Central

van der Wouden, Johannes C; Bosmans, Judith E; Smalbrugge, Martin; van Diest, Willianne; Essery, Rosie; Yardley, Lucy; van der Horst, Henriëtte E; Maarsingh, Otto R

2017-01-01

Introduction Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages. Methods and analysis A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners. Ethics and dissemination The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations. Trial registration number Pre-results, NTR5712. PMID:28110290

Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records.

PubMed

Williams, Peter Huw; de Lusignan, Simon

2006-01-01

The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems. To investigate whether a high stroke quality score is associated with adherence to RCP guidelines. Examination of computer and written medical records of all patients with a diagnosis of stroke. Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age-sex profile and prevalence of stroke. One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%. Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice.

Does integrating research into the prosthetics and orthotics undergraduate curriculum enhance students' clinical practice? An interview study on students' perception.

PubMed

Al Qaroot, Bashar S; Sobuh, Mohammad

2016-06-01

Problem-based learning (where rather than feeding students the knowledge, they look for it themselves) has long been thought of as an ideal approach in teaching because it would encourage students to acquire knowledge from an undetermined medium of wrong and right answers. However, the effect of such approach in the learning experience of prosthetics and orthotics students has never been investigated. This study explores the implications of integrating problem-based learning into teaching on the students' learning experience via implementing a research-informed clinical practice module into the curriculum of last year prosthetics and orthotics undergraduate students at the University of Jordan (Amman, Jordan). Qualitative research pilot study. Grounded theory approach was used based on the data collected from interviewing a focus group of four students. Students have identified a number of arguments from their experience in the research-informed clinical practice where, generally speaking, students described research-informed clinical practice as a very good method of education. Integrating problem-based learning into teaching has many positive implications. In particular, students pointed out that their learning experience and clinical practice have much improved after the research-informed clinical practice. Findings from this investigation demonstrate that embedding problem-based learning into prosthetics and orthotics students' curriculum has the potential to enhance students' learning experience, particularly students' evidence-based practice. This may lead to graduates who are more knowledgeable and thus who can offer the optimal patient care (i.e. clinical practice). © The International Society for Prosthetics and Orthotics 2014.

Physicians’ Perceptions of Autonomy across Practice Types: Is Autonomy in Solo Practice a Myth?

PubMed Central

Lin, Katherine Y.

2013-01-01

Physicians in the United States are now less likely to practice in smaller, more traditional, solo practices, and more likely to practice in larger group practices. Though older theory predicts conflict between bureaucracy and professional autonomy, studies have shown that professions in general, and physicians in particular, have adapted to organizational constraints. However, much work remains in clarifying the nature of this relationship and how exactly physicians have adapted to various organizational settings. To this end, the present study examines physicians’ autonomy experiences in different decision types between organization sizes. Specifically, I ask: In what kinds of decisions do doctors perceive autonomous control? How does this vary by organizational size? Using stacked “spell” data constructed from the Community Tracking Study (CTS) Physician Survey (1996–2005) (n=16,519) I examine how physicians’ perceptions of autonomy vary between solo/two physician practices, small group practices with three to ten physicians, and large practices with ten or more physicians, in two kinds of decisions: logistic-based and knowledge-based decisions. Capitalizing on the longitudinal nature of the data I estimate how changes in practice size are associated with perceptions of autonomy, accounting for previous reports of autonomy. I also test whether managed care involvement, practice ownership, and salaried employment help explain part of this relationship. I find that while physicians practicing in larger group practices reported lower levels of autonomy in logistic-based decisions, physicians in solo/two physician practices reported lower levels of autonomy in knowledge-based decisions. Managed care involvement and ownership explain some, but not all, of the associations. These findings suggest that professional adaptation to various organizational settings can lead to varying levels of perceived autonomy across different kinds of decisions. PMID:24444835

Physicians' perceptions of autonomy across practice types: Is autonomy in solo practice a myth?

PubMed

Lin, Katherine Y

2014-01-01

Physicians in the United States are now less likely to practice in smaller, more traditional, solo practices, and more likely to practice in larger group practices. Though older theory predicts conflict between bureaucracy and professional autonomy, studies have shown that professions in general, and physicians in particular, have adapted to organizational constraints. However, much work remains in clarifying the nature of this relationship and how exactly physicians have adapted to various organizational settings. To this end, the present study examines physicians' autonomy experiences in different decision types between organization sizes. Specifically, I ask: In what kinds of decisions do doctors perceive autonomous control? How does this vary by organizational size? Using stacked "spell" data constructed from the Community Tracking Study (CTS) Physician Survey (1996-2005) (n = 16,519) I examine how physicians' perceptions of autonomy vary between solo/two physician practices, small group practices with three to ten physicians, and large practices with ten or more physicians, in two kinds of decisions: logistic-based and knowledge-based decisions. Capitalizing on the longitudinal nature of the data I estimate how changes in practice size are associated with perceptions of autonomy, accounting for previous reports of autonomy. I also test whether managed care involvement, practice ownership, and salaried employment help explain part of this relationship. I find that while physicians practicing in larger group practices reported lower levels of autonomy in logistic-based decisions, physicians in solo/two physician practices reported lower levels of autonomy in knowledge-based decisions. Managed care involvement and ownership explain some, but not all, of the associations. These findings suggest that professional adaptation to various organizational settings can lead to varying levels of perceived autonomy across different kinds of decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Recruiting primary care practices for practice-based research: a case study of a group-randomized study (TRANSLATE CKD) recruitment process.

PubMed

Loskutova, Natalia Y; Smail, Craig; Ajayi, Kemi; Pace, Wilson D; Fox, Chester H

2018-01-16

We assessed the challenging process of recruiting primary care practices in a practice-based research study. In this descriptive case study of recruitment data collected for a large practice-based study (TRANSLATE CKD), 48 single or multiple-site health care organizations in the USA with a total of 114 practices were invited to participate. We collected quantitative and qualitative measures of recruitment process and outcomes for the first 25 practices recruited. Information about 13 additional practices is not provided due to staff transitions and limited data collection resources. Initial outreach was made to 114 practices (from 48 organizations, 41% small); 52 (45%) practices responded with interest. Practices enrolled in the study (n = 25) represented 22% of the total outreach number, or 48% of those initially interested. Average time to enroll was 71 calendar days (range 11-107). There was no difference in the number of days practices remained under recruitment, based on enrolled versus not enrolled (44.8 ± 30.4 versus 46.8 ± 25.4 days, P = 0.86) or by the organization size, i.e. large versus small (defined by having ≤4 distinct practices; 52 ± 23.6 versus 43.6 ± 27.8 days; P = 0.46). The most common recruitment barriers were administrative, e.g. lack of perceived direct organizational benefit, and were more prominent among large organizations. Despite the general belief that the research topic, invitation method, and interest in research may facilitate practice recruitment, our results suggest that most of the recruitment challenges represent managerial challenges. Future research projects may need to consider relevant methodologies from businesses administration and marketing fields. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Multi-layered reasoning by means of conceptual fuzzy sets

NASA Technical Reports Server (NTRS)

Takagi, Tomohiro; Imura, Atsushi; Ushida, Hirohide; Yamaguchi, Toru

1993-01-01

The real world consists of a very large number of instances of events and continuous numeric values. On the other hand, people represent and process their knowledge in terms of abstracted concepts derived from generalization of these instances and numeric values. Logic based paradigms for knowledge representation use symbolic processing both for concept representation and inference. Their underlying assumption is that a concept can be defined precisely. However, as this assumption hardly holds for natural concepts, it follows that symbolic processing cannot deal with such concepts. Thus symbolic processing has essential problems from a practical point of view of applications in the real world. In contrast, fuzzy set theory can be viewed as a stronger and more practical notation than formal, logic based theories because it supports both symbolic processing and numeric processing, connecting the logic based world and the real world. In this paper, we propose multi-layered reasoning by using conceptual fuzzy sets (CFS). The general characteristics of CFS are discussed along with upper layer supervision and context dependent processing.

Elder abuse: The role of general practitioners in community-based screening and multidisciplinary action

PubMed

Ries, Nola M; Mansfield, Elise

2018-04-01

There are growing calls for elder abuse screening to be conducted by a range of community-based service providers, including general practitioners (GPs), practice nurses, home care workers and lawyers. Improved screening may be a valuable first step towards improving elder abuse detection and response; however, practitioners need evidence-based strategies for screening and follow-up. This article summarises several brief screening tools for various forms of elder abuse. Screening tool properties and evidence gaps are noted. As elder abuse often requires multidisciplinary responses, initiatives to connect health, legal and other service providers are highlighted. GPs are trusted professionals who are well placed to identify older patients at risk of, or experiencing, various forms of abuse. They should be aware of available screening tools and consider how best to incorporate them into their own practice. They also play an important role in multidisciplinary action to address elder abuse.

Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice.

PubMed

Carey, William A; Colby, Christopher E

2013-02-01

In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows. This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit. These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively. Given the clinical and educational structures common to most intensive care unit-based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

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.

A visual study of computers on doctors' desks.

PubMed

Pearce, Christopher; Walker, Hannah; O'Shea, Carolyn

2008-01-01

General practice has rapidly computerised over the past ten years, thereby changing the nature of general practice rooms. Most general practice consulting rooms were designed and created in an era without computer hardware, establishing a pattern of work around maximising the doctor-patient relationship. General practitioners (GPs) and patients have had to integrate the computer into this environment. Twenty GPs allowed access to their rooms and consultations as part of a larger study. The results are based on an analysis of still shots of the consulting rooms. Analysis used dramaturgical methodology; thus the room is described as though it is the setting for a play. First, several desk areas were identified: a shared or patient area, a working area, a clinical area and an administrative area. Then, within that framework, we were able to identify two broad categories of setting, one inclusive of the patient and one exclusive. With the increasing significance of the computer in the three-way doctor-patient-computer relationship, an understanding of the social milieu in which the three players in the consultation interact (the staging) will inform further analysis of the interaction, and allow a framework for assessing the effects of different computer placements.

Continuing medical education for general practitioners: a practice format

PubMed Central

VanNieuwenborg, Lena; Goossens, Martine; De Lepeleire, Jan; Schoenmakers, Birgitte

2016-01-01

Introduction Our current knowledge-based society and the many actualisations within the medical profession require a great responsibility of physicians to continuously develop and refine their skills. In this article, we reflect on some recent findings in the field of continuing education for professional doctors (continuing medical education, CME). Second, we describe the development of a CME from the Academic Center for General Practice (ACHG) of the KU Leuven. Methods First, we performed a literature study and we used unpublished data of a need assessment performed (2013) in a selected group of general practitioners. Second, we describe the development of a proposal to establish a CME programme for general practitioners. Results CME should go beyond the sheer acquisition of knowledge, and also seek changes in practice, attitudes and behaviours of physicians. The continuing education offerings are subject to the goals of the organising institution, but even more to the needs and desires of the end user. Conclusions Integrated education is crucial to meet the conditions for efficient and effective continuing education. The ACHG KU Leuven decided to offer a postgraduate programme consisting of a combination of teaching methods: online courses (self-study), contact courses (traditional method) and a materials database. PMID:26850504

Diabetic Retinopathy Screening and Monitoring of Early Stage Disease in Australian General Practice: Tackling Preventable Blindness within a Chronic Care Model.

PubMed

Crossland, Lisa; Askew, Deborah; Ware, Robert; Cranstoun, Peter; Mitchell, Paul; Bryett, Andrew; Jackson, Claire

2016-01-01

Diabetic retinopathy (DR) is the leading cause of preventable blindness in Australia. Up to 50% of people with proliferative DR who do not receive timely treatment will become legally blind within five years. Innovative and accessible screening, involving a variety of primary care providers, will become increasingly important if patients with diabetes are to receive optimal eye care. An open controlled trial design was used. Five intervention practices in urban, regional, and rural Australia partnered with ophthalmologists via telehealth undertook DR screening and monitoring of type 2 diabetes patients and were compared with control practices undertaking usual care 2011-2014. Recorded screening rates were 100% across intervention practices, compared with 22-53% in control practices. 31/577 (5%) of patients in the control practices were diagnosed with mild-moderate DR, of whom 9 (29%) had appropriate follow-up recorded. This was compared with 39/447 (9%) of patients in the intervention group, of whom 37 (95%) had appropriate follow-up recorded. General practice-based DR screening via Annual Cycle of Care arrangements is effective across differing practice locations. It offers improved recording of screening outcomes for Australians with type 2 diabetes and better follow-up of those with screen abnormalities.

Speech-Language Pathologists' Knowledge of Genetics: Perceived Confidence, Attitudes, Knowledge Acquisition and Practice-Based Variables

ERIC Educational Resources Information Center

Tramontana, G. Michael; Blood, Ingrid M.; Blood, Gordon W.

2013-01-01

The purpose of this study was to determine (a) the general knowledge bases demonstrated by school-based speech-language pathologists (SLPs) in the area of genetics, (b) the confidence levels of SLPs in providing services to children and their families with genetic disorders/syndromes, (c) the attitudes of SLPs regarding genetics and communication…

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

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

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

Developing patient reference groups within general practice: a mixed-methods study.

PubMed

Smiddy, Jane; Reay, Joanne; Peckham, Stephen; Williams, Lorraine; Wilson, Patricia

2015-03-01

Clinical commissioning groups (CCGs) are required to demonstrate meaningful patient and public engagement and involvement (PPEI). Recent health service reforms have included financial incentives for general practices to develop patient reference groups (PRGs). To explore the impact of the patient participation direct enhanced service (DES) on development of PRGs, the influence of PRGs on decision making within general practice, and their interface with CCGs. A mixed-methods approach within three case study sites in England. Three case study sites were tracked for 18 months as part of an evaluation of PPEI in commissioning. A sub-study focused on PRGs utilising documentary and web-based analysis; results were mapped against findings of the main study. Evidence highlighted variations in the establishment of PRGs, with the number of active PRGs via practice websites ranging from 27% to 93%. Such groups were given a number of descriptions such as patient reference groups, patient participation groups, and patient forums. Data analysis highlighted that the mode of operation varied between virtual and tangible groups and whether they were GP- or patient-led, such analysis enabled the construction of a typology of PRGs. Evidence reviewed suggested that groups functioned within parameters of the DES with activities limited to practice level. Data analysis highlighted a lack of strategic vision in relation to such groups, particularly their role within an overall patient and PPEI framework). Findings identified diversity in the operationalisation of PRGs. Their development does not appear linked to a strategic vision or overall PPEI framework. Although local pragmatic issues are important to patients, GPs must ensure that PRGs develop strategic direction if health reforms are to be addressed. © British Journal of General Practice 2015.

Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands.

PubMed

Ironmonger, Dean; Edeghere, Obaghe; Gossain, Savita; Hawkey, Peter M

2016-05-24

There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England. Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community. The response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination. Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.

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

Dental therapists in general dental practices: an economic evaluation.

PubMed

Beazoglou, Tryfon J; Lazar, Vickie F; Guay, Albert H; Heffley, Dennis R; Bailit, Howard L

2012-08-01

Dental access disparities are well documented and have been recognized as a national problem. Their major cause is the lack of reasonable Medicaid reimbursement rates for the underserved. Specifically, Medicaid reimbursement rates for children average 40 percent below market rates. In addition, most state Medicaid programs do not cover adults. To address these issues, advocates of better oral health for the underserved are considering support for a new allied provider--a dental therapist--capable of providing services at a lower cost per service and in low-income and rural areas. Using a standard economic analysis, this study estimated the potential cost, price, utilization, and dentist's income effects of dental therapists employed in general dental practices. The analysis is based on national general dental practice data and the broadest scope of responsibility for dental therapists that their advocates have advanced, including the ability to provide restorations and extractions to adults and children, training for three years, and minimum supervision. Assuming dental therapists provide restorative, extraction, and pulpal services to patients of all ages and dental hygienists continue to deliver all hygiene services, the mean reduction in a general practice costs ranges between 1.57 and 2.36 percent. For dental therapists treating children only, the range is 0.31 to 0.47 percent. The effects on price and utilization are even smaller. In addition, the effects on most dentists' gross income, hours of work, and net income are negative. The estimated economic impact of dental therapists in the United States on private dental practice is very limited; therefore, the demand for dental therapists by private practices also would probably be very limited.

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

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

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

2009-05-01

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. RESEARCH SUBJECT GROUP: "At-risk" patients registered with computerised general practices in two geographical regions in England. Parallel group pragmatic cluster randomised trial. 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. 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. 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. 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. 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.

Synthesis and Characterization of Metal Complexes with Schiff Base Ligands

ERIC Educational Resources Information Center

Wilkinson, Shane M.; Sheedy, Timothy M.; New, Elizabeth J.

2016-01-01

In order for undergraduate laboratory experiments to reflect modern research practice, it is essential that they include a range of elements, and that synthetic tasks are accompanied by characterization and analysis. This intermediate general chemistry laboratory exercise runs over 2 weeks, and involves the preparation of a Schiff base ligand and…

Content Based Image Retrieval and Information Theory: A General Approach.

ERIC Educational Resources Information Center

Zachary, John; Iyengar, S. S.; Barhen, Jacob

2001-01-01

Proposes an alternative real valued representation of color based on the information theoretic concept of entropy. A theoretical presentation of image entropy is accompanied by a practical description of the merits and limitations of image entropy compared to color histograms. Results suggest that image entropy is a promising approach to image…

Experiential, Team-Based Learning in a Baccalaureate Social Work Research Course

ERIC Educational Resources Information Center

Venema, Rachel; Meerman, Judi Ravenhorst; Hossink, Kristin

2015-01-01

This article describes student responses to a BSW research course framed by experiential learning theory to engage the community and offer applied research practice. The study finds that students generally express overall satisfaction with the research course and describe perceptions of learning gains when involved in a team-based research project…

A Simple Inquiry-Based Lab for Teaching Osmosis

ERIC Educational Resources Information Center

Taylor, John R.

2014-01-01

This simple inquiry-based lab was designed to teach the principle of osmosis while also providing an experience for students to use the skills and practices commonly found in science. Students first design their own experiment using very basic equipment and supplies, which generally results in mixed, but mostly poor, outcomes. Classroom "talk…

The Impact of Response to Intervention on Learning Disability Identification: School Based Practices

ERIC Educational Resources Information Center

Smith, Tina B.

2017-01-01

The "Response to Intervention Guidance for New York State School Districts" (2010) document indicates Response to Intervention (RTI) is a mandated general education process intended to provide early interventions to struggling at-risk students. The multi-level RTI framework is structured to include targeted evidence-based interventions…

Guidance for Schools Selecting Antibullying Approaches: Translating Evidence-Based Strategies to Contemporary Implementation Realities

ERIC Educational Resources Information Center

Ansary, Nadia S.; Elias, Maurice J.; Greene, Michael B.; Green, Stuart

2015-01-01

This article synthesizes the current research on bullying prevention and intervention in order to provide guidance to schools seeking to select and implement antibullying strategies. Evidence-based best practices that are shared across generally effective antibullying approaches are elucidated, and these strategies are grounded in examples…

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

Sound therapy for tinnitus management: practicable options.

PubMed

Hoare, Derek J; Searchfield, Grant D; El Refaie, Amr; Henry, James A

2014-01-01

The authors reviewed practicable options of sound therapy for tinnitus, the evidence base for each option, and the implications of each option for the patient and for clinical practice. To provide a general guide to selecting sound therapy options in clinical practice. Practicable sound therapy options. Where available, peer-reviewed empirical studies, conference proceedings, and review studies were examined. Material relevant to the purpose was summarized in a narrative. The number of peer-reviewed publications pertaining to each sound therapy option reviewed varied significantly (from none to over 10). Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients. Clinicians need to be guided by the patient's point of care, patient motivation and expectations of sound therapy, and the acceptability of the intervention both in terms of the sound stimuli they are to use and whether they are willing to use sound extensively or intermittently. Clinicians should also clarify to patients the role sound therapy is expected to play in the management plan. American Academy of Audiology.

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.

Treatment of infants with epilepsy: Common practices around the world.

PubMed

Wilmshurst, Jo M; Burman, Richard; Gaillard, William D; Cross, J Helen

2015-07-01

High quality data to guide recommendations for infants with epilepsy are lacking. This study aimed to develop an understanding of common practice and regional variations in the treatment interventions of infants with epilepsy, and also to identify areas for further study and to highlight where common practice occurs without sound evidence. A survey addressed clinical treatment practice for infants with epilepsy. Alternative interventions were included. The survey found that most regions had similar practice for first-line interventions, except for North America, where more levetiracetam was prescribed. There was a preference for valproate as first-line therapy for generalized seizures, myoclonic seizures, and Dravet syndrome; only Oceania differed for generalized and myoclonic seizures. Phenobarbital was used for generalized and focal seizures in resource-poor and resource-equipped regions. Carbamazepine and oxcarbazepine were the preferred agents for focal seizures from all regions except North America, which uses more levetiracetam. For second- and third-line interventions, the range of choices was diverse, often with little correlation across regions. The ketogenic diet, vagus nerve stimulation, and epilepsy surgery were considered viable choices in most settings, but usually only once seizures were considered medically refractory. The survey highlighted the marked discrepancy in Africa, the one region that consistently confirmed a lack of access to these alternative interventions and to the newer antiepileptic drugs. More randomized controlled trials in infants with seizures are needed to permit useful recommendations. The survey identified widespread use of levetiracetam in North America, which may be the result of effective marketing or based on good clinical practice. The widespread use of valproate may have safety implications. The lack of access to care in the African region highlighted the need for more sustained resources. Although the survey was not evidence based, the findings could be useful to support additional well-designed studies. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Rationalising prescribing: Evidence, marketing and practice-relevant knowledge.

PubMed

Wadmann, Sarah; Bang, Lia E

2015-06-01

Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interact with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable patients to use medication. Therefore, GPs do much more to obtain knowledge about medications than seek advice on 'rational pharmacotherapy'. For instance, GPs also seek opportunities to acquaint themselves with the material objects of medication and medical devices. We conceptualise the knowledge needs of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line-Associated Bloodstream Infections in a Pediatric Oncology Unit [Formula: see text].

PubMed

Linder, Lauri A; Gerdy, Cheryl; Abouzelof, Rouett; Wilson, Andrew

Children with cancer are a subset of patients with central lines with distinct risk factors for infection including periods of prolonged neutropenia and compromised mucous membrane integrity. This article relates the implementation of principles of practice-based evidence to identify interventions in addition to best practice maintenance care bundles to reduce central line-associated bloodstream infections involving viridans group streptococci and coagulase-negative staphylococci on an inpatient pediatric oncology unit. Review of individual events combined with review of current clinical practice guided the development of structured protocols emphasizing routine oral care and general supportive cares. Key principles of the protocols emphasized a 1-2-3 mnemonic and included daily bathing, twice daily oral care, and out-of-bed activity 3 times daily. Poisson regression identified a significant main effect for time period for central line-associated bloodstream infection rates involving both viridans group streptococci and coagulase-negative staphylococci. Significant differences were present between the preintervention baseline and implementation of the supportive care protocols. Project outcomes demonstrate the added value of using principles of practice-based evidence to guide the development of interventions to improve clinical care when evidence-based sources are limited.

Applying TOGAF for e-government implementation based on service oriented architecture methodology towards good government governance

NASA Astrophysics Data System (ADS)

Hodijah, A.; Sundari, S.; Nugraha, A. C.

2018-05-01

As a Local Government Agencies who perform public services, General Government Office already has utilized Reporting Information System of Local Government Implementation (E-LPPD). However, E-LPPD has upgrade limitation for the integration processes that cannot accommodate General Government Offices’ needs in order to achieve Good Government Governance (GGG), while success stories of the ultimate goal of e-government implementation requires good governance practices. Currently, citizen demand public services as private sector do, which needs service innovation by utilizing the legacy system as a service based e-government implementation, while Service Oriented Architecture (SOA) to redefine a business processes as a set of IT enabled services and Enterprise Architecture from the Open Group Architecture Framework (TOGAF) as a comprehensive approach in redefining business processes as service innovation towards GGG. This paper takes a case study on Performance Evaluation of Local Government Implementation (EKPPD) system on General Government Office. The results show that TOGAF will guide the development of integrated business processes of EKPPD system that fits good governance practices to attain GGG with SOA methodology as technical approach.

Post-marketing studies: the work of the Drug Safety Research Unit.

PubMed

Mackay, F J

1998-11-01

The Drug Safety Research Unit (DSRU) is the centre for prescription-event monitoring (PEM) in England. PEM studies are noninterventional observational cohort studies which monitor the safety of newly marketed drugs. The need for post-marketing surveillance is well recognised in the UK and general practice is an ideal source of data. PEM studies are general practitioner (community)-based and exposure is based on dispensed prescription data in England. To date, 65 PEM studies have been completed with a mean cohort size of 10 979 patients and the DSRU database has clinical information on over 700000 patients prescribed new drugs. Unlike spontaneous reporting schemes, PEM produces incidence rates for events reported during treatment. Comparative studies can be conducted for drugs in the same class. The DSRU aggregates outcome data for pregnancies exposed to new drugs. Data for children and the elderly can also be specifically examined. PEM data have a number of advantages over data from computerised general practice databases in the UK. PEM is the only technique within the UK capable of monitoring newly marketed drugs in such a comprehensive and systematic way.

A Standard of Knowledge for the Professional Practice of Toxicology.

PubMed

Hulla, Janis E; Kinter, Lewis B; Kelman, Bruce

2015-08-01

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. We report herein a current Standard of Knowledge in general toxicology compiled from the experience and opinions of 889 certified practicing professional toxicologists. 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. This work was conducted toward ensuring the scientific integrity of the products produced by professional toxicologists.

The Impact of Staff Initiated Referral and Intervention Protocols on Symptoms of Depression in People with Mild Intellectual Disability

ERIC Educational Resources Information Center

McGillivray, Jane A.; Kershaw, Mavis M.

2013-01-01

It has been estimated that people with ID experience the same and possibly higher levels of depression than the general population. Referral to a General Medical Practitioner (GP) for primary care is recommended practice for people with depression and cognitive behavioural (CB) therapy is now an accepted evidence based intervention. A growing body…

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

Internet Mindfulness Meditation Intervention for the General Public: Pilot Randomized Controlled Trial

PubMed Central

2016-01-01

Background Mindfulness meditation interventions improve a variety of health conditions and quality of life, are inexpensive, easy to implement, have minimal if any side effects, and engage patients to take an active role in their treatment. However, the group format can be an obstacle for many to take structured meditation programs. Internet Mindfulness Meditation Intervention (IMMI) is a program that could make mindfulness meditation accessible to all people who want and need to receive it. However, the feasibility, acceptability, and ability of IMMI to increase meditation practice have yet to be evaluated. Objectives The primary objectives of this pilot randomized controlled study were to (1) evaluate the feasibility and acceptability of IMMIs in the general population and (2) to evaluate IMMI’s ability to change meditation practice behavior. The secondary objective was to collect preliminary data on health outcomes. Methods Potential participants were recruited from online and offline sources. In a randomized controlled trial, participants were allocated to IMMI or Access to Guided Meditation arm. IMMI included a 1-hour Web-based training session weekly for 6 weeks along with daily home practice guided meditations between sessions. The Access to Guided Meditation arm included a handout on mindfulness meditation and access to the same guided meditation practices that the IMMI participants received, but not the 1-hour Web-based training sessions. The study activities occurred through the participants’ own computer and Internet connection and with research-assistant telephone and email contact. Feasibility and acceptability were measured with enrollment and completion rates and participant satisfaction. The ability of IMMI to modify behavior and increase meditation practice was measured by objective adherence of daily meditation practice via Web-based forms. Self-report questionnaires of quality of life, self-efficacy, depression symptoms, sleep disturbance, perceived stress, and mindfulness were completed before and after the intervention period via Web-based surveys. Results We enrolled 44 adults were enrolled and 31 adults completed all study activities. There were no group differences on demographics or important variables at baseline. Participants rated the IMMI arm higher than the Access to Guided Meditation arm on Client Satisfaction Questionnaire. IMMI was able to increase home practice behavior significantly compared to the Access to Guided Meditation arm: days practiced (P=.05), total minutes (P=.01), and average minutes (P=.05). As expected, there were no significant differences on health outcomes. Conclusions In conclusion, IMMI was found to be feasible and acceptable. The IMMI arm had increased daily meditation practice compared with the Access to Guided Meditation control group. More interaction through staff and/or through built-in email or text reminders may increase daily practice even more. Future studies will examine IMMI’s efficacy at improving health outcomes in the general population and also compare it directly to the well-studied mindfulness-based group interventions to evaluate relative efficacy. Trial Registration Clinicaltrials.gov NCT02655835; http://clinicaltrials.gov/ct2/show/NCT02655835 (Archived by WebCite at http://www.webcitation/ 6jUDuQsG2) PMID:27502759

The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

PubMed Central

O'Brien, Rosaleen; Fitzpatrick, Bridie; Higgins, Maria; Guthrie, Bruce; Watt, Graham; Wyke, Sally

2016-01-01

Objectives To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. Methods Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. Results Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. Discussion We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial. PMID:27068113

Comparison of cigarette smoking knowledge, attitudes, and practices among staff in perinatal and other substance abuse treatment settings.

PubMed

Miller-Thomas, Tonya; Leoutsakos, Jeannie-Marie S; Terplan, Mishka; Brigham, Emily P; Chisolm, Margaret S

2014-01-01

Despite the high prevalence and known morbidity and mortality caused by cigarette smoking, 60% to 70% of substance abuse treatment programs lack smoking cessation counseling or fail to offer pharmacotherapy for smoking cessation, including those programs designed to meet the needs of drug-dependent pregnant patients. Previous studies of staff knowledge, attitudes, and practices (S-KAP) at general substance abuse/HIV treatment programs have suggested that staff may contribute to the deficiency in smoking cessation treatment in these settings. It is not known whether similar deficiencies exist at perinatal substance abuse treatment programs. This study compared cigarette S-KAP in perinatal substance abuse (n = 41) and general substance abuse/HIV treatment (Veterans Affairs [VA] medical center, hospital-, and community-based) workforce samples (n = 335). Significant differences were seen between the 2 groups on all measures, but perinatal staff compared favorably to general staff only on measures of barriers to smoking cessation services. Perinatal staff compared unfavorably on all other measures: knowledge, beliefs/attitudes, self-efficacy, and smoking cessation practices. Pair-wise comparisons of knowledge and beliefs/attitudes revealed a significant difference between perinatal and VA staff; of self-efficacy, between perinatal and staff at all other settings; and of smoking cessation practices, between perinatal and VA and community-based staff. These results-showing deficiencies of perinatal staff on most S-KAP measures-are concerning and suggest that identifying gaps in and improving S-KAP in perinatal substance abuse programs is urgently needed, for which the VA may provide an efficacious model.

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.

Preoperative Site Marking: Are We Adhering to Good Surgical Practice?

PubMed

Bathla, Sonia; Chadwick, Michael; Nevins, Edward J; Seward, Joanna

2017-06-29

Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom. This included all surgical trainees in Mersey (47 registrars, 56 core trainees), 15 consultants, and 2 surgical care practitioners. This sought to ascertain their routine practice and how they would choose to mark for 12 index procedures in general surgery, if mandated to do so. A total of 72 responses (60%) were obtained to the SurveyMonkey questionnaire. Only 26 (36.1%) said that they routinely marked all of their patients preoperatively. The operating surgeon marked the patient in 69% of responses, with the remainder delegating this task. Markings were visible after draping in only 55.6% of marked cases. Based on our findings, surgeons may not be adhering to "Good Surgical Practice"; practice is widely variable and surgeons are largely opposed and resistant to marking patients unless laterality is involved. We suggest that all surgeons need to be actively engaged in the design of local marking protocols to gain support, change practice, and reduce errors.

Delegation to nurses in general practice

PubMed Central

Bowling, Ann

1981-01-01

A random sample of general practitioners and their nursing staff was interviewed to examine the extent to which the doctors delegated medical tasks to the nurses and to analyse attitudes towards delegation. A significant minority of both doctors and nurses were reluctant to have minor clinical tasks delegated and a majority did not think that nurses should carry out delegated diagnostic procedures. Doctors and nurses who had completed their training since 1960 were more likely to favour delegation than those who had completed their training before 1960. This suggests that delegation may become more common. However, the finding that there is considerable opposition to delegation and that this opposition is often based on feelings of professional threat suggests that many doctors may not be ready to experiment with ways of expanding the nurse's role in general practice. PMID:7328527

Study Modules for Calculus-Based General Physics. [Includes Modules 11-14: Collisions; Equilibrium of Rigid Bodies; Rotational Dynamics; and Fluid Mechanics].

ERIC Educational Resources Information Center

Fuller, Robert G., Ed.; And Others

This is part of a series of 42 Calculus Based Physics (CBP) modules totaling about 1,000 pages. The modules include study guides, practice tests, and mastery tests for a full-year individualized course in calculus-based physics based on the Personalized System of Instruction (PSI). The units are not intended to be used without outside materials;…

Study Modules for Calculus-Based General Physics. [Includes Modules 8-10: Conservation of Energy; Impulse and Momentum; and Rotational Motion].

ERIC Educational Resources Information Center

Fuller, Robert G., Ed.; And Others

This is part of a series of 42 Calculus Based Physics (CBP) modules totaling about 1,000 pages. The modules include study guides, practice tests, and mastery tests for a full-year individualized course in calculus-based physics based on the Personalized System of Instruction (PSI). The units are not intended to be used without outside materials;…

Study Modules for Calculus-Based General Physics. [Includes Modules 3-5: Planar Motion; Newton's Laws; and Vector Multiplication].

ERIC Educational Resources Information Center

Fuller, Robert G., Ed.; And Others

This is part of a series of 42 Calculus Based Physics (CBP) modules totaling about 1,000 pages. The modules include study guides, practice tests, and mastery tests for a full-year individualized course in calculus-based physics based on the Personalized System of Instruction (PSI). The units are not intended to be used without outside materials;…

Reported Knowledge and Management of Acute Low Back Pain by United States Army Nurse Practitioners as Compared to Clinical Practice Guidelines Published by the Agency for Health Care Policy and Research

DTIC Science & Technology

1999-05-01

evidence - based medicine curriculum. The authors selected adult learning theory for this purpose based on its ability to encompass self-initiation, self...Impact of an evidence - based medicine curriculum based on adult learning theory. Journal of General Internal Medicine, 12(12), 742-750. Hart, L. G

Study Modules for Calculus-Based General Physics. [Includes Modules 27-30: Direct-Current Circuits; Magnetic Forces; Ampere's Law; and Faraday's Law].

ERIC Educational Resources Information Center

Fuller, Robert G., Ed.; And Others

This is part of a series of 42 Calculus Based Physics (CBP) modules totaling about 1,000 pages. The modules indlude study guides, practice tests, and mastery tests for a full-year individualized course in calculus-based physics based on the Personalized System of Instruction (PSI). The units are not intended to be used without outside materials;…

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.

Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand.

PubMed

Daly, Barbara; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert

2013-08-16

To describe primary health care (practice and specialist) nurses involvement in the government-funded annual diabetes review 'Get Checked' programme and the division of care between nurses and general practitioners in Auckland, New Zealand. Of the total 911 practice and specialist nurses identified and working in the greater Auckland region, 276 (30%) were randomly selected and invited to undertake a self-administered questionnaire and telephone interview in 2006-8. An 86% response rate was achieved. Over 60% of practice nurses and over half of specialist nurses participate in 'Get Checked' reviews. Of those nurses, 40% of practice and 70% specialist nurses, reported completing over half of the total number of 'Get Checked' reviews at their practice. Of the nurses sampled who work in general practice (n=198), 38% reported that 'nurses mostly complete' the reviews, 45% stated that 'nurses and doctors equally complete' them and 17% reported that only 'doctors' did so. For the nurses who reported that 'nurses and doctors equally complete' the reviews (n=89), most nurses undertake blood pressure measurements (90%), weigh patients (88%), give lifestyle advice (87%), examine patient's feet (73%), and 44% carried out the complete review of the patients they consult. These findings show the 'Get Checked' programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes.

Examining the maintenance and generalization effects of repeated practice: A comparison of three interventions.

PubMed

Ardoin, Scott P; Binder, Katherine S; Zawoyski, Andrea M; Foster, Tori E

2018-06-01

Repeated reading (RR) procedures are consistent with the procedures recommended by Haring and Eaton's (1978) Instructional Hierarchy (IH) for promoting students' fluent responding to newly learned stimuli. It is therefore not surprising that an extensive body of literature exists, which supports RR as an effective practice for promoting students' reading fluency of practiced passages. Less clear, however, is the extent to which RR helps students read the words practiced in an intervention passage when those same words are presented in a new passage. The current study employed randomized control design procedures to examine the maintenance and generalization effects of three interventions that were designed based upon Haring and Eaton's (1978) IH. Across four days, students either practiced reading (a) the same passage seven times (RR+RR), (b) one passage four times and three passages each once (RR+Guided Wide Reading [GWR]), or (c) seven passages each once (GWR+GWR). Students participated in the study across 2weeks, with intervention being provided on a different passage set each week. All passages practiced within a week, regardless of condition, contained four target low frequency and four high frequency words. Across the 130 students for whom data were analyzed, results indicated that increased opportunities to practice words led to greater maintenance effects when passages were read seven days later but revealed minimal differences across conditions in students' reading of target words presented within a generalization passage. Copyright © 2018 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Who attends a UK diabetes screening programme? Findings from the ADDITION-Cambridge study.

PubMed

Sargeant, L A; Simmons, R K; Barling, R S; Butler, R; Williams, K M; Prevost, A T; Kinmonth, A L; Wareham, N J; Griffin, S J

2010-09-01

One of the factors influencing the cost-effectiveness of population screening for Type 2 diabetes may be uptake. We examined attendance and practice- and individual-level factors influencing uptake at each stage of a diabetes screening programme in general practice. A stepwise screening programme was undertaken among 135, 825 people aged 40-69 years without known diabetes in 49 general practices in East England. The programme included a score based on routinely available data (age, sex, body mass index and prescribed medication) to identify those at high risk, who were offered random capillary blood glucose (RBG) and glycosylated haemoglobin tests. Those screening positive were offered fasting capillary blood glucose (FBG) and confirmatory oral glucose tolerance tests (OGTT). There were 33 539 high-risk individuals invited for a RBG screening test; 24 654 (74%) attended. Ninety-four per cent attended the follow-up FBG test and 82% the diagnostic OGTT. Seventy per cent of individuals completed the screening programme. Practices with higher general practitioner staff complements and those located in more deprived areas had lower uptake for RBG and FBG tests. Male sex and a higher body mass index were associated with lower attendance for RBG testing. Older age, prescription of antihypertensive medication and a higher risk score were associated with higher attendance for FBG and RBG tests. High attendance rates can be achieved by targeted stepwise screening of individuals assessed as high risk by data routinely available in general practice. Different strategies may be required to increase initial attendance, ensure completion of the screening programme, and reduce the risk that screening increases health inequalities.

Providing end-of-life care in general practice: findings of a national GP questionnaire survey.

PubMed

Mitchell, Sarah; Loew, Joelle; Millington-Sanders, Catherine; Dale, Jeremy

2016-09-01

With increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of high-quality palliative and end-of-life care (EOLC). To provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. A web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. Responses were analysed using descriptive statistics and an inductive thematic analysis. Responses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care - which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors - with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management - including effective symptom-control and access to specialist palliative care services; and expertise and training - the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. The findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care. © British Journal of General Practice 2016.

Integrating postgraduate and undergraduate general practice education: qualitative study.

PubMed

O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

2013-05-01

Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

The contribution of general practice to medical education: expectations and fulfillment.

PubMed

Lloyd, M H; Rosenthal, J J

1992-11-01

The aim of this study was to discover what students expected to learn during their fourth-year general practice attachment, to compare this with their GP tutors' expectations and to determine the extent to which the students' expectations were fulfilled. Questionnaires were used to gather this information; students completed them on the first and last days of the 4-week attachment and tutors shortly after the attachment. Students and their tutors had the highest expectations of the course in helping to raise awareness of the psychological and social aspects of ill health and develop clinical decision-making and management skills. At the end of the course students thought that they had gained most in these areas. Both students and tutors had lower expectations of the course helping to develop physical examination and practical skills and to improve knowledge in certain clinical areas. These were also rated lowest in terms of fulfillment. This study was carried out at a time when it is being suggested that more undergraduate teaching should take place in general practice and that this could include the teaching of practical skills and clinical subjects traditionally associated with hospital-based teaching. The results suggest that the expectations of students and GP tutors would need to be modified, as well as extra resources provided, if there is to be a shift in teaching towards the community.

Human-computer interaction reflected in the design of user interfaces for general practitioners.

PubMed

Stoicu-Tivadar, Lacramioara; Stoicu-Tivadar, Vasile

2006-01-01

To address the problem of properly built health information systems in general practice as an important issue for their approval and use in clinical practice. We present how a national general practitioner (GP) network was built, put in practice and several results of its activity seen from the clinician's and the software application team's points of view. We used a multi-level incremental development appropriate for the conditions of the required information system. After the development of the first version of the software components (based on rapid prototyping) of the sentinel network, a questionnaire addressed the needs and improvements required by the health professionals. Based on the answers, the functionality of the system and the interface were improved regarding the real needs expressed by the end-users. The network is functional and the collected data from the network are being processed using statistical methods. The academic software team developed a GP application that is well received by the GPs in the network, as resulted from the survey and discussions during the training period. As an added confirmation, several GPs outside the network enrolled after seeing the software at work. Another confirmation that we did a good job was that after the final presentation of the results of the project a representative from the Romanian Society for Cardiology expressed the wish of this society to access the data yielded by the network.

Family-centred care delivery: comparing models of primary care service delivery in Ontario.

PubMed

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-11-01

To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

Evidence-based medicine for neurosurgeons: introduction and methodology.

PubMed

Linskey, Mark E

2006-01-01

Evidence-based medicine is a tool of considerable value for medicine and neurosurgery that provides a secure base for clinical practice and practice improvement, but is not without inherent drawbacks, weaknesses and limitations. EBM finds answers to only those questions open to its techniques, and the best available evidence can be a far cry from scientific truth. With the support and backing of governmental agencies, professional medical societies, the AAMC, the ACGME, and the ABMS, EBM is likely here to stay. The fact that: (1) EBM philosophy and critical appraisal techniques have become fully integrated into the training and culture of our younger colleagues, (2) that maintenance of certification will require individuals to demonstrate personal evidence based practice based on tracking and critical analysis of personal practice outcomes as part of the performance-based learning and improvement competency, and (3) that the progressively growing national healthcare expenditures will necessitate increasing basis of reimbursement and funding based on evidence-based effectiveness and guidelines, all point to the likelihood that complete immersion of neurosurgical practice in EBM is inevitable. This article thoroughly explores the history of EBM in medicine in general and in neurosurgery in particular. Emphasis is placed on identifying the legislative and regulatory motive forces at work behind its promulgation and the role that organized medicine has taken to facilitate and foster its acceptance and implementation. An accounting of resources open to neurosurgeons, and a detailed description EBM clinical decision-making methodology is presented. Special emphasis is placed on outlining the methodology as well as the limitations of meta-analyses, randomized clinic trials, and clinical practice parameter guidelines. Commonly perceived objections, as well as substantive problems and limitations of EBM assumptions, tools, and approaches both for individual clinical practice and health policy design and implementation are explored in detail.