Sample records for large group practices
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A comparison of quality and utilization problems in large and small group practices.
Gleason, S C; Richards, M J; Quinnell, J E
1995-12-01
Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.
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Cowan, D
2001-01-01
Trying to gain a measure of control over their working lives, some physicians are abandoning large group practices for smaller groups. Large groups enjoy whole teams of people performing vital business tasks. Small practices rely on one or two key physicians and managers to tackle everything from customer service to marketing, medical records to human resources. Learn valuable tips for thriving in a small environment and using that extra control to achieve job satisfaction.
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IS/IT the prescription to enable medical group practices attain their goals.
Wickramasinghe, Nilmini; Silvers, J B
2003-05-01
The US spends significantly more money as a percentage of GDP on health care than any other OECD country and more importantly, this amount is anticipated to increase exponentially. In this high cost environment, two important trends have occurred: (1) the movement to managed care, and (2) large investments in Information Systems/Information Technology (IS/IT). Managed care has emerged as an attempt to provide good quality yet cost effective health care treatment. Its implications are not well discussed in the literature while, its impact on different types of medical group practices is even less well understood. The repercussions of the large investments in IS/IT on the health care sector in general and on the medical group practice in particular, although clearly of importance, are also largely ignored by the literature. This study attempts to address this significant void in the literature. By analyzing three different types of group practices; an Independent Practice Association (IPA), a Faculty Practice and a Multi Specialty Group Practice in a managed care environment during their implementation of practice management/billing systems, we are able to draw some conclusions regarding the impacts of these two central trends on health care in general as well as on the medical group practice in particular.
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Cole, James R; Dodge, William W; Findley, John S; Young, Stephen K; Horn, Bruce D; Kalkwarf, Kenneth L; Martin, Max M; Winder, Ronald L
2015-05-01
This Point/Counterpoint article discusses the transformation of dental practice from the traditional solo/small-group (partnership) model of the 1900s to large Dental Support Organizations (DSO) that support affiliated dental practices by providing nonclinical functions such as, but not limited to, accounting, human resources, marketing, and legal and practice management. Many feel that DSO-managed group practices (DMGPs) with employed providers will become the setting in which the majority of oral health care will be delivered in the future. Viewpoint 1 asserts that the traditional dental practice patterns of the past are shifting as many younger dentists gravitate toward employed positions in large group practices or the public sector. Although educational debt is relevant in predicting graduates' practice choices, other variables such as gender, race, and work-life balance play critical roles as well. Societal characteristics demonstrated by aging Gen Xers and those in the Millennial generation blend seamlessly with the opportunities DMGPs offer their employees. Viewpoint 2 contends the traditional model of dental care delivery-allowing entrepreneurial practitioners to make decisions in an autonomous setting-is changing but not to the degree nor as rapidly as Viewpoint 1 professes. Millennials entering the dental profession, with characteristics universally attributed to their generation, see value in the independence and flexibility that a traditional practice allows. Although DMGPs provide dentists one option for practice, several alternative delivery models offer current dentists and future dental school graduates many of the advantages of DMGPs while allowing them to maintain the independence and freedom a traditional practice provides.
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Practice settings and dentists' job satisfaction.
Lo Sasso, Anthony T; Starkel, Rebecca L; Warren, Matthew N; Guay, Albert H; Vujicic, Marko
2015-08-01
The nature and organization of dental practice is changing. The aim of this study was to explore how job satisfaction among dentists is associated with dental practice setting. A survey measured satisfaction with income, benefits, hours worked, clinical autonomy, work-life balance, emotional exhaustion, and overall satisfaction among dentists working in large group, small group, and solo practice settings; 2,171 dentists responded. The authors used logistic regression to measure differences in reported levels of satisfaction across practice settings. Dentists working in small group settings reported the most satisfaction overall. Dentists working in large group settings reported more satisfaction with income and benefits than dentists in solo practice, as well as having the least stress. Findings suggest possible advantages and disadvantages of working in different types of practice settings. Dentists working in different practice settings reported differences in satisfaction. These results may help dentists decide which practice setting is best for them. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.
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Edwards, Roger A; Dee, Deborah; Umer, Amna; Perrine, Cria G; Shealy, Katherine R; Grummer-Strawn, Laurence M
2014-02-01
A substantial proportion of US maternity care facilities engage in practices that are not evidence-based and that interfere with breastfeeding. The CDC Survey of Maternity Practices in Infant Nutrition and Care (mPINC) showed significant variation in maternity practices among US states. The purpose of this article is to use benchmarking techniques to identify states within relevant peer groups that were top performers on mPINC survey indicators related to breastfeeding support. We used 11 indicators of breastfeeding-related maternity care from the 2011 mPINC survey and benchmarking techniques to organize and compare hospital-based maternity practices across the 50 states and Washington, DC. We created peer categories for benchmarking first by region (grouping states by West, Midwest, South, and Northeast) and then by size (grouping states by the number of maternity facilities and dividing each region into approximately equal halves based on the number of facilities). Thirty-four states had scores high enough to serve as benchmarks, and 32 states had scores low enough to reflect the lowest score gap from the benchmark on at least 1 indicator. No state served as the benchmark on more than 5 indicators and no state was furthest from the benchmark on more than 7 indicators. The small peer group benchmarks in the South, West, and Midwest were better than the large peer group benchmarks on 91%, 82%, and 36% of the indicators, respectively. In the West large, the Midwest large, the Midwest small, and the South large peer groups, 4-6 benchmarks showed that less than 50% of hospitals have ideal practice in all states. The evaluation presents benchmarks for peer group state comparisons that provide potential and feasible targets for improvement.
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Workplace relational factors and physicians' intention to withdraw from practice.
Masselink, Leah E; Lee, Shoou-Yih D; Konrad, Thomas R
2008-01-01
Physician turnover threatens continuity of care for patients and is a huge expense for health care organizations. Health care organizations have been advised to help physicians build positive relations with colleagues, staff, and patients as a strategy to socially integrate physicians in the workplace and to increase physician retention. Although these recommendations are touted as "evidence-based" practices, the importance of workplace relationships for physician retention has not been established empirically. The purpose of this study is to examine two questions: Are physicians who report better relationships with colleagues, staff, and patients less likely to intend to withdraw from practice? Do the effects of these relational factors differ for large-group and solo/small-group practice physicians? Using data from the Physician Worklife Survey, we analyzed the associations between physicians' reported relationships with colleagues, staff, and patients and intention to withdraw from practice within 2 years using logistic regression. : Relationships with colleagues had a significant and negative association with intended withdrawal from practice for large-group practice physicians. The joint effect of relationships with colleagues, staff, and patients was significant for large-group practice physicians, but it only approached significance for solo/small-group practice physicians. This study suggests that workplace relationships may influence physicians' intention to withdraw from practice, but the mechanisms by which they do so are unclear. Possible interventions to improve physician retention include promotion of informal mentoring and efforts to support community involvement of physicians and their families. Further research examining the role of these and other programs in promoting physician retention can help employers to foster positive workplace relationships and improve retention.
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ERIC Educational Resources Information Center
Hume, Donald
2018-01-01
This article describes a progressive methodology for teaching the tennis serve to large groups with a focus on optimizing practice opportunities and providing individual feedback to players. Specifically, it delineates teaching the serve to 24 players on two courts. The methodology can be adapted for more players and/or more courts as appropriate,…
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Edwards, Roger A.; Dee, Deborah; Umer, Amna; Perrine, Cria G.; Shealy, Katherine R.; Grummer-Strawn, Laurence M.
2015-01-01
Background A substantial proportion of US maternity care facilities engage in practices that are not evidence-based and that interfere with breastfeeding. The CDC Survey of Maternity Practices in Infant Nutrition and Care (mPINC) showed significant variation in maternity practices among US states. Objective The purpose of this article is to use benchmarking techniques to identify states within relevant peer groups that were top performers on mPINC survey indicators related to breastfeeding support. Methods We used 11 indicators of breastfeeding-related maternity care from the 2011 mPINC survey and benchmarking techniques to organize and compare hospital-based maternity practices across the 50 states and Washington, DC. We created peer categories for benchmarking first by region (grouping states by West, Midwest, South, and Northeast) and then by size (grouping states by the number of maternity facilities and dividing each region into approximately equal halves based on the number of facilities). Results Thirty-four states had scores high enough to serve as benchmarks, and 32 states had scores low enough to reflect the lowest score gap from the benchmark on at least 1 indicator. No state served as the benchmark on more than 5 indicators and no state was furthest from the benchmark on more than 7 indicators. The small peer group benchmarks in the South, West, and Midwest were better than the large peer group benchmarks on 91%, 82%, and 36% of the indicators, respectively. In the West large, the Midwest large, the Midwest small, and the South large peer groups, 4–6 benchmarks showed that less than 50% of hospitals have ideal practice in all states. Conclusion The evaluation presents benchmarks for peer group state comparisons that provide potential and feasible targets for improvement. PMID:24394963
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Horizontal and vertical integration of physicians: a tale of two tails.
Burns, Lawton Robert; Goldsmith, Jeff C; Sen, Aditi
2013-01-01
Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway. DESIGN/METHODOLOGY APPROACH: We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models. The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners. While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization. Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices. Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats. This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.
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Implementing Summative Assessment with a Formative Flavour: A Case Study in a Large Class
ERIC Educational Resources Information Center
Broadbent, Jaclyn; Panadero, Ernesto; Boud, David
2018-01-01
Teaching a large class can present real challenges in design, management and standardisation of assessment practices. One of the main dilemmas for university teachers is how to implement effective formative assessment practices with accompanying high-quality feedback consistently over time with large classroom groups. This article reports on how…
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Makhija, Sonia K; Gilbert, Gregg H; Rindal, D Brad; Benjamin, Paul; Richman, Joshua S; Pihlstrom, Daniel J; Qvist, Vibeke
2009-01-01
Background Practice-based research networks offer important opportunities to move recent advances into routine clinical practice. If their findings are not only generalizable to dental practices at large, but can also elucidate how practice characteristics are related to treatment outcome, their importance is even further elevated. Our objective was to determine whether we met a key objective for The Dental Practice-Based Research Network (DPBRN): to recruit a diverse range of practitioner-investigators interested in doing DPBRN studies. Methods DPBRN participants completed an enrollment questionnaire about their practices and themselves. To date, more than 1100 practitioners from the five participating regions have completed the questionnaire. The regions consist of: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia (Denmark, Norway, and Sweden). We tested the hypothesis that there are statistically significant differences in key characteristics among DPBRN practices, based on responses from dentists who participated in DPBRN's first network-wide study (n = 546). Results There were statistically significant, substantive regional differences among DPBRN-participating dentists, their practices, and their patient populations. Conclusion Although as a group, participants have much in common with practices at large; their substantial diversity offers important advantages, such as being able to evaluate how practice differences may affect treatment outcomes, while simultaneously offering generalizability to dentists at large. This should help foster knowledge transfer in both the research-to-practice and practice-to-research directions. PMID:19832991
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A 10-year ecosystem restoration community of practice tracks large-scale restoration trends
In 2004, a group of large-scale ecosystem restoration practitioners across the United States convened to start the process of sharing restoration science, management, and best practices under the auspices of a traditional conference umbrella. This forum allowed scientists and dec...
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Legaard, Kasey R; Sader, Steven A; Simons-Legaard, Erin M
2015-01-01
Sustainable forest management is based on functional relationships between management actions, landscape conditions, and forest values. Changes in management practices make it fundamentally more difficult to study these relationships because the impacts of current practices are difficult to disentangle from the persistent influences of past practices. Within the Atlantic Northern Forest of Maine, U.S.A., forest policy and management practices changed abruptly in the early 1990s. During the 1970s-1980s, a severe insect outbreak stimulated salvage clearcutting of large contiguous tracts of spruce-fir forest. Following clearcut regulation in 1991, management practices shifted abruptly to near complete dependence on partial harvesting. Using a time series of Landsat satellite imagery (1973-2010) we assessed cumulative landscape change caused by these very different management regimes. We modeled predominant temporal patterns of harvesting and segmented a large study area into groups of landscape units with similar harvest histories. Time series of landscape composition and configuration metrics averaged within groups revealed differences in landscape dynamics caused by differences in management history. In some groups (24% of landscape units), salvage caused rapid loss and subdivision of intact mature forest. Persistent landscape change was created by large salvage clearcuts (often averaging > 100 ha) and conversion of spruce-fir to deciduous and mixed forest. In groups that were little affected by salvage (56% of landscape units), contemporary partial harvesting caused loss and subdivision of intact mature forest at even greater rates. Patch shape complexity and edge density reached high levels even where cumulative harvest area was relatively low. Contemporary practices introduced more numerous and much smaller patches of stand-replacing disturbance (typically averaging <15 ha) and a correspondingly large amount of edge. Management regimes impacted different areas to different degrees, producing different trajectories of landscape change that should be recognized when studying the impact of policy and management practices on forest ecology.
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Legaard, Kasey R.; Sader, Steven A.; Simons-Legaard, Erin M.
2015-01-01
Sustainable forest management is based on functional relationships between management actions, landscape conditions, and forest values. Changes in management practices make it fundamentally more difficult to study these relationships because the impacts of current practices are difficult to disentangle from the persistent influences of past practices. Within the Atlantic Northern Forest of Maine, U.S.A., forest policy and management practices changed abruptly in the early 1990s. During the 1970s-1980s, a severe insect outbreak stimulated salvage clearcutting of large contiguous tracts of spruce-fir forest. Following clearcut regulation in 1991, management practices shifted abruptly to near complete dependence on partial harvesting. Using a time series of Landsat satellite imagery (1973-2010) we assessed cumulative landscape change caused by these very different management regimes. We modeled predominant temporal patterns of harvesting and segmented a large study area into groups of landscape units with similar harvest histories. Time series of landscape composition and configuration metrics averaged within groups revealed differences in landscape dynamics caused by differences in management history. In some groups (24% of landscape units), salvage caused rapid loss and subdivision of intact mature forest. Persistent landscape change was created by large salvage clearcuts (often averaging > 100 ha) and conversion of spruce-fir to deciduous and mixed forest. In groups that were little affected by salvage (56% of landscape units), contemporary partial harvesting caused loss and subdivision of intact mature forest at even greater rates. Patch shape complexity and edge density reached high levels even where cumulative harvest area was relatively low. Contemporary practices introduced more numerous and much smaller patches of stand-replacing disturbance (typically averaging <15 ha) and a correspondingly large amount of edge. Management regimes impacted different areas to different degrees, producing different trajectories of landscape change that should be recognized when studying the impact of policy and management practices on forest ecology. PMID:26106893
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The Oral Health Care Delivery System in 2040: Executive Summary.
Bailit, Howard L
2017-09-01
This executive summary for Section 4 of the "Advancing Dental Education in the 21 st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices.
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Characteristics of Medical Practices in Three Developed Managed Care Markets
Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J
2005-01-01
Objective To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Data Sources/Study Design Surveys of medical practices in three managed care markets conducted in 2000–2001. Study Design We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. Data Collection A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. Principal Findings We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1–125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. Conclusions We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped. PMID:15960686
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Characteristics of medical practices in three developed managed care markets.
Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J
2005-06-01
To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Surveys of medical practices in three managed care markets conducted in 2000-2001. We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.
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Greenfield, S; Nelson, E C; Zubkoff, M; Manning, W; Rogers, W; Kravitz, R L; Keller, A; Tarlov, A R; Ware, J E
1992-03-25
To examine whether specialty and system of care exert independent effects on resource utilization. Cross-sectional analysis of just over 20,000 patients (greater than or equal to 18 years of age) who visited providers' offices during 9-day periods in 1986. Patient- and physician-provided information was obtained by self-administered questionnaires. Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three major US cities. Indicators of the intensity of resource utilization were examined among four medical specialties (family practice, general internal medicine, cardiology, and endocrinology) and five systems of care (health maintenance organization, multispecialty group-fee-for-service, multispecialty group-prepaid; solo practice and single-specialty group-fee-for-service, and solo practice and single-specialty group-prepaid) before and after controlling for the mix of patients seen in these offices. The indicators of resource utilization were hospitalizations, annual office visits, prescription drugs, and common tests and procedures, with rates estimated on both a per-visit and per-year basis. Variation in patient mix was a major determinant of the large variations in resource use. However, increased utilization was also independently related to specialty (cardiology and endocrinology), fee-for-service payment plan, and solo and single-specialty group practice arrangements. After adjusting for patient mix, solo practice/single-specialty groups-fee-for-service had 41% more hospitalizations than health maintenance organizations. General internists had utilization rates somewhat greater than family physicians on some indicators. Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication. The 2- and 4-year outcomes now being analyzed will provide information critical to interpretation of the variations reported herein.
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Maximizing User Satisfaction With Office Practice Data Processing Systems
O'Flaherty, Thomas; Jussim, Judith
1980-01-01
Significant numbers of physicians are using data processing services and a large number of firms are offering an increasing variety of services. This paper quantifies user dissatisfaction with office practice data processing systems and analyzes factors affecting dissatisfaction in large group practices. Based on this analysis, a proposal is made for a more structured approach to obtaining data processing services in order to lower the risks and increase satisfaction with data processing.
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Nurture Groups: A Large-Scale, Controlled Study of Effects on Development and Academic Attainment
ERIC Educational Resources Information Center
Reynolds, Sue; MacKay, Tommy; Kearney, Maura
2009-01-01
Nurture groups have contributed to inclusive practices in primary schools in the UK for some time now and have frequently been the subject of articles in this journal. This large-scale, controlled study of nurture groups across 32 schools in the City of Glasgow provides further evidence for their effectiveness in addressing the emotional…
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Enhancing Large-Group Problem-Based Learning in Veterinary Medical Education.
ERIC Educational Resources Information Center
Pickrell, John A.
This project for large-group, problem-based learning at Kansas State University College of Veterinary Medicine developed 47 case-based videotapes that are used to model clinical conditions and also involved veterinary practitioners to formulate true practice cases into student learning opportunities. Problem-oriented, computer-assisted diagnostic…
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ERIC Educational Resources Information Center
Jacobson, Miriam; Kolarek, Mary Hebert; Newton, Bonnie
This publication presents the efforts and results of leading large employers to improve the health of mothers and children. Section 1 profiles the pioneering efforts and innovative practices of seven large employers and one business group: Haggar Clothing Co.; Honeywell Inc.; Los Angeles Department of Water and Power; Monfort, Inc.; First Chicago…
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ERIC Educational Resources Information Center
Dollman, James
2005-01-01
The "Learning Trail" is an innovative application of peer-mediated instruction designed to enhance student learning in large practical classes. The strategy specifically seeks to improve participants' attention to details of protocol that are often difficult to observe during teacher-centered demonstrations to large groups. Students…
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Linzer, Mark; Konrad, Thomas R; Douglas, Jeffrey; McMurray, Julia E; Pathman, Donald E; Williams, Eric S; Schwartz, Mark D; Gerrity, Martha; Scheckler, William; Bigby, JudyAnn; Rhodes, Elnora
2000-01-01
OBJECTIVE To assess the association between HMO practice, time pressure, and physician job satisfaction. DESIGN National random stratified sample of 5,704 primary care and specialty physicians in the United States. Surveys contained 150 items reflecting 10 facets (components) of satisfaction in addition to global satisfaction with current job, one's career and one's specialty. Linear regression–modeled satisfaction (on 1–5 scale) as a function of specialty, practice setting (solo, small group, large group, academic, or HMO), gender, ethnicity, full-time versus part-time status, and time pressure during office visits. “HMO physicians” (9% of total) were those in group or staff model HMOs with>50% of patients capitated or in managed care. RESULTS Of the 2,326 respondents, 735 (32%) were female, 607 (26%) were minority (adjusted response rate 52%). HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types (moderate to large effect sizes). However, physicians in many other practice settings averaged higher satisfaction than HMO physicians with resources and relationships with staff and community (small to moderate effect sizes). Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians (P < .05), and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years (P < .05). Time pressure detracted from satisfaction in 7 of 10 satisfaction facets (P < .05) and from job, career, and specialty satisfaction (P < .01). Time allotted for new patients in HMOs (31 min) was less than that allotted in solo (39 min) and academic practices (44 min), while 83% of family physicians in HMOs felt they needed more time than allotted for new patients versus 54% of family physicians in small group practices (P < .05 after Bonferroni's correction). CONCLUSIONS HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings. Our data suggest that HMO physicians' satisfaction with staff, community, resources, and the duration of new patient visits should be assessed and optimized. Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice settings remains to be determined. PMID:10940129
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Wei, Gao-Xia; Gong, Zhu-Qing; Yang, Zhi; Zuo, Xi-Nian
2017-01-01
Cognitive control impairment is a typical symptom largely reported in populations with neurological disorders. Previous studies have provided evidence about the changes in cognitive control induced by mind-body training. However, the neural correlates underlying the effect of extensive mind-body practice on cognitive control remain largely unknown. Using resting-state functional magnetic resonance imaging, we characterized dynamic fluctuations in large-scale intrinsic connectivity networks associated with mind-body practice, and examined their differences between healthy controls and Tai Chi Chuan (TCC) practitioners. Compared with a control group, the TCC group revealed significantly decreased fractional Amplitude of Low Frequency Fluctuations (fALFF) in the bilateral frontoparietal network, default mode network and dorsal prefrontal-angular gyri network. Furthermore, we detected a significant association between mind-body practice experience and fALFF in the default mode network, as well as an association between cognitive control performance and fALFF of the frontoparietal network. This provides the first evidence of large-scale functional connectivity in brain networks associated with mind-body practice, shedding light on the neural network changes that accompany intensive mind-body training. It also highlights the functionally plastic role of the frontoparietal network in the context of the “immune system” of mental health recently developed in relation to flexible hub theory. PMID:28736535
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Wei, Gao-Xia; Gong, Zhu-Qing; Yang, Zhi; Zuo, Xi-Nian
2017-01-01
Cognitive control impairment is a typical symptom largely reported in populations with neurological disorders. Previous studies have provided evidence about the changes in cognitive control induced by mind-body training. However, the neural correlates underlying the effect of extensive mind-body practice on cognitive control remain largely unknown. Using resting-state functional magnetic resonance imaging, we characterized dynamic fluctuations in large-scale intrinsic connectivity networks associated with mind-body practice, and examined their differences between healthy controls and Tai Chi Chuan (TCC) practitioners. Compared with a control group, the TCC group revealed significantly decreased fractional Amplitude of Low Frequency Fluctuations (fALFF) in the bilateral frontoparietal network, default mode network and dorsal prefrontal-angular gyri network. Furthermore, we detected a significant association between mind-body practice experience and fALFF in the default mode network, as well as an association between cognitive control performance and fALFF of the frontoparietal network. This provides the first evidence of large-scale functional connectivity in brain networks associated with mind-body practice, shedding light on the neural network changes that accompany intensive mind-body training. It also highlights the functionally plastic role of the frontoparietal network in the context of the "immune system" of mental health recently developed in relation to flexible hub theory.
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Large-Eddy Simulation: Current Capabilities, Recommended Practices, and Future Research
NASA Technical Reports Server (NTRS)
Georgiadis, Nicholas J.; Rizzetta, Donald P.; Fureby, Christer
2009-01-01
This paper presents the results of an activity by the Large Eddy Simulation (LES) Working Group of the AIAA Fluid Dynamics Technical Committee to (1) address the current capabilities of LES, (2) outline recommended practices and key considerations for using LES, and (3) identify future research needs to advance the capabilities and reliability of LES for analysis of turbulent flows. To address the current capabilities and future needs, a survey comprised of eleven questions was posed to LES Working Group members to assemble a broad range of perspectives on important topics related to LES. The responses to these survey questions are summarized with the intent not to be a comprehensive dictate on LES, but rather the perspective of one group on some important issues. A list of recommended practices is also provided, which does not treat all aspects of a LES, but provides guidance on some of the key areas that should be considered.
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Beidas, Rinad S.; Stewart, Rebecca E.; Adams, Danielle R.; Fernandez, Tara; Lustbader, Susanna; Powell, Byron J.; Aarons, Gregory; Hoagwood, Kimberly E.; Evans, Arthur C.; Hurford, Matthew O.; Rubin, Ronnie; Hadley, Trevor; Mandell, David; Barg, Frances
2015-01-01
Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices. PMID:26658692
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Balderson, Benjamin H; McCurry, Susan M; Vitiello, Michael V; Shortreed, Susan M; Rybarczyk, Bruce D; Keefe, Francis J; Korff, Michael Von
2016-01-01
This article considers methodology for developing an education-only control group and proposes a simple approach to designing rigorous and well-accepted control groups. This approach is demonstrated in a large randomized trial. The Lifestyles trial (n = 367) compared three group interventions: (a) cognitive-behavioral treatment (CBT) for osteoarthritis pain, (b) CBT for osteoarthritis pain and insomnia, and (c) education-only control (EOC). EOC emulated the interventions excluding hypothesized treatment components and controlling for nonspecific treatment effects. Results showed this approach resulted in a control group that was highly credible and acceptable to patients. This approach can be an effective and practical guide for developing high-quality control groups in trials of behavioral interventions.
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STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 3 - BASIN BEST MANAGEMENT PRACTICES
This manual provides design guidelines for a group of stormwater management (SWM) best management practices (BMPs) broadly referred to as basin or pond BMPs. Basin BMPs are the mainstay of stormwater management. Water resources engineers have designed small and large ponds for ma...
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Bierema, Andrea M.-K.; Schwarz, Christina V.; Stoltzfus, Jon R.
2017-01-01
National calls for improving science education (e.g., Vision and Change) emphasize the need to learn disciplinary core ideas through scientific practices. To address this need, we engaged small groups of students in developing diagrammatic models within two (one large-enrollment and one medium-enrollment) undergraduate introductory biology courses. During these activities, students developed scientific models of biological phenomena such as enhanced growth in genetically modified fish. To investigate whether undergraduate students productively engaged in scientific practices during these modeling activities, we recorded groups of students as they developed models and examined three characteristics: how students 1) interacted with one another, 2) made sense of phenomena, and 3) justified their ideas. Our analysis indicates that students spent most of the time on task, developing and evaluating their models. Moreover, they worked cooperatively to make sense of core ideas and justified their ideas to one another throughout the activities. These results demonstrate that, when provided with the opportunity to develop models during class, students in large-enrollment lecture courses can productively engage in scientific practices. We discuss potential reasons for these outcomes and suggest areas of future research to continue advancing knowledge regarding engaging students in scientific practices in large-enrollment lecture courses. PMID:29196429
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Hughes, Jeffrey; Grossmann, Igor; Cohen, Adam B.
2015-01-01
Past research has found a robust effect of prejudice against atheists in largely Christian-dominated (belief-oriented) samples. We propose that religious centrality of beliefs vs. practices influences attitudes toward atheists, such that religious groups emphasizing beliefs perceive non-believers more negatively than believers, while groups emphasizing practices perceive non-practicing individuals more negatively than practicing individuals. Studies 1–2, in surveys of 41 countries, found that Muslims and Protestants (belief-oriented) had more negative attitudes toward atheists than did Jews and Hindus (practice-oriented). Study 3 experimentally manipulated a target individual's beliefs and practices. Protestants had more negative attitudes toward a non-believer (vs. a believer), whereas Jews had more negative attitudes toward a non-practicing individual (vs. a practicing individual, particularly when they had a Jewish background). This research has implications for the psychology of religion, anti-atheist prejudice, and cross-cultural attitudes regarding where dissent in beliefs or practices may be tolerated or censured within religious groups. PMID:26441728
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Hughes, Jeffrey; Grossmann, Igor; Cohen, Adam B
2015-01-01
Past research has found a robust effect of prejudice against atheists in largely Christian-dominated (belief-oriented) samples. We propose that religious centrality of beliefs vs. practices influences attitudes toward atheists, such that religious groups emphasizing beliefs perceive non-believers more negatively than believers, while groups emphasizing practices perceive non-practicing individuals more negatively than practicing individuals. Studies 1-2, in surveys of 41 countries, found that Muslims and Protestants (belief-oriented) had more negative attitudes toward atheists than did Jews and Hindus (practice-oriented). Study 3 experimentally manipulated a target individual's beliefs and practices. Protestants had more negative attitudes toward a non-believer (vs. a believer), whereas Jews had more negative attitudes toward a non-practicing individual (vs. a practicing individual, particularly when they had a Jewish background). This research has implications for the psychology of religion, anti-atheist prejudice, and cross-cultural attitudes regarding where dissent in beliefs or practices may be tolerated or censured within religious groups.
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Letting the Drama into Group Work: Using Conflict Constructively in Performing Arts Group Practice
ERIC Educational Resources Information Center
Crossley, Tracy
2006-01-01
The article examines conflict avoidance in performing arts group work and issues arising in relation to teaching and learning. In group theory, conflict is addressed largely in terms of its detrimental effects on group work, and its constructive potential is often marginalized. Similarly, undergraduate students usually interpret "effective…
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ERIC Educational Resources Information Center
Jayanthi, Madhavi; Dimino, Joseph; Gersten, Russell; Taylor, Mary Jo; Haymond, Kelly; Smolkowski, Keith; Newman-Gonchar, Rebecca
2018-01-01
The purpose of this replication study was to examine the impact of the Teacher Study Group (TSG) professional development in vocabulary on first-grade teachers' knowledge of vocabulary instruction and observed teaching practice, and on students' vocabulary knowledge. Sixty-two schools from 16 districts in four states were randomly assigned to…
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Beliefs, Practices, and Expectations of Oral Teachers of the Deaf
ERIC Educational Resources Information Center
Brown, P. Margaret; Paatsch, Louise
2010-01-01
This study investigated the beliefs and practices of 28 teachers of the deaf about their practices. The teachers were all working in oral settings either as visiting teachers or teachers in a mainstream school facility supporting groups of students with hearing loss. Teachers who used an Auditory Verbal approach largely adopted a positivist…
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Assessing the work of medical audit advisory groups in promoting audit in general practice.
Baker, R; Hearnshaw, H; Cooper, A; Cheater, F; Robertson, N
1995-12-01
Objectives--To determine the role of medical audit advisory groups in audit activities in general practice. Design--Postal questionnaire survey. Subjects--All 104 advisory groups in England and Wales in 1994. Main measures--Monitoring audit: the methods used to classify audits, the methods used by the advisory group to collect data on audits from general practices, the proportion of practices undertaking audit. Directing and coordinating audits: topics and number of practices participating in multipractice audits. Results--The response rate was 86-5%. In 1993-4, 54% of the advisory groups used the Oxfordshire or Kirklees methods for classifying audits, or modifications of them. 99% of the advisory groups collected data on audit activities at least once between 1991-2 and 1993-4. Visits, questionnaires, and other methods were used to collect information from all or samples of practices in each of the advisory group's areas. Some advisory groups used different methods in different years. In 1991-2, 57% of all practices participated in some audit, in 1992-3, 78%, and in 1993-4, 86%. 428 multipractice audits were identified. The most popular topic was diabetes. Conclusions--Advisory groups have been active in monitoring audit in general practice. However, the methods used to classify and collect information about audits in general practices varied widely. The number of practices undertaking audit increased between 1991-2 and 1993 1. The large number of multipractice audits supports the view that the advisory groups have directed and coordinated audit activities. This example of a national audit programme for general practice may be helpful in other countries in which the introduction of quality assurance is being considered.
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Beidas, Rinad S; Stewart, Rebecca E; Adams, Danielle R; Fernandez, Tara; Lustbader, Susanna; Powell, Byron J; Aarons, Gregory A; Hoagwood, Kimberly E; Evans, Arthur C; Hurford, Matthew O; Rubin, Ronnie; Hadley, Trevor; Mandell, David S; Barg, Frances K
2016-11-01
Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.
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Martirosov, Amber Lanae; Michael, Angela; McCarty, Melissa; Bacon, Opal; DiLodovico, John R; Jantz, Arin; Kostoff, Diana; MacDonald, Nancy C; Mikulandric, Nancy; Neme, Klodiana; Sulejmani, Nimisha; Summers, Bryant B
2018-05-29
The use of the ASHP Ambulatory Care Self-Assessment Tool to advance pharmacy practice at 8 ambulatory care clinics of a large academic medical center is described. The ASHP Ambulatory Care Self-Assessment Tool was developed to help ambulatory care pharmacists assess how their current practices align with the ASHP Practice Advancement Initiative. The Henry Ford Hospital Ambulatory Care Advisory Group (ACAG) opted to use the "Practitioner Track" sections of the tool to assess pharmacy practices within each of 8 ambulatory care clinics individually. The responses to self-assessment items were then compiled and discussed by ACAG members. The group identified best practices and ways to implement action items to advance ambulatory care practice throughout the institution. Three recommended action items were common to most clinics: (1) identify and evaluate solutions to deliver financially viable services, (2) develop technology to improve patient care, and (3) optimize the role of pharmacy technicians and support personnel. The ACAG leadership met with pharmacy administrators to discuss how action items that were both feasible and deemed likely to have a medium-to-high impact aligned with departmental goals and used this information to develop an ambulatory care strategic plan. This process informed and enabled initiatives to advance ambulatory care pharmacy practice within the system. The ASHP Ambulatory Care Self-Assessment Tool was useful in identifying opportunities for practice advancement in a large academic medical center. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
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Improving Online Teaching by Using Established Best Classroom Teaching Practices.
Price, Jill M; Whitlatch, Joy; Maier, Cecilia Jane; Burdi, Melissa; Peacock, James
2016-05-01
This pilot study explored the effectiveness of an online workshop provided to faculty teaching one course in a large online RN-to-baccalaureate nursing (BSN) program. This exploration helped to fill a gap in knowledge related to implementing best classroom teaching practices into distance education for online nursing students. Focus groups with purposeful sampling (three focus groups: two faculty focus groups with a total of 11 faculty and one student focus group with a total of six students) were used to assess the effectiveness of the workshop and faculty and student perceptions of the seven best classroom teaching practices. Themes derived from the faculty focus groups included reaffirmation, commitments from students, and opportunities for instructor improvement. Themes derived from the student focus group included engagement, availability, encouragement, and diverse learning. Online teaching recommendations, created from the emerged themes of the study, could be considered to improve teaching practices of online nurse educators. J Contin Educ Nurs. 2016;47(5):222-227. Copyright 2016, SLACK Incorporated.
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Evaluation of an Ongoing Diabetes Group Medical Visit in a Family Medicine Practice.
Cunningham, Amy T; Delgado, David J; Jackson, Joseph D; Crawford, Albert G; Jabbour, Serge; Lieberthal, Robert D; Diaz, Victor; LaNoue, Marianna
2018-01-01
Group medical visits (GMVs), which combine 1-on-1 clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management in primary care. However, few evaluations exist of ongoing diabetes GMVs embedded in medical practices. This study used a quasi-experimental design to evaluate diabetes GMV at a large family medicine practice. We examined program attendance and attrition, used propensity score matching to create a matched comparison group, and compared participants and the matched group on clinical, process of care, and utilization outcomes. GMV participants (n = 230) attended an average of 1 session. Participants did not differ significantly from the matched comparison group (n = 230) on clinical, process of care or utilization outcomes. The diabetes GMV was not associated with improvements in outcomes. Further studies should examine diabetes GMV implementation challenges to enhance their effectiveness in everyday practice. © Copyright 2018 by the American Board of Family Medicine.
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Improving Chronic Diseases Management Through the Development of an Evidence-Based Resource.
Khalil, Hanan; Chambers, Helen; Munn, Zachary; Porritt, Kylie
2015-06-01
There is a large gap between evidence and practice within health care, particularly within the field of chronic disease. To reduce this gap and improve the management of chronic disease, a collaborative partnership between two schools within a large university and two industry partners (a large regional rural hospital and a rural community health center) in rural Victoria, Australia, was developed. The aim of the collaboration was to promote the development of translation science and the implementation of evidence-based health care in chronic disease with a specific focus on developing evidence-based resources that are easily accessed by clinicians. A working group consisting of members of the collaborating organizations and an internationally renowned expert reference group was formed. The group acted as a steering committee and was tasked with developing a taxonomy of the resources. In addition, a peer review process of all resources was established. A corresponding reference group consisting of researchers and clinicians who are clinical experts in various fields was involved in the review process. The resources developed by the group include evidence summaries and recommended practices made available on a web-based database, which can be accessed via subscription by clinicians and researchers worldwide. As of mid-2014, there were 109 new evidence summaries and 25 recommended practices detailing the best available evidence on topics related to chronic disease management including asthma, diabetes, heart failure, dementia, and others. Training sessions and a newsletter were developed for clinicians within the node to enable them to use the content effectively. This paper describes the processes involved in the successful development of the collaborative partnership and its evolution into producing a valuable resource for the translation of evidence into practice in the areas of chronic disease management. The resource developed is being used by clinicians to inform practice and support their clinical decision making. © 2015 Sigma Theta Tau International.
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Practical Educational Prescriptions for Students in the Mainstream.
ERIC Educational Resources Information Center
Choate, Joyce S., Ed.; Young, Larry S., Ed.
Activity suggestions developed by experienced teachers are presented for mainstreamed students with difficulties in specific instructional areas of reading, mathematics, spelling, writing, and behavior. Activity descriptions are grouped according to instructional area, and are classified as large group, small group, or one to one exercises.…
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Translating learning into practice
Armson, Heather; Kinzie, Sarah; Hawes, Dawnelle; Roder, Stefanie; Wakefield, Jacqueline; Elmslie, Tom
2007-01-01
PROBLEM ADDRESSED The need for effective and accessible educational approaches by which family physicians can maintain practice competence in the face of an overwhelming amount of medical information. OBJECTIVE OF PROGRAM The practice-based small group (PBSG) learning program encourages practice changes through a process of small-group peer discussion—identifying practice gaps and reviewing clinical approaches in light of evidence. PROGRAM DESCRIPTION The PBSG uses an interactive educational approach to continuing professional development. In small, self-formed groups within their local communities, family physicians discuss clinical topics using prepared modules that provide sample patient cases and accompanying information that distils the best evidence. Participants are guided by peer facilitators to reflect on the discussion and commit to appropriate practice changes. CONCLUSION The PBSG has evolved over the past 15 years in response to feedback from members and reflections of the developers. The success of the program is evidenced in effect on clinical practice, a large and increasing number of members, and the growth of interest internationally. PMID:17872876
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Quantitative Approaches to Group Research: Suggestions for Best Practices
ERIC Educational Resources Information Center
McCarthy, Christopher J.; Whittaker, Tiffany A.; Boyle, Lauren H.; Eyal, Maytal
2017-01-01
Rigorous scholarship is essential to the continued growth of group work, yet the unique nature of this counseling specialty poses challenges for quantitative researchers. The purpose of this proposal is to overview unique challenges to quantitative research with groups in the counseling field, including difficulty in obtaining large sample sizes…
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Creating and Implementing a Faculty Interest Group for Historically Underrepresented Faculty
ERIC Educational Resources Information Center
Follins, Lourdes D.; Paler, Lisa K.; Nanin, Jose E.
2015-01-01
This article describes the creation and implementation of a faculty interest group for historically underrepresented faculty at a large, urban community college in the Northeast. Faculty interest groups provide opportunities for faculty across disciplines to meet to explore common interests and share concerns and best practices. The faculty…
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2011-01-01
Background The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Methods Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. Results A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. Conclusions EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light. PMID:21899754
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Green, Amy E; Aarons, Gregory A
2011-09-07
The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.
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Mind-Body Practices and the Adolescent Brain: Clinical Neuroimaging Studies.
Sharma, Anup; Newberg, Andrew B
Mind-Body practices constitute a large and diverse group of practices that can substantially affect neurophysiology in both healthy individuals and those with various psychiatric disorders. In spite of the growing literature on the clinical and physiological effects of mind-body practices, very little is known about their impact on central nervous system (CNS) structure and function in adolescents with psychiatric disorders. This overview highlights findings in a select group of mind-body practices including yoga postures, yoga breathing techniques and meditation practices. Mind-body practices offer novel therapeutic approaches for adolescents with psychiatric disorders. Findings from these studies provide insights into the design and implementation of neuroimaging studies for adolescents with psychiatric disorders. Clinical neuroimaging studies will be critical in understanding how different practices affect disease pathogenesis and symptomatology in adolescents. Neuroimaging of mind-body practices on adolescents with psychiatric disorders will certainly be an open and exciting area of investigation.
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Encouraging Gender Analysis in Research Practice
ERIC Educational Resources Information Center
Thien, Deborah
2009-01-01
Few resources for practical teaching or fieldwork exercises exist which address gender in geographical contexts. This paper adds to teaching and fieldwork resources by describing an experience with designing and implementing a "gender intervention" for a large-scale, multi-university, bilingual research project that brought together a group of…
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Branding your practice: twelve practical steps to creating lifelong patient relationships.
Neely, Melinda Hinson
2005-01-01
The concept of branding is not limited to large companies. It can be successfully applied in medical practices to those individuals or groups that wish to establish a distinct identity in the marketplace. Branding a medical practice establishes a competitive advantage, ensures a more predictable flow of patients, and ultimately enhances patient satisfaction. This article conceptualizes the branding process and provides guidelines for implementation that are applicable to a variety of budgets.
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Robinson, James C; Casalino, Lawrence P; Gillies, Robin R; Rittenhouse, Diane R; Shortell, Stephen S; Fernandes-Taylor, Sara
2009-04-01
Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices. National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT. Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001). External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.
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Verbal and Performance IQ for Discrimination Among Psychiatric Diagnostic Groups
ERIC Educational Resources Information Center
Loro, Bert; Woodward, J. Arthur
1976-01-01
In view of the practical and theoretical importance of the issues involved, the current research was undertaken to investigate the diagnostic relevance of WAIS Verbal and Performance IQ in a large sample of psychiatric patients that included a variety of functional diagnostic groups as well as groups of mentally deficient and organic brain…
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Enhancing the Student Experience of Laboratory Practicals through Digital Video Guides
ERIC Educational Resources Information Center
Croker, Karen; Andersson, Holger; Lush, David; Prince, Rob; Gomez, Stephen
2010-01-01
Laboratory-based learning allows students to experience bioscience principles first hand. In our experience, practical content and equipment may have changed over time, but teaching methods largely remain the same, typically involving; whole class introduction with a demonstration, students emulating the demonstration in small groups, gathering…
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Large Independent Primary Care Medical Groups
Casalino, Lawrence P.; Chen, Melinda A.; Staub, C. Todd; Press, Matthew J.; Mendelsohn, Jayme L.; Lynch, John T.; Miranda, Yesenia
2016-01-01
PURPOSE In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges. METHODS We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers—leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. RESULTS The groups’ physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. CONCLUSIONS Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting. PMID:26755779
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ERIC Educational Resources Information Center
Miller, David; Schraeder, Matthew
2015-01-01
At a research University near the east coast, researchers restructured a College Algebra course by formatting the course into two large lectures a week, an active recitation size laboratory class once a week, and an extra day devoted to active group work called Supplemental Practice (SP). SP was added as an extra day of class where the SP leader…
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Mechanic, Robert E; Zinner, Darren
2016-06-01
Little is known about the scope of alternative payment models outside of Medicare. This study measures the full complement of public and private payment arrangements in large, multi-specialty group practices as a barometer of payment reform among advanced organizations. We collected information from 33 large, multi-specialty group practices about the proportion of their total revenue in 7 payment models, physician compensation strategies, and the implementation of selected performance management initiatives. We grouped respondents into 3 categories based on the proportion of their revenue in risk arrangements: risk-based (45%-100%), mixed (10%-35%), and fee-for-service (FFS) (0%-10%). We analyzed changes in contracting and operating characteristics between 2011 and 2013. In 2013, 68% of groups' total patient revenue was from FFS payments and 32% was from risk arrangements (unweighted average). Risk-based groups had 26% FFS revenue, whereas mixed-payment and FFS groups had 75% and 98%, respectively. Between 2011 and 2013, 9 groups increased risk contract revenue by about 15 percentage points and 22 reported few changes. Risk-based groups reported more advanced implementation of performance management strategies and were more likely to have physician financial incentives for quality and patient experience. The groups in this study are well positioned to manage risk-based contracts successfully, but less than one-third receive a majority of their revenue from risk arrangements. The experience of these relatively advanced groups suggests that expanding risk-based arrangements across the US health system will likely be slower and more challenging than many people assume.
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Effects of variable practice on the motor learning outcomes in manual wheelchair propulsion.
Leving, Marika T; Vegter, Riemer J K; de Groot, Sonja; van der Woude, Lucas H V
2016-11-23
Handrim wheelchair propulsion is a cyclic skill that needs to be learned during rehabilitation. It has been suggested that more variability in propulsion technique benefits the motor learning process of wheelchair propulsion. The purpose of this study was to determine the influence of variable practice on the motor learning outcomes of wheelchair propulsion in able-bodied participants. Variable practice was introduced in the form of wheelchair basketball practice and wheelchair-skill practice. Motor learning was operationalized as improvements in mechanical efficiency and propulsion technique. Eleven Participants in the variable practice group and 12 participants in the control group performed an identical pre-test and a post-test. Pre- and post-test were performed in a wheelchair on a motor-driven treadmill (1.11 m/s) at a relative power output of 0.23 W/kg. Energy consumption and the propulsion technique variables with their respective coefficient of variation were calculated. Between the pre- and the post-test the variable practice group received 7 practice sessions. During the practice sessions participants performed one-hour of variable practice, consisting of five wheelchair-skill tasks and a 30 min wheelchair basketball game. The control group did not receive any practice between the pre- and the post-test. Comparison of the pre- and the post-test showed that the variable practice group significantly improved the mechanical efficiency (4.5 ± 0.6% → 5.7 ± 0.7%) in contrast to the control group (4.5 ± 0.6% → 4.4 ± 0.5%) (group x time interaction effect p < 0.001).With regard to propulsion technique, both groups significantly reduced the push frequency and increased the contact angle of the hand with the handrim (within group, time effect). No significant group × time interaction effects were found for propulsion technique. With regard to propulsion variability, the variable practice group increased variability when compared to the control group (interaction effect p < 0.001). Compared to a control, variable practice, resulted in an increase in mechanical efficiency and increased variability. Interestingly, the large relative improvement in mechanical efficiency was concomitant with only moderate improvements in the propulsion technique, which were similar in the control group, suggesting that other factors besides propulsion technique contributed to the lower energy expenditure.
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Ferguson, Melanie; Brandreth, Marian; Brassington, William; Wharrad, Heather
2015-09-01
An educational intervention to improve knowledge of hearing aids and communication in first-time hearing aid users was assessed. This intervention was based on the concept of reusable learning objects (RLOs). A randomized controlled trial was conducted. One group received the educational intervention, and the other acted as a control group. RLOs were delivered online and through DVD for television and personal computer. Knowledge of both practical and psychosocial aspects of hearing aids and communication was assessed using a free-recall method 6 weeks postfitting. Knowledge of both practical and psychosocial issues was significantly higher in the group that received the RLOs than in the control group. Moderate to large effect sizes indicated that these differences were clinically significant. An educational intervention that supplements clinical practice results in improved knowledge in first-time hearing aid users.
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About the Early Detection Research Group | Division of Cancer Prevention
The Early Detection Research Group supports research that seeks to determine the effectiveness, operating characteristics and clinical impact (harms as well as benefits) of cancer early detection technologies and practices, such as imaging and molecular biomarker approaches. The group ran two large-scale early detection trials for which data and biospecimens are available
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Udani, Ankeet Deepak; Harrison, T Kyle; Mariano, Edward R; Derby, Ryan; Kan, Jack; Ganaway, Toni; Shum, Cynthia; Gaba, David M; Tanaka, Pedro; Kou, Alex; Howard, Steven K
2016-01-01
Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation. Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded. Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001). In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.
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Walking the Talk in Initial Teacher Education: Making Teacher Educator Modeling Effective
ERIC Educational Resources Information Center
Hogg, Linda; Yates, Anne
2013-01-01
This self-study investigated student teachers' perceptions of teacher educators modeling practices within a large lecture class in an initial teacher education program. It also studied factors that affected student teachers' developing ideas and practice. Phase 1 collected data from student teachers through focus group interviews and…
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Blooming Flowers: A Case for Developmentally Appropriate Practice
ERIC Educational Resources Information Center
Vengopal, Kalpana
2015-01-01
Early Childhood Education in India derives its premise from its sociocultural context. In spite of policies in place for developmentally and contextually appropriate Early Childhood Education, the practices are largely detrimental for this age group. The ray of hope, amidst such a scenario are a few initiatives, one such being the rural preschool…
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The T.M.R. Data Dictionary: A Management Tool for Data Base Design
Ostrowski, Maureen; Bernes, Marshall R.
1984-01-01
In January 1981, a dictionary-driven ambulatory care information system known as TMR (The Medical Record) was installed at a large private medical group practice in Los Angeles. TMR's data dictionary has enabled the medical group to adapt the software to meet changing user needs largely without programming support. For top management, the dictionary is also a tool for navigating through the system's complexity and assuring the integrity of management goals.
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Mind-Body Practices and the Adolescent Brain: Clinical Neuroimaging Studies
Sharma, Anup; Newberg, Andrew B
2016-01-01
Background Mind-Body practices constitute a large and diverse group of practices that can substantially affect neurophysiology in both healthy individuals and those with various psychiatric disorders. In spite of the growing literature on the clinical and physiological effects of mind-body practices, very little is known about their impact on central nervous system (CNS) structure and function in adolescents with psychiatric disorders. Method This overview highlights findings in a select group of mind-body practices including yoga postures, yoga breathing techniques and meditation practices. Results Mind-body practices offer novel therapeutic approaches for adolescents with psychiatric disorders. Findings from these studies provide insights into the design and implementation of neuroimaging studies for adolescents with psychiatric disorders. Conclusions Clinical neuroimaging studies will be critical in understanding how different practices affect disease pathogenesis and symptomatology in adolescents. Neuroimaging of mind-body practices on adolescents with psychiatric disorders will certainly be an open and exciting area of investigation. PMID:27347478
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Casalino, Lawrence P; Chenven, Norman
2017-03-01
Value-based purchasing (VBP) favors provider organizations large enough to accept financial risk and develop care management infrastructure. Independent Practice Associations (IPAs) are a potential alternative for physicians to becoming employed by a hospital or large medical group. But little is known about IPAs. We selected four IPAs that vary in location, structure, and strategy, and conducted interviews with their president and medical director, as well as with a hospital executive and health plan executive familiar with that IPA. The IPAs studied vary in size and sophistication, but overall are performing well and are highly regarded by hospital and health plan executives. IPAs can grow rapidly without the cost of purchasing and operating physician practices and make it possible for physicians to remain independent in their own practices while providing the scale and care management infrastructure to make it possible to succeed in VBP. However, it can be difficult for IPAs to gain cooperation from hundreds to thousands of independent physicians, and the need for capital for growth and care management infrastructure is increasing as VBP becomes more prevalent and more demanding. Some IPAs are succeeding at VBP. As VBP raises the performance bar, IPAs will have to demonstrate that they can achieve results equal to more highly capitalized and tightly structured large medical groups and hospital-owned practices. Physicians should be aware of IPAs as a potential option for participating in VBP. Payers are aware of IPAs; the Medicare ACO program and health insurer ACO programs include many IPAs. Copyright © 2016 Elsevier Inc. All rights reserved.
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Bini, Stefano A; Mahajan, John
2016-11-01
Little is known about the implementation rate of clinical practice guidelines (CPGs). Our purpose was to report on the adoption rate of CPGs created and implemented by a large orthopedic group using the Delphi consensus method. The draft CPGs were created before the group's annual meeting by 5 teams each assigned a subset of topics. The draft guidelines included a statement and a summary of the available evidence. Each guideline was debated in both small-group and plenary sessions. Voting was anonymous and a 75% supermajority was required for passage. A Likert scale was used to survey the patient's experience with the process at 1 week, and the Kirkpatrick evaluation model was used to gauge the efficacy of the process over a 6-month time frame. Eighty-five orthopedic surgeons attended the meeting. Fifteen guidelines grouped into 5 topics were created. All passed. Eighty-six percent of attendees found the process effective and 84% felt that participating in the process made it more likely that they would adopt the guidelines. At 1 week, an average of 62% of attendees stated they were practicing the guideline as written (range: 35%-72%), and at 6 months, 96% stated they were practicing them (range: 82%-100%). We have demonstrated that a modified Delphi method for reaching consensus can be very effective in both creating CPGs and leading to their adoption. Further we have shown that the process is well received by participants and that an inclusionary approach can be highly successful. Copyright © 2016 Elsevier Inc. All rights reserved.
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Physician response to the United Mine Workers' cost-sharing program: the other side of the coin.
Fahs, M C
1992-01-01
The effect of cost sharing on health services utilization is analyzed from a new perspective, that is, its effects on physician response to cost sharing. A primary data set was constructed using medical records and billing files from a large multispecialty group practice during the three-year period surrounding the introduction of cost sharing to the United Mine Workers Health and Retirement Fund. This same group practice also served an equally large number of patients covered by United Steelworkers' health benefit plans, for which similar utilization data were available. The questions addressed in this interinsurer study are: (1) to what extent does a physician's treatment of medically similar cases vary, following a drop in patient visits as a result of cost sharing? and (2) what is the impact, if any, on costs of care for other patients in the practice (e.g., "spillover effects" such as cost shifting)? Answers to these kinds of questions are necessary to predict the effects of cost sharing on overall health care costs. A fixed-effects model of physician service use was applied to data on episodes of treatment for all patients in a private group practice. This shows that the introduction of cost sharing to some patients in a practice does, in fact, increase the treatment costs to other patients in the same practice who remain under stable insurance plans. The analysis demonstrates that when the economic effects of cost sharing on physician service use are analyzed for all patients within a physician practice, the findings are remarkably different from those of an analysis limited to those patients directly affected by cost sharing. PMID:1563952
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Let your name be known. OB-GYN practice's marketing strategies keep it prominent in community.
Schneck, Lisa H
2003-08-01
Take a large dose of innovation, add a dollop of shrewd business sense and a heaping measure of community awareness, mix well, and you get the marketing success enjoyed by San Dimas Medical Group Inc. of Bakersfield, Calif. The practice has established wide name recognition, become a community benefactor and positioned itself as the practice that local women want to visit for a wide range of health concerns.
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Rhodes, Karin V; Basseyn, Simon; Gallop, Robert; Noll, Elizabeth; Rothbard, Aileen; Crits-Christoph, Paul
2016-11-01
The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008-2011. Determine whether the CCI impacted the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. Analysis of Medicaid claims using difference-in-difference regression analyses to compare changes in utilization and costs for patients treated at CCI practices to propensity score-matched patients treated at comparison non-CCI practices. Ninety-six CCI practices in Pennsylvania and 60 non-CCI practices during the same time period. A total of 11,105 comorbid Medicaid patients treated in CCI practices and an equal number of propensity-matched comparison patients treated in non-CCI practices. Changes in total per-patient costs from 1 year prior to 1 year following an index episode period. Secondary outcomes included utilization and costs for emergency department (ED), inpatient, and outpatient services. The CCI group experienced an average adjusted total cost savings of $4145.28 per patient per year (P = 0.023) for the CCI relative to the non-CCI group. This was largely driven by a $3521.15 savings (P = 0.046) in inpatient medical costs, in addition to relative savings in outpatient psychiatric ($21.54, P < 0.001) and substance abuse service costs ($16.42, P = 0.013), compared to the non-CCI group. The CCI group, related to the non-CCI group, had decreases in expected mean counts of ED visits (for those who had any) and psychiatric hospitalizations of 15.6 (95 % CI: -21, -9) and 40.7 (95 % CI: -57, -18) percentage points respectively. We do not measure quality of care and cannot make conclusions about the overall cost-effectiveness or long-term effects of the CCI. The CCI was associated with substantial cost savings, attributable primarily to reduced inpatient costs, among a high-risk group of Medicaid patients, who may disproportionally benefit from care management in patient-centered medical homes.
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Carlos, Ruth C; Sicks, JoRean D; Chang, George J; Lyss, Alan P; Stewart, Teresa L; Sung, Lillian; Weaver, Kathryn E
2017-12-01
Cancer care spans the spectrum from screening and diagnosis through therapy and into survivorship. Delivering appropriate care requires patient transitions across multiple specialties, such as primary care, radiology, and oncology. From the program's inception, the National Cancer Institute Community Oncology Research Program (NCORP) sites were tasked with conducting cancer care delivery research (CCDR) that evaluates structural, organizational, and social factors, including care transitions that determine patient outcomes. The aim of this study is to describe the capacity of the NCORP to conduct multidisciplinary CCDR that includes radiology and primary care practices. The NCORP includes 34 community and 12 minority and underserved community sites. The Landscape Capacity Assessment was conducted in 2015 across these 46 sites, composed of the 401 components and subcomponents designated to conduct CCDR. Each respondent had the opportunity to designate an operational practice group, defined as a group of components and subcomponents with common care practices and resources. The primary outcomes were the proportion of adult oncology practice groups with affiliated radiology and primary care practices. The secondary outcomes were the proportion of those affiliated radiology and primary care groups that participate in research. Eighty-seven percent of components and subcomponents responded to at least some portion of the assessment, representing 230 practice groups. Analyzing the 201 adult oncology practice groups, 85% had affiliated radiologists, 69% of whom participate in research. Seventy-nine percent had affiliated primary care practitioners, 31% of whom participate in research. Institutional size, multidisciplinary group practice, and ownership by large regional or multistate health systems was associated with research participation by affiliated radiology and primary care groups. Research participation by these affiliated specialists was not significantly different between the community and the minority and underserved community sites. Research relationships exist between the majority of community oncology sites and affiliated radiology practices. Research relationships with affiliated primary care practices lagged. NCORP as a whole has the opportunity to encourage continued and expanded engagement where relationships exist. Where no relationship exists, the NCORP can encourage recruitment, particularly of primary care practices as partners. Copyright © 2017. Published by Elsevier Inc.
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Gray, Doug; Dawson, Kristin L; Grey, Todd C; McMahon, William M
2011-12-01
Utah is among a group of Western Mountain states in which suicide rates among youths are consistently high. The Utah Youth Suicide Study incorporated data from every government agency in Utah, utilizing a statewide Office of the Medical Examiner. A key finding was that 63% of suicide decedents had contact with the juvenile courts. The group developed a best practices model within the juvenile court system for early mental health intervention. Significant cost savings were demonstrated. The model includes screening at-risk teenagers with the Youth Outcome Questionnaire. Treatment includes both psychiatric care and in-home behavioral intervention. Services were effectively delivered on a large scale.
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ERIC Educational Resources Information Center
Patel, Vimla L.; Branch, Timothy; Gutnik, Lily; Arocha, Jose F.
2006-01-01
High-risk behavior in youths related to HIV transmission continues to occur despite large-scale efforts to disseminate information about safe sexual practices through education. Our study examined the relationships among knowledge, decision-making strategies, and risk assessment about HIV by youths during peer group focused discussions. Two focus…
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ERIC Educational Resources Information Center
Bierema, Andrea M.-K.; Schwarz, Christina V.; Stoltzfus, Jon R.
2017-01-01
National calls for improving science education (e.g., "Vision and Change") emphasize the need to learn disciplinary core ideas through scientific practices. To address this need, we engaged small groups of students in developing diagrammatic models within two (one large-enrollment and one medium-enrollment) undergraduate introductory…
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Transactional Analysis and the Student Personnel Worker
ERIC Educational Resources Information Center
Hickerson, J. Douglas
1973-01-01
This article cites reasons why Transactional Analysis (as described in Harris' book I'm Okay - You're Okay) is uniquely suited for group mental health counseling in student populations. Ideal in its emphasis on group counseling (the only kind practical for large student masses), its teaching-learning method, and its simplicity of language T.A.…
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A Community of Practice Model for Introducing Mobile Tablets to University Faculty
ERIC Educational Resources Information Center
Drouin, Michelle; Vartanian, Lesa Rae; Birk, Samantha
2014-01-01
We examined the effectiveness of a community of practice (CoP) model for introducing tablets to 139 faculty members at a higher education institution. Using a CoP within a systems model, we used large- and small-group mentorship to foster collaboration among faculty members. Most faculty members agreed that the project was well organized and…
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Adedokun, Omolola A; Plonski, Paula; Jenkins-Howard, Brooke; Cotterill, Debra B; Vail, Ann
2018-06-01
To evaluate the impact of the University of Kentucky's Healthy Choices for Every Body (HCEB) adult nutrition education curriculum on participants' food resource management (FRM) skills and food safety practices. A quasi-experimental design was employed using propensity score matching to pair 8 intervention counties with 8 comparison counties. Independent-samples t tests and ANCOVA models compared gains in FRM skills and food safety practices between the intervention and comparison groups (n = 413 and 113, respectively). Propensity score matching analysis showed a statistical balance and similarities between the comparison and intervention groups. Food resource management and food safety gain scores were statistically significantly higher for the intervention group (P < .001), with large effect sizes (d = 0.9) for both variables. The group differences persisted even after controlling for race and age in the ANCOVA models. The HCEB curriculum was effective in improving the FRM skills and food safety practices of participants. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
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Student's perception about innovative teaching learning practices in Forensic Medicine.
Gupta, Sanjay; Parekh, Utsav N; Ganjiwale, Jaishree D
2017-11-01
Since decades, Forensic Medicine is mainly taught by didactic methods but in last couple of years some other teachinglearning and assessment methods are also introduced at some places which also lacks uniformity. Feedback from learners is most fundamental aspect to assess effectiveness of applied methods, but is not implemented in practice at most medical schools in India. Unfortunately, medical students are deprived of this practical empowerment and thus may not be efficient enough to contribute potentially to the justice system during their professional life. In order to improve their efficiency in the field, we introduced few innovative teaching-learning methods and documented their perceptions. This pilot study was carried out with students who had completed their second professional year (5th semester) of medical curriculum. Students were exposed to few innovative teaching-learning and assessment approaches in addition to conventional methods during their Forensic Medicine term. These approaches were interactivity in large group lecturing, small group activities, student led objective tutorial, court visit in real scenario, practical records book, surprise tests, structured theory question papers, model answers, objective structured practical examinations and structured oral viva. Their perceptions were documented later through structured questionnaire. Students reported all methods as 'interesting' except 'surprise tests'. Court visits were rated highest for generating interest (98%). Clarity of concept was experienced through all methods (range of 71-95%). Interactive large group lectures reported highest (by 95%students) for clarifying concepts, although this is not a typical characteristic of large group teaching. Enhanced learning experience was reported in 75-92.5% for different methods. Student Led Objective Tutorials seemed to facilitate enhance learning most (92.5%). Innovations in teaching-learning are need of hour especially in subject like Forensic Medicine which has direct implications to add into administration of justice in the court of law. This pilot study has given us ideas for making teaching-learning and assessment more student centric considering emerging societal needs. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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Gamm, Larry; Bolin, Jane Nelson; Kash, Bita A
2005-01-01
Four large rural multispecialty group practice systems employ a mix of organizational technologies to provide chronic disease management with measurable impacts on their patient populations and costs. Four technologies-administrative, clinical, information, and social-are proposed as key dimensions for examining disease management programs. The benefits of disease management are recognized by these systems despite marked variability in the organization of the programs. Committees spanning health plans and clinics in the 4 systems and electronic medical records and/or other disease management information systems are important coordinating mechanisms. Increased reliance on nurses for patient education and care coordination in all 4 systems reflects significant extension of clinical and social technologies in the management of patient care. The promise of disease management as offered by these systems and other auspices are considered.
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Drug users in contact with general practice.
Robertson, J R
1985-01-05
A group of heroin users who are in contact with a general practice in north west Edinburgh are described. The study group was younger and included more women than previous studies. These people used a large variety of drugs and mainly purchased them locally. Frequent and often prolonged abstinent periods occurred with no prescribed opiate treatment. The group had experienced a high rate of drug related medical disorders. All these points raise the possibility that opiate users who are known to general practitioners may be a distinctly different population from those who attend drug dependency clinics. The frequency of remission and the prevalence of polydrug use have profound implications for planning and evaluating an effective medical response.
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ERIC Educational Resources Information Center
Garrett Dikkers, Amy
2015-01-01
This mixed-method study reports perspectives of virtual school teachers on the impact of online teaching on their face-to-face practice. Data from a large-scale survey of teachers in the North Carolina Virtual Public School (n = 214), focus groups (n = 7), and interviews (n = 5) demonstrate multiple intersections between online and face-to-face…
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Applying Best Business Practices from Corporate Performance Management to DoD
2013-01-01
leading or governing large, complex corporations and are experienced in creating reliable solutions to complex management issues guided by best business ...recommendations and effective solutions aimed at improving DoD. Defense Business Board Corporate Performance Management REPORT FY13-03 Task...Group 1 Applying Best Business Practices from Corporate Performance Management to DoD TASK The Deputy Secretary of Defense (DEPSECDEF
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Brunero, Scott; Lamont, Scott
2012-03-01
Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
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ERIC Educational Resources Information Center
Gray, Sarah K.
2015-01-01
In recent years, media, health organizations and researchers have raised concern over the health of Canadian children and adolescents. Stakeholders have called on the government to confront the problem. Schools are seen as an ideal location for developing and implementing large-scale interventions because of the ease of access to large groups of…
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Supporting practice teachers to identify failing students.
Skingley, Ann; Arnott, J; Greaves, J; Nabb, J
2007-01-01
The subject of identifying and supporting failing students in community nursing education programmes has been largely overlooked in the literature, yet is of great concern to practice teachers. This article discusses the views on the topic of a group of practice teachers in the light of existing, related research and proposes a number of indicators for good practice. It is suggested that of central importance is the need for higher education institutions and practice teachers to work together in identifying students causing concern at an early stage in their studies, based on both objective and subjective observations, and to have in place documented procedures to be followed when such situations arise.
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Law and psychiatry. Doing forensic work, II: fees, billing, and collections.
Reid, William H
2012-05-01
Forensic practice fees, billing, and collection procedures are quite different from those in general psychiatry. Most forensic practices have far fewer "clients," and individual bills are usually larger. Collections are usually better (and less frequently discounted) in forensic practice, and resolving billing disputes is far more straightforward. Medicare, Medicaid, other insurance coverage, provider networks and agreements, procedure codes, and diagnosis-related groups (DRGs) are all largely irrelevant in forensic work (although sometimes important to direct clinical services in correctional psychiatry or forensic treatment clinics). An understanding of the practicalities and ethics of charging and billing for forensic services greatly simplifies practice management.
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Improving coding accuracy in an academic practice.
Nguyen, Dana; O'Mara, Heather; Powell, Robert
2017-01-01
Practice management has become an increasingly important component of graduate medical education. This applies to every practice environment; private, academic, and military. One of the most critical aspects of practice management is documentation and coding for physician services, as they directly affect the financial success of any practice. Our quality improvement project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. Design: single group, pretest-posttest. military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess improvement between 2 intervention periods, both aggregate and by year group. Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. Didactic teaching and small group discussion sessions did not improve overall coding accuracy in a residency practice. Future interventions could focus on educating providers at the individual level.
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White, Jay; Shenoy, B Vittal; Tutrone, Ronald F; Karsh, Lawrence I; Saltzstein, Daniel R; Harmon, William J; Broyles, Dennis L; Roddy, Tamra E; Lofaro, Lori R; Paoli, Carly J; Denham, Dwight; Reynolds, Mark A
2018-04-01
Deciding when to biopsy a man with non-suspicious DRE findings and tPSA in the 4-10 ng/ml range can be challenging, because two-thirds of such biopsies are typically found to be benign. The Prostate Health Index (phi) exhibits significantly improved diagnostic accuracy for prostate cancer detection when compared to tPSA and %fPSA, however only one published study to date has investigated its impact on biopsy decisions in clinical practice. An IRB approved observational study was conducted at four large urology group practices using a physician reported two-part questionnaire. Physician recommendations were recorded before and after receiving the phi test result. A historical control group was queried from each site's electronic medical records for eligible men who were seen by the same participating urologists prior to the implementation of the phi test in their practice. 506 men receiving a phi test were prospectively enrolled and 683 men were identified for the historical control group (without phi). Biopsy and pathological findings were also recorded for both groups. Men receiving a phi test showed a significant reduction in biopsy procedures performed when compared to the historical control group (36.4% vs. 60.3%, respectively, P < 0.0001). Based on questionnaire responses, the phi score impacted the physician's patient management plan in 73% of cases, including biopsy deferrals when the phi score was low, and decisions to perform biopsies when the phi score indicated an intermediate or high probability of prostate cancer (phi ≥36). phi testing significantly impacted the physician's biopsy decision for men with tPSA in the 4-10 ng/ml range and non-suspicious DRE findings. Appropriate utilization of phi resulted in a significant reduction in biopsy procedures performed compared to historical patients seen by the same participating urologists who would have met enrollment eligibility but did not receive a phi test.
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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.
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Interactive large-group teaching in a dermatology course.
Ochsendorf, F R; Boehncke, W-H; Sommerlad, M; Kaufmann, R
2006-12-01
This is a prospective study to find out whether an interactive large-group case-based teaching approach combined with small-group bedside teaching improves student satisfaction and learning outcome in a practical dermatology course. During two consecutive terms a rotating system of large-group interactive case-study-method teaching with two tutors (one content expert, one process facilitator) and bedside teaching with randomly appointed tutors was evaluated with a nine-item questionnaire and multiple-choice test performed at the beginning and the end of the course (n = 204/231 students evaluable). The results of three different didactic approaches utilized over the prior year served as a control. The interactive course was rated significantly better (p < 0.0001) than the standard course with regard to all items. The aggregate mark given by the students for the whole course was 1.58-0.61 (mean +/- SD, range 1 (good)-5 (poor)). This was significantly better than the standard course (p < 0.0001) and not different from small-group teaching approaches. The mean test results in the final examination improved significantly (p < 0.01). The combination of large-group interactive teaching and small-group bedside teaching was well accepted, improved the learning outcome, was rated as good as a small-group didactic approach and needed fewer resources in terms of personnel.
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Newbould, Jennifer; Abel, Gary; Ball, Sarah; Corbett, Jennie; Elliott, Marc; Exley, Josephine; Martin, Adam; Saunders, Catherine; Wilson, Edward; Winpenny, Eleanor; Yang, Miaoqing; Roland, Martin
2017-09-27
Objective To evaluate a "telephone first" approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data. Participants 147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England. Intervention Management support for workload planning and introduction of the telephone first approach provided by two commercial companies. Main outcome measures Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies' protocols. Results After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices -38%, 95% confidence interval -45% to -29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval -1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs. Conclusions The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Rand, Miya K.; Rentsch, Sebastian
2016-01-01
This study examined adaptive changes of eye-hand coordination during a visuomotor rotation task under the use of terminal visual feedback. Young adults made reaching movements to targets on a digitizer while looking at targets on a monitor where the rotated feedback (a cursor) of hand movements appeared after each movement. Three rotation angles (30°, 75° and 150°) were examined in three groups in order to vary the task difficulty. The results showed that the 30° group gradually reduced direction errors of reaching with practice and adapted well to the visuomotor rotation. The 75° group made large direction errors of reaching, and the 150° group applied a 180° reversal shift from early practice. The 75°and 150° groups, however, overcompensated the respective rotations at the end of practice. Despite these group differences in adaptive changes of reaching, all groups gradually adapted gaze directions prior to reaching from the target area to the areas related to the final positions of reaching during the course of practice. The adaptive changes of both hand and eye movements in all groups mainly reflected adjustments of movement directions based on explicit knowledge of the applied rotation acquired through practice. Only the 30° group showed small implicit adaptation in both effectors. The results suggest that by adapting gaze directions from the target to the final position of reaching based on explicit knowledge of the visuomotor rotation, the oculomotor system supports the limb-motor system to make precise preplanned adjustments of reaching directions during learning of visuomotor rotation under terminal visual feedback. PMID:27812093
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Paying physician group practices for quality: A statewide quasi-experiment.
Conrad, Douglas A; Grembowski, David; Perry, Lisa; Maynard, Charles; Rodriguez, Hector; Martin, Diane
2013-12-01
This article presents the results of a unique quasi-experiment of the effects of a large-scale pay-for-performance (P4P) program implemented by a leading health insurer in Washington state during 2001-2007. The authors received external funding to provide an objective impact evaluation of the program. The program was unique in several respects: (1) It was designed dynamically, with two discrete intervention periods-one in which payment incentives were based on relative performance (the "contest" period) and a second in which payment incentives were based on absolute performance compared to achievable benchmarks. (2) The program was designed in collaboration with large multispecialty group practices, with an explicit run-in period to test the quality metrics. Public reporting of the quality scorecard for all participating medical groups was introduced 1 year before the quality incentive payment program's inception, and continued throughout 2002-2007. (3) The program was implemented in stages with distinct medical groups. A control group of comparable group practices also was assembled, and difference-in-differences methodology was applied to estimate program effects. Case mix measures were included in all multivariate analyses. The regression design permitted a contrast of intervention effects between the "contest" approach in the sub-period of 2003-2004 and the absolute standard, "achievable benchmarks of care" approach in sub-period 2005-2007. Most of the statistically significant quality incentive program coefficients were small and negative (opposite to program intent). A consistent pattern of differential intervention impact in the sub-periods did not emerge. Cumulatively, the probit regression estimates indicate that neither the quality scorecard nor the quality incentive payment program had a significant positive effect on general clinical quality. Based on key informant interviews with medical leaders, practicing physicians, and administrators of the participating groups, the authors conclude that several factors likely combined to dampen program effects: (1) modest size of the incentive; (2) use of rewards only, rather than a balance of rewards and penalties; (3) targeting incentive payments to the group, thus potentially weakening incentive effects at the individual level. Copyright © 2013 Elsevier Inc. All rights reserved.
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ERIC Educational Resources Information Center
Thamuku, Masego; Daniel, Marguerite
2013-01-01
In the context of AIDS, the Botswana Government has adopted a group therapy program to help large numbers of orphaned children cope with bereavement. This study explores the effectiveness of the therapy and examines how it interacts with cultural attitudes and practices concerning death. Ten orphaned children were involved in five rounds of data…
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Enhancing performance expectancies through visual illusions facilitates motor learning in children.
Bahmani, Moslem; Wulf, Gabriele; Ghadiri, Farhad; Karimi, Saeed; Lewthwaite, Rebecca
2017-10-01
In a recent study by Chauvel, Wulf, and Maquestiaux (2015), golf putting performance was found to be affected by the Ebbinghaus illusion. Specifically, adult participants demonstrated more effective learning when they practiced with a hole that was surrounded by small circles, making it look larger, than when the hole was surrounded by large circles, making it look smaller. The present study examined whether this learning advantage would generalize to children who are assumed to be less sensitive to the visual illusion. Two groups of 10-year olds practiced putting golf balls from a distance of 2m, with perceived larger or smaller holes resulting from the visual illusion. Self-efficacy was increased in the group with the perceived larger hole. The latter group also demonstrated more accurate putting performance during practice. Importantly, learning (i.e., delayed retention performance without the illusion) was enhanced in the group that practiced with the perceived larger hole. The findings replicate previous results with adult learners and are in line with the notion that enhanced performance expectancies are key to optimal motor learning (Wulf & Lewthwaite, 2016). Copyright © 2017 Elsevier B.V. All rights reserved.
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Nonlinear dissipative devices in structural vibration control: A review
NASA Astrophysics Data System (ADS)
Lu, Zheng; Wang, Zixin; Zhou, Ying; Lu, Xilin
2018-06-01
Structural vibration is a common phenomenon existing in various engineering fields such as machinery, aerospace, and civil engineering. It should be noted that the effective suppression of structural vibration is conducive to enhancing machine performance, prolonging the service life of devices, and promoting the safety and comfort of structures. Conventional linear energy dissipative devices (linear dampers) are largely restricted for wider application owing to their low performance under certain conditions, such as the detuning effect of tuned mass dampers subjected to nonstationary excitations and the excessively large forces generated in linear viscous dampers at high velocities. Recently, nonlinear energy dissipative devices (nonlinear dampers) with broadband response and high robustness are being increasingly used in practical engineering. At the present stage, nonlinear dampers can be classified into three groups, namely nonlinear stiffness dampers, nonlinear-stiffness nonlinear-damping dampers, and nonlinear damping dampers. Corresponding to each nonlinear group, three types of nonlinear dampers that are widely utilized in practical engineering are reviewed in this paper: the nonlinear energy sink (NES), particle impact damper (PID), and nonlinear viscous damper (NVD), respectively. The basic concepts, research status, engineering applications, and design approaches of these three types of nonlinear dampers are summarized. A comparison between their advantages and disadvantages in practical engineering applications is also conducted, to provide a reference source for practical applications and new research.
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Hadjipanayis, Adamos; Grossman, Zachi; Del Torso, Stefano; van Esso, Diego; Dornbusch, Hans Juergen; Mazur, Artur; Drabik, Anna; Montini, Giovanni
2015-04-01
To describe current practice among European paediatricians regarding diagnosis and management of urinary tract infections in children aged 1-36 months and to compare these practices with recently published guidelines. Web-based large scale survey evaluating knowledge of, attitudes towards and the methods for diagnosing, treating and managing urinary tract infections in children. Primary and secondary care practices in Europe. 1129 paediatricians. A diagnosis of urinary tract infection is considered by 62% of the respondents in children aged 1-36 months with unexplained fever. The preferred method of urine collection is use of a bag (53% for infants <3 months and 59% for children 4-36 months of age). 60% of paediatricians agree that oral and parenteral antibiotics have equal efficacy. Co-amoxiclav is the antibiotic of choice for 41% of participants, while 9% prescribe amoxicillin. 80% of respondents prescribe ultrasound in all children with a confirmed urinary tract infection. 63% of respondents prescribe a cystography when abnormalities are revealed during ultrasound evaluation. A quarter of respondents recommend antibiotic prophylaxis for all children with any vesicoureteral reflux. The data among European countries are very heterogeneous. The three most recent urinary tract infection guidelines (the National Institute for Health and Care Excellence (NICE), the American Academy of Paediatrics and the Italian Society of Paediatric Nephrology) are not followed properly. Management of febrile urinary tract infections remains controversial and heterogeneous in Europe. Simple, short, practical and easy-to-remember guidelines and educational strategies to ensure their implementation should be developed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Neurophysiological correlates of visuo-motor learning through mental and physical practice.
Allami, Nadia; Brovelli, Andrea; Hamzaoui, El Mehdi; Regragui, Fakhita; Paulignan, Yves; Boussaoud, Driss
2014-03-01
We have previously shown that mental rehearsal can replace up to 75% of physical practice for learning a visuomotor task (Allami, Paulignan, Brovelli, & Boussaoud, (2008). Experimental Brain Research, 184, 105-113). Presumably, mental rehearsal must induce brain changes that facilitate motor learning. We tested this hypothesis by recording scalp electroencephalographic activity (EEG) in two groups of subjects. In one group, subjects executed a reach to grasp task for 240 trials. In the second group, subjects learned the task through a combination of mental rehearsal for the initial 180 trials followed by the execution of 60 trials. Thus, one group physically executed the task for 240 trials, the other only for 60 trials. Amplitudes and latencies of event-related potentials (ERPs) were compared across groups at different stages during learning. We found that ERP activity increases dramatically with training and reaches the same amplitude over the premotor regions in the two groups, despite large differences in physically executed trials. These findings suggest that during mental rehearsal, neuronal changes occur in the motor networks that make physical practice after mental rehearsal more effective in configuring functional networks for skilful behaviour. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Reflective practice: a framework for case manager development.
Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia
2011-01-01
The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.
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Baxter, Louisa; Nash, David B
2013-01-01
Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.
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Exploring the experiences and expectations of year 1 children's nursing students.
Wright, Jackie; Wray, Jane
2012-05-01
Attrition among children's nursing students remains high despite the field of practice attracting large numbers of applicants. While previous studies have examined nursing students as a group, this study specifically examines the children's nursing student experience. To explore the expectations and early experiences of children's nursing students. A phenomenological approach was adopted. Four focus groups were conducted at the beginning and end of the first year of a three-year programme. The students defined children's nursing by the age and needs of the client group. They had expected practice experience would solely be within the acute setting. The acquisition and confidence in undertaking psychomotor skills was of importance to this group of students. The students' unmet expectations may have a negative effect on their experience of the programme and therefore potentially on their decision to continue on the programme.
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Olsen, Catherine M; Thompson, Bridie S; Green, Adèle C; Neale, Rachel E; Whiteman, David C
2015-09-01
Primary prevention and early detection are integral strategies to reduce the burden of skin cancer. To describe the prevalence of sun protection and skin examination practices in a population exposed to high levels of ambient solar radiation and to identify associated factors. Cross-sectional analyses of baseline data from a prospective cohort of 40,172 adults aged 40 through 69 years from Queensland, Australia, recruited in 2011. We obtained data on all melanoma diagnoses through 2009 via record linkage with the Queensland Cancer Registry (notifications have been mandatory since 1982). We calculated prevalence proportion ratios to compare prevalence of sun protection and skin examination practices in 3 separate groups: those with a history of melanoma (group 1), those with a self-reported history of treated actinic lesions (group 2), and those without either (group 3). We used multivariate generalized linear models to identify factors associated with each practice. Participants with a previously confirmed melanoma (group 1; n = 1433) and/or treated actinic lesions (group 2; n = 24,006) were more likely than those without (group 3; n = 14,733) to report sun protection practices, including regular use of sunscreen (53.3%, 45.1%, and 38.1%, respectively) and wearing hats (74.7%, 68.2%, and 58.2%, respectively). They were also more likely to have had a whole-body skin examination by a physician in the past 3 years (93.7%, 83.4%, and 52.1%, respectively). Within all 3 groups, the strongest association with sun protection practices was with sun-sensitive skin type. Within group 3 (no history of treated skin lesions), the strongest factor associated with clinical skin examinations was self-reported nevus density at 21 years of age, whereas a family history of melanoma was a significant factor in groups 2 and 3. In this large sample exposed to high levels of ambient solar radiation, sun protection and skin examination practices were most frequent among those with a history of treated skin lesions or sun-sensitive skin types.
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Practice management companies improve practices' financial position.
Dupell, T
1997-11-01
To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.
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The embodiment of tourism among bisexually-behaving Dominican male sex workers.
Padilla, Mark B
2008-10-01
While theories of "structure" and social inequality have increasingly informed global health efforts for HIV prevention--with growing recognition of the linkages between large-scale political and economic factors in the distribution and impact of the HIV/AIDS epidemic--there is still little theorization of precisely how structural factors shape the very bodies and sexualities of specific populations and groups. In order to extend the theoretical understanding of these macro-micro linkages, this article examines how the growth of the tourism industry in the Dominican Republic has produced sexual practices and identities that reflect both the influence of large-scale structural processes and the resistant responses of local individuals. Drawing on social science theories of political economy, embodiment, and authenticity, I argue that an understanding of patterns of sexuality and HIV risk in the region requires analysis of how political-economic transformations related to tourism intersect with the individual experiences and practices of sexuality on the ground. The analysis draws on long-term ethnographic research with bisexually behaving male sex workers in two cities in the Dominican Republic, including participant observation, in-depth interviews, focus groups, and surveys. By examining the global and local values placed on these men's bodies and the ways sex workers use their bodies to broker tourists' pleasure, we may better understand how the large-scale structures of the tourism industry are linked to the specific meanings and practices of sexuality.
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Physicians’ Perceptions of Autonomy across Practice Types: Is Autonomy in Solo Practice a Myth?
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
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Physicians' perceptions of autonomy across practice types: Is autonomy in solo practice a myth?
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.
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Prepaid group practice staffing and U.S. physician supply: lessons for workforce policy.
Weiner, Jonathan P
2004-01-01
This paper describes staffing at eight large prepaid group practices (PGPs) serving more than eight million enrollees at Kaiser Permanente and two other health maintenance organizations (HMOs). Even after characteristics of the patient populations and outside referrals are accounted for, these PGPs have a physician-to-population ratio that is 22-37 percent below the national rate. Two decades of historical data at Kaiser Permanente indicate that its rate of specialist growth was far higher than that of primary care. The study suggests that efficient systems of care can readily meet the demands of patient populations with workforce staffing ratios below current U.S. levels.
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NASA Astrophysics Data System (ADS)
Chien, Yu-Ta; Chang, Chun-Yen
2012-02-01
This study developed three forms of computer-based multimedia, including Static Graphics (SG), Simple Learner-Pacing Animation (SLPA), and Full Learner-Pacing Animation (FLPA), to assist students in learning topographic measuring. The interactive design of FLPA allowed students to physically manipulate the virtual measuring mechanism, rather than passively observe dynamic or static images. The students were randomly assigned to different multimedia groups. The results of a one-way ANOVA analysis indicated that (1) there was a significant difference with a large effect size ( f = .69) in mental effort ratings among three groups, and the post-hoc test indicated that FLPA imposed less cognitive load on students than did SG ( p = .007); (2) the differences of practical performance scores among groups reached the statistic significant level with a large effect size ( f = .76), and the post-hoc test indicated that FLPA fostered better learning outcomes than both SLPA and SG ( p = .004 and p = .05, respectively); (3) the difference in instructional efficiency that was computed by the z-score combination of students' mental effort ratings and practical performance scores among the three groups obtained the statistic significant level with a large effect size ( f = .79), and the post-hoc test indicated that FLPA brought students higher instructional efficiency than those of both SLPA and SG ( p = .01 and .005, respectively); (4) no significant effect was found in instructional time-spans between groups ( p = .637). Overall, FLPA was recommended as the best multimedia form to facilitate topographic measurement learning. The implications of instructional multimedia design were discussed from the perspective of cognitive load theory.
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Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L
2018-03-31
To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.
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Memory Transmission in Small Groups and Large Networks: An Agent-Based Model.
Luhmann, Christian C; Rajaram, Suparna
2015-12-01
The spread of social influence in large social networks has long been an interest of social scientists. In the domain of memory, collaborative memory experiments have illuminated cognitive mechanisms that allow information to be transmitted between interacting individuals, but these experiments have focused on small-scale social contexts. In the current study, we took a computational approach, circumventing the practical constraints of laboratory paradigms and providing novel results at scales unreachable by laboratory methodologies. Our model embodied theoretical knowledge derived from small-group experiments and replicated foundational results regarding collaborative inhibition and memory convergence in small groups. Ultimately, we investigated large-scale, realistic social networks and found that agents are influenced by the agents with which they interact, but we also found that agents are influenced by nonneighbors (i.e., the neighbors of their neighbors). The similarity between these results and the reports of behavioral transmission in large networks offers a major theoretical insight by linking behavioral transmission to the spread of information. © The Author(s) 2015.
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ERIC Educational Resources Information Center
Keddie, Amanda
2014-01-01
This paper explores issues of equity and group identity at "Hamilton Court," a large comprehensive multi-faith and multi-cultural school located in England. The exploration draws on data gathered from a study that examined the conditions, structures and practices associated with productively addressing issues of justice and cultural…
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Enrichment options for African painted dogs (Lycaon pictus).
Cloutier, Tammy L; Packard, Jane M
2014-01-01
Best practices for carnivore enrichment encourage the diversity of species-typical behaviors, increased activity, and reduced stereotypic behavior; ideally considering the life-history and behavior of each species. African wild dogs (Lycaon pictus), or painted dogs, are social carnivores that have large home ranges and complex pack dynamics (e.g., variation in group size, relatedness, etc.). As there are relatively few studies on painted dog enrichment, the goal of this study was to compile a list of enrichment options used by institutions participating in the species survival plan (SSP). Representatives were asked to describe social groups (n = 45), enclosures (n = 21), enrichment practices (options, delivery frequency, perceived success), and overall best practices. Respondents (61%, n = 23) reported using options for all six enrichment categories recommended by the Canid Taxon Advisory Group: environmental enrichment devices, habitat, sensory, food, behavioral, and social. Perceived success was significantly higher for the food category, followed by the sensory and behavioral categories. All respondents reported delivering enrichment at least multiple times a month, and most reported multiple times per week. Enclosure size did not differ significantly for mixed-sex groups (n = 28) compared to single-sex groups (n = 17). We discuss respondents' suggestions for best practices and the need to record data to compare perceived success with actual behavioral effects, controlling for variation in group size and composition. Overall, respondents recommended a flexible approach, since not all painted dogs and groups respond in the same way to the enrichment options. © 2014 Wiley Periodicals, Inc.
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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
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Huntink, Elke; van Lieshout, Jan; Aakhus, Eivind; Baker, Richard; Flottorp, Signe; Godycki-Cwirko, Maciek; Jäger, Cornelia; Kowalczyk, Anna; Szecsenyi, Joachim; Wensing, Michel
2014-12-06
Tailored strategies to implement evidence-based practice can be generated in several ways. In this study, we explored the usefulness of group interviews for generating these strategies, focused on improving healthcare for patients with chronic diseases. Participants included at least four categories of stakeholders (researchers, quality officers, health professionals, and external stakeholders) in five countries. Interviews comprised brainstorming followed by a structured interview and focused on different chronic conditions in each country. We compared the numbers and types of strategies between stakeholder categories and between interview phases. We also determined which strategies were actually used in tailored intervention programs. In total, 127 individuals participated in 25 group interviews across five countries. Brainstorming generated 8 to 120 strategies per group; structured interviews added 0 to 55 strategies. Healthcare professionals and researchers provided the largest numbers of strategies. The type of strategies for improving healthcare practice did not differ systematically between stakeholder groups in four of the five countries. In three out of five countries, all components of the chosen intervention programs were mentioned by the group of researchers. Group interviews with different stakeholder categories produced many strategies for tailored implementation of evidence-based practice, of which the content was largely similar across stakeholder categories.
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Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach.
McCoy, Lise; Pettit, Robin K; Kellar, Charlyn; Morgan, Christine
2018-01-01
Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.
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Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach
McCoy, Lise; Pettit, Robin K; Kellar, Charlyn; Morgan, Christine
2018-01-01
Background: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Methods: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Results: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. Conclusions: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction. PMID:29707649
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Financial incentives for quality in breast cancer care.
Tisnado, Diana M; Rose-Ash, Danielle E; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L
2008-07-01
To examine the use of financial incentives related to performance on quality measures reported by oncologists and surgeons associated with a population-based cohort of patients with breast cancer in Los Angeles County, California, and to explore the physician and practice characteristics associated with the use of these incentives among breast cancer care providers. Cross-sectional observational study. Physician self-reported financial arrangements from a survey of 348 medical oncologists, radiation oncologists, and surgeons caring for patients with breast cancer in Los Angeles County (response rate, 76%). Physicians were asked whether they were subject to financial incentives for quality (ie, patient satisfaction surveys and adherence to practice guidelines). We examined the prevalence and correlates of incentives and performed multivariate logistic regression analyses to assess predictors of incentives, controlling for other covariates. Twenty percent of respondents reported incentives based on patient satisfaction, and 15% reported incentives based on guideline adherence. The use of incentives for quality in this cohort of oncologists and surgeons was modest and was primarily associated with staff- or group-model health maintenance organization (HMO) settings. In other settings, important predictors were partial physician ownership interest, large practice size, and capitation. Most cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. Those who are, seem more likely to be associated with large practice settings. New approaches are needed to direct financial incentives for quality toward specialists outside of staff- or group-model HMOs if pay-for-performance programs are to succeed in influencing care.
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Stenner, Karen; Iacovou, Nicci
2006-01-01
WHAT IS ALREADY KNOWN IN THIS AREA • Research indicates that Protected Learning Time (PLT) events in primary care enable professionals to network and share ideas. • A variety of educational techniques have been shown to improve performance of: individual practitioners in other settings. • Beyond one-off examples, there is little published evidence that PLT helps to improve practice. WHAT THIS WORK ADDS • It describes a range of ways in which PLT has impacted on practice at the level of the individual, the team and the wider organisation. • It highlights the main benefits of large event PLT according to participants at a Berkshire initiative. The benefits include increased awareness of services, increased understanding of illnesses and improved treatment. SUGGESTIONS FOR FUTURE RESEARCH • Do large PLT events have different outcomes from practice-based PLT? • How does PLT impact on the development of a learning culture? • How can large; learning events best meet the needs of different groups of professionals? • What impact, if any, does the closure of surgeries for PLT have on use of out-of-hours services or subsequent workload?
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Hawn, Carleen
2009-01-01
If you want a glimpse of what health care could look like a few years from now, consider "Hello Health," the Brooklyn-based primary care practice that is fast becoming an emblem of modern medicine. A paperless, concierge practice that eschews the limitations of insurance-based medicine, Hello Health is popular and successful, largely because of the powerful and cost-effective communication tools it employs: Web-based social media. Indeed, across the health care industry, from large hospital networks to patient support groups, new media tools like weblogs, instant messaging platforms, video chat, and social networks are reengineering the way doctors and patients interact.
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Brownie, Sonya
2013-06-01
To explore older people's views about how getting older has influenced their dietary practices. Focus groups with independently living residents aged 60 years and older in northern NSW, Australia. An inductive approach to thematic analysis was used. Five focus groups (n= 29) were conducted. The majority of participants were women (79%), mean age 73 years. The main findings were that reduced ability to eat large meals; health maintenance and disease management; food messages; food taste and convenience; and living arrangements appear to impact food choices and eating behaviour in this sample. In the presence of reduced and/or modified food intake, older people might benefit from an understanding of the concept of nutrient density in order to help them attain and maintain nutritional adequacy. Lifelong exposure to food messages (sometimes conflicting) resulted in many participants feeling confused about appropriate dietary practices for this age group. © 2012 The Author; Australasian Journal on Ageing © 2012 ACOTA.
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IRRIGATION PRACTICES IN LONG-TERM SURVIVORS OF COLORECTAL CANCER (CRC) WITH COLOSTOMIES
Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.
2014-01-01
Creation of a colostomy in colorectal (CRC) cancer patients results in a loss of control over bowel evacuation. The only way to re-establish some control is through irrigation, a procedure that involves instilling fluid into the bowel to allow for gas and fecal output. This article reports on irrigation practices of participants in a large, multi-site, multi-investigator study of health-related quality of life (HR-QOL) in long term CRC survivors. Questions about irrigation practices were identified in open-ended questions within a large HR-QOL survey and in focus groups of men and women with high and low HR-QOL. Descriptive data on survivors were combined with content analysis of irrigation knowledge and practices. Patient education and use of irrigation in the United States has decreased over the years, with no clear identification of why this change in practice has occurred. Those respondents who used irrigation had their surgery longer ago, and spent more time in colostomy care than those that did not irrigate. Reasons for the decrease in colostomy irrigation are unreported and present priorities for needed research. PMID:23022935
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Todd, E Michelle; Torrence, Brett S; Watts, Logan L; Mulhearn, Tyler J; Connelly, Shane; Mumford, Michael D
2017-01-01
In order to delineate best practices for courses on research ethics, the goal of the present effort was to identify themes related to instructional methods reflected in effective research ethics and responsible conduct of research (RCR) courses. By utilizing a qualitative review, four themes relevant to instructional methods were identified in effective research ethics courses: active participation, case-based activities, a combination of individual and group approaches, and a small number of instructional methods. Three instructional method themes associated with less effective courses were also identified: passive learning, a group-based approach, and a large number of instructional methods. Key characteristics of each theme, along with example courses relative to each theme, are described. Additionally, implications regarding these instructional method themes and recommendations for best practices in research ethics courses are discussed.
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LeBlanc, Thomas W.; Abernethy, Amy P.; Currow, David C.; Kutner, Jean S.
2014-01-01
Purpose of Review The nature of palliative care practice, especially the reliance on referrals and differing models of service delivery, poses unique challenges for the creation and interpretation of an evidence base, frequently limiting the applicability of data to patient care. Here we discuss two core aspects of clinical trials reporting in palliative medicine: 1) proposed standards governing the collection and reporting of data, and 2) rules governing authorship and publication. Recent Findings Existing literature often inadequately describes the characteristics of patients, caregivers, clinicians, systems, and interventions included in studies, thereby limiting the utility of results. Summary A generalizability framework is needed to ensure a robust evidence base that advances practice. Lessons learned through the development of research cooperative groups in palliative care reinforce the importance of an authorship protocol for large trials and working groups. PMID:23080306
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ERIC Educational Resources Information Center
Chace, Sarah Valentine
2013-01-01
This study undertook to examine the effects of a unique leadership-training program on one group of urban school superintendents. This two-year program, called the Program for Leading Superintendents (PLS), was largely based on concepts of Heifetz's adaptive leadership model. The purpose of the research on the effects of this program was to…
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Khunti, K; Goyder, E; Baker, R
1999-01-01
BACKGROUND: Different methods have been used to determine the prevalence and treatment of diabetes. Despite the large number of studies, previous estimations of prevalence and treatment have been carried out on relatively small numbers of patients, and then in only a few practices in single geographical regions. AIM: To investigate the feasibility of collating data from multi-practice audits organized by primary care audit groups in order to estimate the prevalence and treatment of patients with known diabetes, and to discuss the methodological issues and reasons for variation. METHOD: A postal questionnaire survey of all primary care audit groups in England and Wales that had conducted a multi-practice audit of diabetes between 1993-1995. Prevalence rates and patterns of diabetic care were compared with other community-based surveys of known diabetes from 1986-1996 identified on MEDLINE. RESULTS: Twenty-five (43%) audit groups supplied data from multi-practice audits of diabetes. Seven (28%) multi-practice audits involving 259 practices fulfilled the inclusion criteria for prevalence estimation. The overall prevalence of diabetes based on a population of 1,475,512 patients was 1.46% (range between audit groups = 1.18% to 1.66%; chi 2 = 308; df = 6; P < 0.0001). Male to female ratio was 1.15:1. Treatment of diabetes could be ascertained for 10 (40%) audit groups comprising 319 practices. Of these, 23.4% (range = 16.5%-27.4%) were controlled by diet, 48.5% (range = 43.6%-55.8%) were prescribed oral hypoglycaemic drugs, and 28.2% (range = 25.0%-32.4%) were treated with insulin. There were significant variations between audit groups in treatment pattern (chi 2 = 250; df = 18; P < 0.0001). CONCLUSION: Prevalence and treatment rates of diabetes and other chronic diseases can be assessed and compared using data from multi-practice audits. Collation of audit data could improve the precision of quantitative estimates of health status in populations. A standard method of data recording and collection may provide a new approach that could considerably improve our ability to monitor disease and its management. PMID:10736888
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A qualitative study of medical students in a rural track: views on eventual rural practice.
Roseamelia, Carrie; Greenwald, James L; Bush, Tiffany; Pratte, Morgan; Wilcox, Jessica; Morley, Christopher P
2014-04-01
Rural tracks (RTs) exist within medical schools across the United States. These programs often target those students from rural areas and those with primary care career interests, given that these factors are robust predictors of eventual rural practice. However, only 26% to 64% of graduates from RTs enter eventual rural practice. We conducted a qualitative, exploratory study of medical students enrolled in one school's RT, examining their interests in rural training, specialization, and eventual rural practice, via open coding of transcripts from focus groups and in-depth individual interviews, leading to identification of emerging themes. A total of 16 out of 54 eligible first- and second-year preclinical medical students participated in focus group sessions, and a total of seven out of 17 eligible third- and fourth-year medical students participated in individual interviews. Analyses revealed the recognition of a "Rural Identity," typical characteristics, and the importance of "Program Fit" and "Intentions for Practice" that trended toward family medicine specialization and rural practice. However, nuances within the comments reveal incomplete commitment to rural practice. In many cases, student preference for rural practice was driven largely by a disinterest in urban practice. Students with rural and primary care practice interests are often not perfectly committed to rural practice. However, RTs may provide a haven for such students within medical school.
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A comparison of surgical assisting in a prepaid group practice and a community hospital.
Lewit, E M; Bentkover, J D; Bentkover, S H; Watkins, R N; Hughes, E F
1980-09-01
Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.
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Branding an anatomic pathology practice to build revenue.
Johnson, Paul
2004-01-01
Innovative Pathology Services (IPS) is an Associate Practice of Pathology Service Associates (PSA). PSA is an organization known as the "Business Solution for Pathology." IPS provides pathology services to nine hospitals, including two large tertiary-care medical centers, a progressive and renowned children's hospital, a cancer survival center, five surgery centers, and numerous physician's offices and clinics throughout east Tennessee. We accept specimen referrals from other pathology practices and providers from across the country. The center of operations is in Knoxville, a mid-sized metropolitan district. Until January 1, 2003, we were known as Knoxville Pathology Group (KPG). We renamed our practice because KPG did not reflect our service area, was limiting by perception, barely distinguished us from other groups, and did not describe our culture and philosophy. IPS is a new name for a well-established pathology group with a solid foundation and a long history of providing services at the point-of-care. As such, we offer all services that we offered through our foundation practice, and, in addition, these services were enhanced and new services were added. Our entire "team" and, in particular, the pathologists, were involved in the successful "branding" of IPS. Whether you are an independent anatomic pathology or clinical laboratory or you are hospital based, you may benefit from our experiences detailed in this article.
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Clark, Thomas R
2008-09-01
To understand the importance of services provided by consultant pharmacists and to assess perception of their performance of services. Cross-sectional; nursing facility team. Random e-mail survey of consultant pharmacists; phone survey of team members. 233 consultant pharmacists (practicing in a nursing facility); 540 team members (practicing in a nursing facility, interacting with > or = 1 consultant pharmacist): 120 medical directors, 210 directors of nursing, 210 administrators. Consultant pharmacists, directors of nursing, medical directors, and administrators rating importance/performance of 21 services. Gap between teams' ratings of importance and consultant pharmacists' performance is assessed to categorize services. Importance/performance ranked on five-point scale. Mean scores used for gap analysis to cluster services into four categories. Per combined group, six services categorized as "Keep It Up" (important, good performance), consensus with individual groups, except discrepancy with medical directors, for one service. Six services each categorized as "Improve" (important, large gap) and "Improve Second" (lower importance, large gap), with varied responses by individual groups. Three different services were categorized into "Don't Worry," with consensus within individual groups. Consensus from all groups found 5 of 21 services are important and performed well by consultant pharmacists, indicating to maintain performance of services. For three services, consultant pharmacists do not need to worry about their performance. Thirteen services require improvement in consultant pharmacists' performance; various groups differ on extent of improvement needed. Results can serve as benchmark comparisons with results obtained by consultant pharmacists in their own facilities.
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Marketing Practices of Vapor Store Owners
Gowin, Mary; Wann, Taylor Franklin
2015-01-01
Objectives. We examined the marketing strategies for local vapor stores in a large metropolitan area in Oklahoma. Methods. Vapor store owners or managers (n = 33) participated in individual interviews regarding marketing practices in 2014. We asked owners about their marketing strategies and the groups they targeted. We transcribed the interviews and analyzed them for themes. Results. Store owners used a variety of marketing strategies to bring new customers to their stores and keep current customers coming back. These marketing strategies showed many parallels to tobacco industry strategies. Most owners engaged in some form of traditional marketing practices (e.g., print media), but only a few used radio or television advertising because of budget constraints. Owners used social media and other forms of electronic communication, pricing discounts and specials, and loyalty programs. Owners also had booths at local events, sponsored community events, and hosted them in their stores. Owners attempted to target different groups of users, such as college students and long-term smokers. Conclusions. Local vapor store marketing practices closely resemble current and former tobacco industry marketing strategies. Surveillance of marketing practices should include local and Web-based strategies. PMID:25880960
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Marketing practices of vapor store owners.
Cheney, Marshall; Gowin, Mary; Wann, Taylor Franklin
2015-06-01
We examined the marketing strategies for local vapor stores in a large metropolitan area in Oklahoma. Vapor store owners or managers (n = 33) participated in individual interviews regarding marketing practices in 2014. We asked owners about their marketing strategies and the groups they targeted. We transcribed the interviews and analyzed them for themes. Store owners used a variety of marketing strategies to bring new customers to their stores and keep current customers coming back. These marketing strategies showed many parallels to tobacco industry strategies. Most owners engaged in some form of traditional marketing practices (e.g., print media), but only a few used radio or television advertising because of budget constraints. Owners used social media and other forms of electronic communication, pricing discounts and specials, and loyalty programs. Owners also had booths at local events, sponsored community events, and hosted them in their stores. Owners attempted to target different groups of users, such as college students and long-term smokers. Local vapor store marketing practices closely resemble current and former tobacco industry marketing strategies. Surveillance of marketing practices should include local and Web-based strategies.
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Wardle, Jonathan Lee; Sarris, Jerome
2014-06-01
Complementary medicine is forming an increasingly large part of health care in developed countries and is increasingly being formally taught in tertiary academic settings. An exploratory study of naturopathic student perceptions of, use of and attitudes towards teaching resources in naturopathic clinical training and education. Focus groups were conducted with current and recent students of 4-year naturopathic degree programmes in Brisbane and Sydney to ascertain how they interact with clinical teaching materials, and their perceptions and attitudes towards teaching materials in naturopathic education. Naturopathic students have a complex and critical relationship with their learning materials. Although naturopathic practice is often defined by traditional evidence, students want information that both supports and is critical of traditional naturopathic practices, and focuses heavily on evidence-based medicine. Students remain largely ambivalent about new teaching technologies and would prefer that these develop organically as an evolution from printed materials, rather than depart from dramatically and radically from these previously established materials. Findings from this study will assist publishers, librarians and academics develop clinical information sources that appropriately meet student expectations and support their learning requirements. © 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group.
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Brotzman, R L; Döpfer, D; Foy, M R; Hess, J P; Nordlund, K V; Bennett, T B; Cook, N B
2015-11-01
A survey of management practices was conducted to investigate potential associations with groupings of herds formed by cluster analysis (CA) of Dairy Herd Improvement (DHI) data of 557 Upper Midwest herds of 200 cows or greater. Differences in herd management practices were identified between the groups, despite underlying similarities; for example, freestall housing and milking in a parlor. Group 6 comprised larger herds with a high proportion of primiparous cows and most frequently utilized practices promoting increased production [e.g., 84.4% used recombinant bovine somatotropin (rbST)], decreased lameness (e.g., 96.9% used routine hoof trimming for cows), and improved efficiency in reproduction [e.g., 93.8% synchronized the first breeding in cows (SYNCH)] and labor (e.g., mean ± SD, 67 ± 19 cows per 50-h per week full-time equivalent worker). Group 1 had the best mean DHI performances and followed most closely group 6 for the rate of adoption of intensive management practices while tending to outperform group 6 despite a generally smaller mean herd size (e.g., 42.3 ± 3.6 kg vs. 39.9 ± 3.6 kg of energy-corrected milk production; 608 ± 352 cows vs. 1,716 ± 1,405 cows). Group 2 were smaller herds with relatively high levels of performance that used less intensive management (e.g., 100% milked twice daily) and less technology (33.3 vs. 73.0% of group 1 used rbST). Group 4 were smaller but poorer-performing herds with low turnover and least frequently used intensive management practices (e.g., 39.1% SYNCH; 30.4% allowed mature, high-producing cows access to pasture). Group 5 used modern technologies and practices associated with improved production, yet had the least desirable mean DHI performance of all 6 groups. This group had the lowest proportion of deep loose-bedded stalls (only 52.2% used sand bedding) and the highest proportion (34.8%) of herds not using routine hoof trimming. The survey of group 3 herds did not reveal strong trends in management. The differences identified between herd groupings confirm significant variation in management practices linked to variation in overall herd performance measured by DHI variables. This approach provides an opportunity for consultants and outreach educators to better tailor efforts toward a certain type of dairy management philosophy, rather than taking a blanket approach to applying recommendations to farms simply because of their larger herd size. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
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Achieving Greater Musical Independence in Ensembles through Cognitive Apprenticeship
ERIC Educational Resources Information Center
Weidner, Brian N.
2018-01-01
Musical independence is a common objective for large-ensemble classes, but traditional, teacher-centric instructional practices for these groups may discourage rather than promote students' critical thinking and decision making in music. Cognitive apprenticeship provides an instructional approach through which student musicians can develop skills…
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Pre-Service Teachers and Classroom Authority
ERIC Educational Resources Information Center
Pellegrino, Anthony M.
2010-01-01
This study examined the classroom practices of five pre-service teachers from three secondary schools in a large southeastern state. Through classroom observations, survey responses, reviews of refection logs, and focus-group interview responses, we centered on the issue of developing classroom authority as a means to effective classroom…
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Solo and Small Practices: A Vital, Diverse Part of Primary Care.
Liaw, Winston R; Jetty, Anuradha; Petterson, Stephen M; Peterson, Lars E; Bazemore, Andrew W
2016-01-01
Solo and small practices are facing growing pressure to consolidate. Our objectives were to determine (1) the percentage of family physicians in solo and small practices, and (2) the characteristics of and services provided by these practices. A total of 10,888 family physicians seeking certification through the American Board of Family Medicine in 2013 completed a demographic survey. Their practices were split into categories by size: solo, small (2 to 5 providers), medium (6 to 20 providers), and large (more than 20 providers). We also determined the rurality of the county where the physicians practiced. We developed 2 logistic regression models: one assessed predictors of practicing in a solo or small practice, while the other was restricted to solo and small practices and assessed predictors of practicing in a solo practice. More than one-half of respondents worked in solo or small practices. Small practices were the largest group (36%) and were the most likely to be located in a rural setting (20%). The likelihood of having a care coordinator and medical home certification increased with practice size. Physicians were more likely to be practicing in small or solo practices (vs medium-sized or large ones) if they were African American or Hispanic, had been working for more than 30 years, and worked in rural areas. Physicians were more likely to be practicing in small practices (vs solo ones) if they worked in highly rural areas. Family physicians in solo and small practices comprised the majority among all family physicians seeking board certification and were more likely to work in rural geographies. Extension programs and community health teams have the potential to support transformation within these practices. © 2016 Annals of Family Medicine, Inc.
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Solo and Small Practices: A Vital, Diverse Part of Primary Care
Liaw, Winston R.; Jetty, Anuradha; Petterson, Stephen M.; Peterson, Lars E.; Bazemore, Andrew W.
2016-01-01
PURPOSE Solo and small practices are facing growing pressure to consolidate. Our objectives were to determine (1) the percentage of family physicians in solo and small practices, and (2) the characteristics of and services provided by these practices. METHODS A total of 10,888 family physicians seeking certification through the American Board of Family Medicine in 2013 completed a demographic survey. Their practices were split into categories by size: solo, small (2 to 5 providers), medium (6 to 20 providers), and large (more than 20 providers). We also determined the rurality of the county where the physicians practiced. We developed 2 logistic regression models: one assessed predictors of practicing in a solo or small practice, while the other was restricted to solo and small practices and assessed predictors of practicing in a solo practice. RESULTS More than one-half of respondents worked in solo or small practices. Small practices were the largest group (36%) and were the most likely to be located in a rural setting (20%). The likelihood of having a care coordinator and medical home certification increased with practice size. Physicians were more likely to be practicing in small or solo practices (vs medium-sized or large ones) if they were African American or Hispanic, had been working for more than 30 years, and worked in rural areas. Physicians were more likely to be practicing in small practices (vs solo ones) if they worked in highly rural areas. CONCLUSIONS Family physicians in solo and small practices comprised the majority among all family physicians seeking board certification and were more likely to work in rural geographies. Extension programs and community health teams have the potential to support transformation within these practices. PMID:26755778
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Sun safety knowledge and practice in UK postal delivery workers.
Houdmont, J; Davis, S; Griffiths, A
2016-06-01
Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK. To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group. Postal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics. A total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics. There is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine.
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Family physicians’ perspectives on care of dementia patients and family caregivers
Yaffe, Mark J.; Orzeck, Pam; Barylak, Lucy
2008-01-01
ABSTRACT OBJECTIVE To identify factors that facilitate or impede family physicians in ambulatory care of patients with dementia and the family caregivers of such patients. DESIGN Explanatory qualitative analyses of focus group discussions. SETTING Large, medium, and small urban; suburban; and rural family practices from various regions of the province of Quebec. PARTICIPANTS Twenty-five family doctors whose practices had at least 75% ambulatory patients; of these patients, an estimated minimum of 20% were 65 years old or older and at least 2% suffered from dementia. METHOD Physicians were recruited by telephone to be paid participants in their regions in focus groups studying aspects of dementia care in ambulatory settings. Grounded theory and constant comparative methods were used to explore data from 3 French-speaking focus groups and 1 English-speaking focus group. MAIN FINDINGS Physicians were 72% male, had a mean of 21.3 years in practice, and spent about 87% of their professional time in office practice. An estimated 38.7% of their patients were 65 years old or older, and 5.6% of these patients had Alzheimer disease or related dementias. Physicians were comfortable caring for these patients and their family caregivers but thought much of this care should come from support services offered elsewhere. Physicians admitted they had little knowledge of these services and had little interest in acquiring information about them. Government-run, community-based health and social service centres were the “black boxes” to which they referred patients and their caregivers for any form of help. Inconsistencies in the services offered by these centres were noted. CONCLUSION While family doctors are seeking a more seamless form of interdisciplinary dementia care, a large amount of that care comes from support services about which physicians are not well informed and are not interested in learning. PMID:18625826
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SU-E-T-257: Output Constancy: Reducing Measurement Variations in a Large Practice Group
DOE Office of Scientific and Technical Information (OSTI.GOV)
Hedrick, K; Fitzgerald, T; Miller, R
2014-06-01
Purpose: To standardize output constancy check procedures in a large medical physics practice group covering multiple sites, in order to identify and reduce small systematic errors caused by differences in equipment and the procedures of multiple physicists. Methods: A standardized machine output constancy check for both photons and electrons was instituted within the practice group in 2010. After conducting annual TG-51 measurements in water and adjusting the linac to deliver 1.00 cGy/MU at Dmax, an acrylic phantom (comparable at all sites) and PTW farmer ion chamber are used to obtain monthly output constancy reference readings. From the collected charge reading,more » measurements of air pressure and temperature, and chamber Ndw and Pelec, a value we call the Kacrylic factor is determined, relating the chamber reading in acrylic to the dose in water with standard set-up conditions. This procedure easily allows for multiple equipment combinations to be used at any site. The Kacrylic factors and output results from all sites and machines are logged monthly in a central database and used to monitor trends in calibration and output. Results: The practice group consists of 19 sites, currently with 34 Varian and 8 Elekta linacs (24 Varian and 5 Elekta linacs in 2010). Over the past three years, the standard deviation of Kacrylic factors measured on all machines decreased by 20% for photons and high energy electrons as systematic errors were found and reduced. Low energy electrons showed very little change in the distribution of Kacrylic values. Small errors in linac beam data were found by investigating outlier Kacrylic values. Conclusion: While the use of acrylic phantoms introduces an additional source of error through small differences in depth and effective depth, the new standardized procedure eliminates potential sources of error from using many different phantoms and results in more consistent output constancy measurements.« less
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Professional development in inquiry-based science for elementary teachers of diverse student groups
NASA Astrophysics Data System (ADS)
Lee, Okhee; Hart, Juliet E.; Cuevas, Peggy; Enders, Craig
2004-12-01
As part of a larger project aimed at promoting science and literacy for culturally and linguistically diverse elementary students, this study has two objectives: (a) to describe teachers' initial beliefs and practices about inquiry-based science and (b) to examine the impact of the professional development intervention (primarily through instructional units and teacher workshops) on teachers' beliefs and practices related to inquiry-based science. The research involved 53 third- and fourth-grade teachers at six elementary schools in a large urban school district. At the end of the school year, teachers reported enhanced knowledge of science content and stronger beliefs about the importance of science instruction with diverse student groups, although their actual practices did not change significantly. Based on the results of this first year of implementation as part of a 3-year longitudinal design, implications for professional development and further research are discussed.
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A Randomized Controlled Trial of COMPASS Web-Based and Face-to-Face Teacher Coaching in Autism
Ruble, Lisa A.; McGrew, John H.; Toland, Michael D.; Dalrymple, Nancy J.; Jung, Lee Ann
2013-01-01
Objective Most children with autism rely on schools as their primary source of intervention, yet research has suggested that teachers rarely use evidence-based practices. To address the need for improved educational outcomes, a previously tested consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple, & McGrew, 2010; Ruble, Dalrymple, & McGrew, 2012) was evaluated in a 2nd randomized controlled trial, with the addition of a web-based group. Method Forty-nine teacher–child dyads were randomized into 1 of 3 groups: (1) a placebo control (PBO) group, (2) COMPASS followed by face-to-face (FF) coaching sessions, and (3) COMPASS followed by web-based (WEB) coaching sessions. Three individualized goals (social, communication, and independence skills) were selected for intervention for each child. The primary outcome of independent ratings of child goal attainment and several process measures (e.g., consultant and teacher fidelity) were evaluated. Results Using an intent-to-treat approach, findings replicated earlier results with a very large effect size (d = 1.41) for the FF group and a large effect size (d = 1.12) for the WEB group relative to the PBO group. There were no differences in overall change across goal domains between the FF and WEB groups, suggesting the efficacy of videoconferencing technology. Conclusions COMPASS is effective and results in improved educational outcomes for young children with autism. Videoconferencing technology, as a scalable tool, has promise for facilitating access to autism specialists and bridging the research-to-practice gap. PMID:23438314
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NASA Astrophysics Data System (ADS)
Zhang, Gai; Tian, Min
2015-04-01
This proposed method regulated the determination of platinum, palladium, ruthenium, rhodium, iridium and gold in platinum-group ores by nickel sulfide fire assay—inductively coupled plasma optical emission spectrometry (ICP-OES) combined with ultrasound extraction for the first time. The quantitative limits were 0.013-0.023μg/g. The samples were fused to separate the platinum-group elements from matrix. The nickel sulfide button was then dissolved with hydrochloric acid and the insoluble platinum-group sulfide residue was dissolved with aqua regia by ultrasound bath and finally determined by ICP-OES. The proposed method has been applied into the determination of platinum-group element and gold in large amounts of ultrabasic rocks from the Great Dyke of Zimbabwe.
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Saunders, Hannele; Vehviläinen-Julkunen, Katri; Stevens, Kathleen R
2016-08-01
Nurses' lack of readiness for evidence-based practice slows down the uptake, adoption, and implementation of evidence-based practice which is of international concern as it impedes attainment of the highest quality of care and best patient outcomes. There is limited evidence about the most effective approaches to strengthen nurses' readiness for evidence-based practice. To evaluate the effectiveness of an Advanced Practice Nurse-delivered education program to strengthen nurses' readiness for evidence-based practice at a university hospital. A single-blind randomized controlled trial with repeated measures design, with measures completed during spring and fall 2015, before the education program (T0), within 1week after (T1), 8weeks after (T2), and 4months after completion of education interventions (T3). One large university hospital system in Finland, consisting of 15 acute care hospitals. The required sample size, calculated by a priori power analysis and including a 20% estimated attrition rate, called for 85 nurse participants to be recruited. Nurses working in different professional nursing roles and care settings were randomly allocated into two groups: intervention (evidence-based practice education, N=43) and control (research utilization education, N=34). The nurse participants received live 4-h education sessions on the basic principles of evidence-based practice (intervention group) and on the principles of research utilization (control group). The intervention group also received a web-based interactive evidence-based practice education module with a booster mentoring intervention. Readiness for evidence-based practice data, previous experience with evidence-based practice, and participant demographics were collected using the Stevens' EBP Readiness Inventory. Nurses' confidence in employing evidence-based practice and actual evidence-based practice knowledge were lower at T0, compared with the post-education scores, specifically at T1. The improvement in the confidence or actual evidence-based practice knowledge levels did not differ between the intervention and control groups. Confidence in employing evidence-based practice was directly correlated with level of education and inversely correlated with age. Actual evidence-based practice knowledge was lowest among nurses who had no previous knowledge or experience of evidence-based practice. Both the evidence-based practice and research utilization education interventions improved nurses' confidence in employing evidence-based practice and actual evidence-based practice knowledge, strengthening their evidence-based practice readiness at least in the short-term. Most of the variation in the confidence in employing evidence-based practice and actual evidence-based practice knowledge levels was due to background factors, such as primary role and education level, which emphasize differences in educational needs between nurses with diverse backgrounds. Copyright © 2016 Elsevier Inc. All rights reserved.
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Interweaving Objects, Gestures, and Talk in Context
ERIC Educational Resources Information Center
Brassac, Christian; Fixmer, Pierre; Mondada, Lorenza; Vinck, Dominique
2008-01-01
In a large French hospital, a group of professional experts (including physicians and software engineers) are working on the computerization of a blood-transfusion traceability device. By focusing on a particular moment in this slow process of design, we analyze their collaborative practices during a work session. The analysis takes a…
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Participant Observation and the Political Scientist: Possibilities, Priorities, and Practicalities
ERIC Educational Resources Information Center
Gillespie, Andra; Michelson, Melissa R.
2011-01-01
Surveys, experiments, large-"N" datasets and formal models are common instruments in the political scientist's toolkit. In-depth interviews and focus groups play a critical role in helping scholars answer important political questions. In contrast, participant observation techniques are an underused methodological approach. In this article, we…
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Confronting History: Holocaust Books for Children (Practical Reflections).
ERIC Educational Resources Information Center
Rudman, Masha Kabakow; Rosenberg, Susan P.
1991-01-01
Provides a comprehensive picture of current Holocaust literature, largely for readers age 10 and older. Describes books that look at individual responsibility, group responsibility, non-Jewish perspectives, and Jewish resistance and survivors' stories. Explores nonfiction works for varying ages, and closes with a special book that takes the form…
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Conversations around the Large Table: Building Community in a Portuguese Public Kindergarten.
ERIC Educational Resources Information Center
Vasconcelos, Teresa; Walsh, Daniel J.
2001-01-01
Analyzes how one teacher builds community in the daily life of her Portuguese public kindergarten classroom. Focuses on six themes: membership, awareness, negotiation, responsibility, ritual, and group memory. Concludes with a discussion of the teacher's practice and commitment to the community of the classroom. (Author/SD)
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Parenting Stress: Maternal & Child Health Correlates.
ERIC Educational Resources Information Center
Abidin, Richard R.; Wilfong, Ellen M.
A study was undertaken to examine the relationship among parenting stress, maternal and child health, and medical utilization. Participants were patients from a large group pediatric practice. Mothers (N=56) of patients completed the Parenting Stress Index. Twelve months after completion of the Parenting Stress Index, subjects were assessed using…
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A Self-Report Measure of Physical Activity
ERIC Educational Resources Information Center
Siegel, Donald
2005-01-01
There are multiple approaches to measuring physical activity. Among these are direct observation, electronic monitoring, direct and indirect calorimetry, and self-report instruments. Self-report instruments are the most practical and cost effective option for use with a large group. In a study by Motl, Dishman, Dowda, and Pate (2004), two groups…
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From Injustice to Indifference: The Politics of School Violence.
ERIC Educational Resources Information Center
Michaelis, Karen L.
Understanding and addressing the social structures that give rise to student violence require educators, parents, and society at large to adopt a critical, feminist perspective focusing on injustice and incorporating perspectives of marginalized students. Because practices of social groups play a critical role in self-identity, the violent actions…
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1977-11-01
past and present discriminatory practices against women in legislation, in occupational restric- tions, in educational policies, and in social ... relationships . The objective attempts to measure attitudes toward women have dealt largely with roles of women within specific occupational groups. For example
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Best practices: applying management analysis of excellence to immunization.
Wishner, Amy; Aronson, Jerold; Kohrt, Alan; Norton, Gary
2005-01-01
The authors applied business management tools to analyze and promote excellence and to evaluate differences between average and above-average immunization peformers in private practices. The authors conducted a pilot study of 10 private practices in Pennsylvania using tools common in management to assess practices' organizational climate and managerial style. Authoritative and coaching styles of physician leaders were common to both groups. Managerial styles that emphasized higher levels of clarity and responsibility managerial styles were evident in the large practices; and rewards and flexibility styles were higher in the small above-average practices. The findings of this pilot study match results seen in high performers in other industries. It concludes that the authoritative style appears to have the most impact on performance. It has interesting implications for training/behavior change to improve immunization rates, along with traditional medical interventions.
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Assessing hand hygiene resources and practices at a large african teaching hospital.
Owusu-Ofori, Alex; Jennings, Rebecca; Burgess, Jennifer; Prasad, Priya A; Acheampong, Faustina; Coffin, Susan E
2010-08-01
To gather baseline data on hand hygiene (HH) practices in an African hospital with a newly established infection prevention and control team. Cross-sectional, observational study. Setting. Komfo Anokye Teaching Hospital, a large teaching hospital in Ghana with approximately 1,000 beds. All hospital staff with patient contact were eligible for assessment of HH practices. HH observations were conducted using a standardized data collection tool and method based on the World Health Organization's "5 Moments of Hand Hygiene." Small-group interviews were conducted to gather additional information on perceptions of HH and barriers to its use. HH resource needs were also assessed using a standardized tool. HH was attempted in 12% of the opportunities and was performed appropriately in 4% of the opportunities. Most main wards (89%) had at least 1 functional HH station. The most commonly identified barriers to HH were limited resources and lack of knowledge on appropriate times to perform HH. We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.
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Increasing Childhood Influenza Vaccination
Nowalk, Mary Patricia; Lin, Chyongchiou J.; Hannibal, Kristin; Reis, Evelyn C.; Gallik, Gregory; Moehling, Krissy K.; Huang, Hsin-Hui; Allred, Norma J.; Wolfson, David H.; Zimmerman, Richard K.
2014-01-01
Background Since the 2008 inception of universal childhood influenza vaccination, national rates have risen more dramatically among younger children than older children and reported rates across racial/ethnic groups are inconsistent. Interventions may be needed to address age and racial disparities to achieve the recommended childhood influenza vaccination target of 70%. Purpose To evaluate an intervention to increase childhood influenza vaccination across age and racial groups. Methods In 2011–2012, 20 primary care practices treating children were randomly assigned to Intervention and Control arms of a cluster randomized controlled trial to increase childhood influenza vaccination uptake using a toolkit and other strategies including early delivery of donated vaccine, in-service staff meetings, and publicity. Results The average vaccination differences from pre-intervention to the intervention year were significantly larger in the Intervention arm (n=10 practices) than the Control arm (n=10 practices), for children aged 2–8 years (10.2 percentage points (pct pts) Intervention vs 3.6 pct pts Control) and 9–18 years (11.1 pct pts Intervention vs 4.3 pct pts Control, p<0.05), for non-white children (16.7 pct pts Intervention vs 4.6 pct pts Control, p<0.001), and overall (9.9 pct pts Intervention vs 4.2 pct pts Control, p<0.01). In multi-level modeling that accounted for person- and practice-level variables and the interactions among age, race and intervention, the likelihood of vaccination increased with younger age group (6–23 months), white race, commercial insurance, the practice’s pre-intervention vaccination rate, and being in the Intervention arm. Estimates of the interaction terms indicated that the intervention increased the likelihood of vaccination for non-white children in all age groups and white children aged 9–18 years. Conclusions A multi-strategy intervention that includes a practice improvement toolkit can significantly improve influenza vaccination uptake across age and racial groups without targeting specific groups, especially in practices with large percentages of minority children. PMID:25113138
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Cancer education and effective dissemination: information access is not enough.
Ousley, Anita L; Swarz, Jeffrey A; Milliken, Erin L; Ellis, Steven
2010-06-01
Education is the main avenue for disseminating new research findings into clinical practice. Understanding factors that affect translation of research into practice may help cancer educators design programs that facilitate the time it takes for research-indicated practices to become standard care. To understand various factors, the National Cancer Institute (NCI) Office of Education and Special Initiatives (OESI)(1) with individual cooperation from Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), and Association of Oncology Social Work (AOSW) administered a Practitioner Information Needs survey to five different types of practitioners involved in cancer care. While most of the 2,864 practitioners (83%) agreed they had access to current practice information, practitioners in large practice settings were more likely to report having access to research than those small practice settings. However, only 33% indicated that they had adequate time to access the information. Colleagues or experts within the organization were cited as the most frequently relied on information resource (60%), and peer-reviewed journals were cited as second (57%). Overall, 66% strongly or somewhat agreed that their organizations exhibit effective change management practices. A majority (69%) agreed that implementation of new practices is hindered by the lack of available staff time. Financial factors and the characteristics of the information presented were also believed to be factors contributing to research implementation. Group differences were observed among practitioner groups and practice settings for some factors.
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Atkins, Christiana D.; Burnett,, Harvey J.
2016-01-01
Abstract This study examined the relationship between having training in key disaster behavioral health (DBH) interventions and trauma health (compassion fatigue, burnout and compassion satisfaction), resilience, the number of crisis responses participated in within the last year, and the frequency of assembling to practice crisis interventions skills. Data was collected from a convenience sample of disaster behavioral health responders (N = 139) attending a training conference in Michigan. Measures included the Professional Quality of Life Scale, the 14-item Resilience Scale, and a demographic questionnaire. Point biserial correlations revealed that having training in large and small group crisis interventions and individual and peer crisis interventions was significantly correlated with higher resilience and lower levels of burnout. Psychological First Aid was not significantly associated with any of the trauma health variables or with resilience. Compassion fatigue and compassion satisfaction were not significantly associated with DBH training. Chi-square tests for independence found no significant association between key DBH training strategies and the number of crisis responses participated in within the past year and the frequency of assembling to practice crisis interventions skills. These findings suggest that completing training in both, large and small group and individual and peer crisis intervention techniques may help to increase resiliency and reduce burnout among disaster behavioral health providers. PMID:28229015
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Ding, Yongxia; Zhang, Peili
2018-06-12
Problem-based learning (PBL) is an effective and highly efficient teaching approach that is extensively applied in education systems across a variety of countries. This study aimed to investigate the effectiveness of web-based PBL teaching pedagogies in large classes. The cluster sampling method was used to separate two college-level nursing student classes (graduating class of 2013) into two groups. The experimental group (n = 162) was taught using a web-based PBL teaching approach, while the control group (n = 166) was taught using conventional teaching methods. We subsequently assessed the satisfaction of the experimental group in relation to the web-based PBL teaching mode. This assessment was performed following comparison of teaching activity outcomes pertaining to exams and self-learning capacity between the two groups. When compared with the control group, the examination scores and self-learning capabilities were significantly higher in the experimental group (P < 0.01) compared with the control group. In addition, 92.6% of students in the experimental group expressed satisfaction with the new web-based PBL teaching approach. In a large class-size teaching environment, the web-based PBL teaching approach appears to be more optimal than traditional teaching methods. These results demonstrate the effectiveness of web-based teaching technologies in problem-based learning. Copyright © 2018. Published by Elsevier Ltd.
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When is bigger better? The effects of group size on the evolution of helping behaviours.
Powers, Simon T; Lehmann, Laurent
2017-05-01
Understanding the evolution of sociality in humans and other species requires understanding how selection on social behaviour varies with group size. However, the effects of group size are frequently obscured in the theoretical literature, which often makes assumptions that are at odds with empirical findings. In particular, mechanisms are suggested as supporting large-scale cooperation when they would in fact rapidly become ineffective with increasing group size. Here we review the literature on the evolution of helping behaviours (cooperation and altruism), and frame it using a simple synthetic model that allows us to delineate how the three main components of the selection pressure on helping must vary with increasing group size. The first component is the marginal benefit of helping to group members, which determines both direct fitness benefits to the actor and indirect fitness benefits to recipients. While this is often assumed to be independent of group size, marginal benefits are in practice likely to be maximal at intermediate group sizes for many types of collective action problems, and will eventually become very small in large groups due to the law of decreasing marginal returns. The second component is the response of social partners on the past play of an actor, which underlies conditional behaviour under repeated social interactions. We argue that under realistic conditions on the transmission of information in a population, this response on past play decreases rapidly with increasing group size so that reciprocity alone (whether direct, indirect, or generalised) cannot sustain cooperation in very large groups. The final component is the relatedness between actor and recipient, which, according to the rules of inheritance, again decreases rapidly with increasing group size. These results explain why helping behaviours in very large social groups are limited to cases where the number of reproducing individuals is small, as in social insects, or where there are social institutions that can promote (possibly through sanctioning) large-scale cooperation, as in human societies. Finally, we discuss how individually devised institutions can foster the transition from small-scale to large-scale cooperative groups in human evolution. © 2016 Cambridge Philosophical Society.
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Practice makes perfect in memory recall
Romani, Sandro; Katkov, Mikhail
2016-01-01
A large variability in performance is observed when participants recall briefly presented lists of words. The sources of such variability are not known. Our analysis of a large data set of free recall revealed a small fraction of participants that reached an extremely high performance, including many trials with the recall of complete lists. Moreover, some of them developed a number of consistent input-position-dependent recall strategies, in particular recalling words consecutively (“chaining”) or in groups of consecutively presented words (“chunking”). The time course of acquisition and particular choice of positional grouping were variable among participants. Our results show that acquiring positional strategies plays a crucial role in improvement of recall performance. PMID:26980785
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Meehan, S K; Zabukovec, J R; Dao, E; Cheung, K L; Linsdell, M A; Boyd, L A
2013-10-01
Consolidation of motor memories associated with skilled practice can occur both online, concurrent with practice, and offline, after practice has ended. The current study investigated the role of dorsal premotor cortex (PMd) in early offline motor memory consolidation of implicit sequence-specific learning. Thirty-three participants were assigned to one of three groups of repetitive transcranial magnetic stimulation (rTMS) over left PMd (5 Hz, 1 Hz or control) immediately following practice of a novel continuous tracking task. There was no additional practice following rTMS. This procedure was repeated for 4 days. The continuous tracking task contained a repeated sequence that could be learned implicitly and random sequences that could not. On a separate fifth day, a retention test was performed to assess implicit sequence-specific motor learning of the task. Tracking error was decreased for the group who received 1 Hz rTMS over the PMd during the early consolidation period immediately following practice compared with control or 5 Hz rTMS. Enhanced sequence-specific learning with 1 Hz rTMS following practice was due to greater offline consolidation, not differences in online learning between the groups within practice days. A follow-up experiment revealed that stimulation of PMd following practice did not differentially change motor cortical excitability, suggesting that changes in offline consolidation can be largely attributed to stimulation-induced changes in PMd. These findings support a differential role for the PMd in support of online and offline sequence-specific learning of a visuomotor task and offer converging evidence for competing memory systems. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
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Laterality effects in motor learning by mental practice in right-handers.
Gentili, R J; Papaxanthis, C
2015-06-25
Converging evidences suggest that mental movement simulation and actual movement production share similar neurocognitive and learning processes. Although a large body of data is available in the literature regarding mental states involving the dominant arm, examinations for the nondominant arm are sparse. Does mental training, through motor-imagery practice, with the dominant arm or the nondominant arm is equally efficient for motor learning? In the current study, we investigated laterality effects in motor learning by motor-imagery practice. Four groups of right-hander adults mentally and physically performed as fast and accurately as possible (speed/accuracy trade-off paradigm) successive reaching movements with their dominant or nondominant arm (physical-training-dominant-arm, mental-training-dominant-arm, physical-training-nondominant-arm, and mental-training-nondominant-arm groups). Movement time was recorded and analyzed before, during, and after the training sessions. We found that physical and mental practice had a positive effect on the motor performance (i.e., decrease in movement time) of both arms through similar learning process (i.e., similar exponential learning curves). However, movement time reduction in the posttest session was significantly higher after physical practice than motor-imagery practice for both arms. More importantly, motor-imagery practice with the dominant arm resulted in larger and more robust improvements in movement speed compared to motor-imagery practice with the nondominant arm. No such improvements were observed in the control group. Our results suggest a superiority of the dominant arm in motor learning by mental practice. We discussed these findings from the perspective of the internal models theory. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.
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Gordon, Nancy P; Iribarren, Carlos
2008-09-09
Latinos are a fast growing segment of the U.S. health care population. Acculturation factors, including English fluency, result in an ethnic group heterogeneous with regard to SES, health practices, and health education needs. This study examined how demographic and health-related characteristics of Spanish-dominant (SD), Bilingual (BIL), and English-dominant (ED) Latino men and women aged 25-64 differed among members of a large Northern California health plan. This observational study was based on data from cohorts of 171 SD (requiring an interpreter), 181 BIL, and 734 ED Latinos aged 25-64 who responded to random sample health plan member surveys conducted 2005-2006. Language groups were compared separately by gender on education, income, behavioral health risks (smoking, obesity, exercise frequency, dietary practices, health beliefs), health status (overall health and emotional health, diabetes, hypertension, high cholesterol, heartburn/acid reflux, back pain, depression), computer and Internet access, and health education modality preferences. Compared with ED Latinos, higher percentages of the SD and BIL groups had very low educational attainment and low income. While groups were similar in prevalence of diabetes, hypertension, and high cholesterol, SD were less likely than ED Latinos to rate overall health and emotional well-being as good, very good, or excellent and more likely to report heartburn and back pain (women only). The groups were similar with regard to smoking and obesity, but among women, SD were more likely to be physically inactive than ED, and BIL were less likely than SD and ED groups to eat <3 servings of fruit/vegetables per day. SD and BIL of both genders were significantly less likely than ED Latinos to believe that health practices had a large impact on health. Compared to ED men and women, SD and BIL Latinos had significantly lower Internet and computer access. As a result, SD Latinos had a greater preference for lower technology health education modalities such as videos and taped phone messages. There are important differences among Latinos of different English language proficiency with regard to education, income, health status, health behaviors, IT access, and health education modality preferences that ought to be considered when planning and implementing health programs for this growing segment of the U.S. population.
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Gordon, Nancy P; Iribarren, Carlos
2008-01-01
Background Latinos are a fast growing segment of the U.S. health care population. Acculturation factors, including English fluency, result in an ethnic group heterogeneous with regard to SES, health practices, and health education needs. This study examined how demographic and health-related characteristics of Spanish-dominant (SD), Bilingual (BIL), and English-dominant (ED) Latino men and women aged 25–64 differed among members of a large Northern California health plan. Methods This observational study was based on data from cohorts of 171 SD (requiring an interpreter), 181 BIL, and 734 ED Latinos aged 25–64 who responded to random sample health plan member surveys conducted 2005–2006. Language groups were compared separately by gender on education, income, behavioral health risks (smoking, obesity, exercise frequency, dietary practices, health beliefs), health status (overall health and emotional health, diabetes, hypertension, high cholesterol, heartburn/acid reflux, back pain, depression), computer and Internet access, and health education modality preferences. Results Compared with ED Latinos, higher percentages of the SD and BIL groups had very low educational attainment and low income. While groups were similar in prevalence of diabetes, hypertension, and high cholesterol, SD were less likely than ED Latinos to rate overall health and emotional well-being as good, very good, or excellent and more likely to report heartburn and back pain (women only). The groups were similar with regard to smoking and obesity, but among women, SD were more likely to be physically inactive than ED, and BIL were less likely than SD and ED groups to eat <3 servings of fruit/vegetables per day. SD and BIL of both genders were significantly less likely than ED Latinos to believe that health practices had a large impact on health. Compared to ED men and women, SD and BIL Latinos had significantly lower Internet and computer access. As a result, SD Latinos had a greater preference for lower technology health education modalities such as videos and taped phone messages. Conclusion There are important differences among Latinos of different English language proficiency with regard to education, income, health status, health behaviors, IT access, and health education modality preferences that ought to be considered when planning and implementing health programs for this growing segment of the U.S. population. PMID:18782454
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Modern medical practice: a profession in transition.
Merry, M D
1984-05-01
Modern medical practice is in a state of transition. The solo practitioner is slowly giving way to the large organized groups of health care providers. Driving this force of change is a change in payment for health care services from cost plus to preestablished pricing. For the first time, medical practice patterns are having a direct impact on the financial viability of the health care institution. To maintain quality of patient care and contain costs, more and more physicians are becoming involved in the administrative side of running a hospital. This article describes the forces of change, the change itself, and the future of medicine.
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Sivagnanam, G; Namasivayam, K; Rajasekaran, M; Thirumalaikolundusubramanian, P; Ravindranath, C
2002-04-01
The aim of this study was to determine and compare the knowledge, beliefs, and practices of diabetics receiving free medical care and those paying for medical care in Tamilnadu, India. A questionnaire was administered to elicit diabetic patients' knowledge regarding diet, exercise, adverse effects, habits, and other matters; their beliefs about diabetes; and their practices regarding diet, medication, and self-monitoring. The results showed a large gap between knowledge and action in both groups and a need for increased efforts toward patient education regarding diabetes.
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Models of practice organisation using dental therapists: English case studies.
Sun, N; Harris, R V
2011-08-12
A new dental remuneration system based on bands of activity has changed the reward system operating in dental practices and influenced practitioner behaviour in relation to the delegation of tasks to English dental therapists (DTs). Since dental practitioners operate as independent contractors they are free to innovate. A variety of models incorporating DTs in general practice teams exist, some of which may overcome the apparent delegation constraints embedded within this system of remuneration. To describe the way different practices are organised to take account of DTs in their teams and identify whether any of these models address delegation disincentives arising from the system of remuneration. A purposive sample of six dental practices was identified, comprising two small, two medium and two large dental practices, including a variety of models of practice organisation. Semi-structured interviews were carried out with principal dentists, associate dentists, DTs, practice managers and dental hygienists (35 participants in total). A thematic analysis was applied to interview transcripts. The six dental practices demonstrated six different models of practice organisation which could be grouped into 'practice payment' and 'dentist payment' models according to whether the salary costs of the DT were met by a central practice fund or from the income of individual dentists in the team. In both of the large practices only some of the dentists in the team referred work to the DT because of reimbursement issues. In two practices the system was perceived to be satisfactory to all parties, one of these being a single-handed practice with two DTs. Although the remuneration system contained some potential disincentives to DT delegation, some practices innovated in their organisations to overcome these issues.
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NASA Astrophysics Data System (ADS)
Risnawati; Khairinnisa, S.; Darwis, A. H.
2018-01-01
The purpose of this study was to develop a CORE model-based worksheet with recitation task that were valid and practical and could facilitate students’ communication skills in Linear Algebra course. This study was conducted in mathematics education department of one public university in Riau, Indonesia. Participants of the study were media and subject matter experts as validators as well as students from mathematics education department. The objects of this study are students’ worksheet and students’ mathematical communication skills. The results of study showed that: (1) based on validation of the experts, the developed students’ worksheet was valid and could be applied for students in Linear Algebra courses; (2) based on the group trial, the practicality percentage was 92.14% in small group and 90.19% in large group, so the worksheet was very practical and could attract students to learn; and (3) based on the post test, the average percentage of ideals was 87.83%. In addition, the results showed that the students’ worksheet was able to facilitate students’ mathematical communication skills in linear algebra course.
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NASA Astrophysics Data System (ADS)
Lawlor, John; Conneely, Claire; Tangney, Brendan
The poor assimilation of ICT in formal education is firmly rooted in models of learning prevalent in the classroom which are largely teacher-led, individualistic and reproductive, with little connection between theory and practice and poor linkages across the curriculum. A new model of classroom practice is required to allow for creativity, peer-learning, thematic learning, collaboration and problem solving, i.e. the skills commonly deemed necessary for the knowledge-based society of the 21st century. This paper describes the B2C model for group-based, technology-mediated, project-oriented learning which, while being developed as part of an out of school programme, offers a pragmatic alternative to traditional classroom pedagogy.
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Reflecting on our practice: an evaluation of Balint groups for medical students in psychiatry.
Parker, Stephen D; Leggett, Andrew
2014-04-01
This paper qualitatively evaluates a one-year trial of Balint clinical reflection groups for medical students in psychiatry at a large Australian tertiary referral hospital. The trial considered whether clinical reflection groups following the Balint process would be perceived as useful and relevant to the learning needs of the student participants. A grounded theory approach was undertaken. This included survey data, thematic analysis of written feedback, and facilitator reflection on the process. Facilitators adapted the group process in response to participants' needs. These modifications included: increased education regarding the Balint process; the introduction of co-presenters; and the inclusion of a didactic summary following each session. The evaluation suggested that fidelity of the Balint group experience was achieved and that student attitudes were neutral to mildly positive regarding the educational experience. Balint groups are potentially useful to medical students in the Australian context. We suggest that Balint groups may be more useful when applied in less alienating learning environments, such as during general practice rotations. Emphasis is placed on the need to maintain a dynamic approach by adapting the group and the educational processes as the work unfolds.
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Ware, Fiona
2011-09-01
This feature considers the challenges that academic librarians are increasingly being faced with in the delivery of information skills training to large student numbers with limited time and staff resources. A case study is presented of how an academic liaison librarian used a blended learning approach and innovative teaching practice to successfully deliver information skills training to large student numbers within the Faculty of Health and Social Care at Hull University. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.
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Female genital mutilation in Britain.
Black, J A; Debelle, G D
1995-06-17
The practice of female genital mutilation predates the founding of both Christianity and Islam. Though largely confined among Muslims, the operation is also practiced in some Christian communities in Africa such that female genital mutilation takes place in various forms in more than twenty African countries, Oman, Yemen, the United Arab Emirates, and by some Muslims in Malaysia and Indonesia. In recent decades, ethnic groups which practice female genital mutilation have immigrated to Britain. The main groups are from Eritrea, Ethiopia, Somalia, and Yemen. In their own countries, an estimated 80% of women have had the operation. Female genital mutilation has been illegal in Britain since 1985, but it is practiced illegally or children are sent abroad to undergo the operation typically at age 7-9 years. It is a form of child abuse which poses special problems. The authors review the history of female genital mutilation and describe its medical complications. Assuming that the size of the population in Britain of ethnic groups which practice or favor female genital mutilation remains more or less unchanged, adaptation and acculturation will probably cause the practice to die out within a few generations. Meanwhile, there is much to be done. A conspiracy of silence exists in medical circles as well as widespread ignorance. Moreover, none of a number of well-known obstetric and pediatric textbooks mentions female genital mutilation, while the National Society for the Prevention of Cruelty to Children has neither information nor instructional material. It is high time that the problem was more widely and openly discussed.
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2012-01-01
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development. PMID:22762776
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Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven
2012-07-04
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.
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ERIC Educational Resources Information Center
Karpudewan, Mageswary; Ismail, Zurida; Roth, Wolff-Michael
2012-01-01
The purpose of this article is to describe a best practice: an approach to teaching chemistry that our quantitative research has shown to produce large differences between experimental and control groups in terms of achievement, pro-environmental attitudes, values, and motivation. Our interest in teaching chemistry by focusing on sustainable…
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Teacher Grading Decisions: Influences, Rationale, and Practices
ERIC Educational Resources Information Center
Kunnath, Joshua P.
2017-01-01
This mixed-methods study applied a decision-making theoretical framework to an investigation of teacher grading in a large urban school district in California. A sample of 251 high school teachers of core subjects were surveyed, and 15 teachers participated in four focus group interviews in order provide data on the influences, rationale, and…
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Complex Ecologies of Indigenous Education at the Native American Community Academy
ERIC Educational Resources Information Center
Lee, Tiffany S.
2010-01-01
The Native American Community Academy (NACA) is demonstrating an example of Indigenous philosophies and practices in education through its holistic, student-centered approach to education. NACA was one school in a large statewide study on Indian education in New Mexico. Focus groups with students, teachers, and community members illustrate the…
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Estimation of Unreimbursed Patient Education Costs at a Large Group Practice
ERIC Educational Resources Information Center
Williams, Arthur R.; McDougall, John C.; Bruggeman, Sandra K.; Erwin, Patricia J.; Kroshus, Margo E.; Naessens, James M.
2004-01-01
Introduction: A search of the literature on the cost of patient education found that provider education time per patient per day was rarely reported and usually not derivable from published reports. Costs of continuing education needed by health professionals to support patient education also were not given. Without this information, it is…
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Old Money: Financial Understanding for Older Adult Learners.
ERIC Educational Resources Information Center
Carlton, Shiela; Soulsby, Jim; Whitelegg, Di
This document discusses policy and practice addressing the need for financial literacy education for older people in the United Kingdom. The discussion is based largely on the findings of survey and focus groups that were conducted to identify the difficulties older people encounter in dealing with different financial services and managing their…
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Malaysian Students' Scientific Argumentation: Do Groups Perform Better than Individuals?
ERIC Educational Resources Information Center
Heng, Lee Ling; Surif, Johari; Seng, Cher Hau
2015-01-01
The practices of argumentation have recently been upheld as an important need to develop students' understanding of scientific concepts. However, the present education system in Malaysia is still largely examination-based and teacher-oriented. Thus, this study aims to examine the mastery level of scientific argumentation and its scheme among…
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Instructional Effectiveness in the SHL Classroom: Comparing Teacher and Student Perceptions
ERIC Educational Resources Information Center
Beaudrie, Sara M.
2015-01-01
This article reports on a comparative study of teacher and student perceptions on effective instructional practices in the Spanish heritage language classroom. The data were collected through an online questionnaire administered to 460 students in different Spanish courses and 9 instructors at a large university as well as focus groups. Based on…
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A Primer for Beginning Psychotherapy. Second Edition.
ERIC Educational Resources Information Center
Goldstein, William N.
This book provides a practice guide for students and mental health professionals who provide psychotherapy. It begins by looking at who the patients are and discussing why they come for therapy. A classification system divides all patients into one of four large groups: (1) normal-neurotic; (2) narcissistic; (3) borderline; and (4) psychotic. This…
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Winston, Flaura K; Mirman, Jessica H; Curry, Allison E; Pfeiffer, Melissa R; Elliott, Michael R; Durbin, Dennis R
2015-02-01
Inexperienced, less-skilled driving characterises many newly licensed drivers and contributes to high crash rates. A randomised trial of TeenDrivingPlan (TDP), a new learner driver phase internet-based intervention, demonstrated effectiveness in improving safety relevant, on-road driving behaviour, primarily through greater driving practice diversity. To inform future learner driver interventions, this analysis examined TDP use and its association with practice diversity. Posthoc analysis of data from teen/parent dyads (n=107), enrolled early in learner phase and assigned to treatment arm in randomised trial. Inserted software beacons captured TDP use data. Electronic surveys completed by parents and teens assessed diversity of practice driving and TDP usability ratings at 24 weeks (end of study period). Most families (84%) used TDP early in the learner period; however, the number of TDP sessions in the first week was three times higher among dyads who achieved greater practice diversity than those with less. By week five many families still engaged with TDP, but differences in TDP use could not be detected between families with high versus low practice diversity. Usability was not a major issue for this sample based on largely positive user ratings. An engaging internet-based intervention, such as TDP, can support families in achieving high practice diversity. Future learner driver interventions should provide important information early in the learner period when engagement is greatest, encourage continued learning as part of logging practice drives, and incorporate monitoring software for further personalisation to meet family needs. NCT01498575. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Gathering, strategizing, motivating and celebrating: the team huddle in a teaching general practice.
Walsh, Allyn; Moore, Ainsley; Everson, Jennifer; DeCaire, Katharine
2018-03-01
To understand how implementing a daily team huddle affected the function of a complex interprofessional team including learners. A qualitative descriptive study using semi-structured interviews in focus groups. An academic general practice teaching practice. All members of one interprofessional team, including nurses, general practitioners, junior doctors, and support staff. Focus group interviews using semi-structured guidance were transcribed and the results analysed using qualitative content analysis. Four interrelated themes were identified: communication and knowledge sharing; efficiency of care; relationship and team building; and shared responsibility for team function. The implementation of the daily team huddle was seen by participants to enhance the collaboration within the team and to contribute to work life enjoyment. Participants perceived that problems were anticipated and solved quickly. Clinical updates and information about patients benefited the team including learners. Junior doctors quickly understood the scope of practice of other team members, but some felt reluctant to offer clinical opinions. The implementation of a daily team huddle was viewed as worthwhile by this large interprofessional general practice team. The delivery of patient care was more efficient, knowledge was readily distributed, and problem solving was shared across the team, including junior doctors.
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Online Chats to Assess Stakeholder Perceptions of Meat Chicken Intensification and Welfare
Howell, Tiffani J.; Rohlf, Vanessa I.; Coleman, Grahame J.; Rault, Jean-Loup
2016-01-01
Simple Summary Most people care about animal welfare. Nevertheless, divergent views remain on what constitutes animal welfare, despite a growing body of scientific evidence. We used online chats to trigger discussion among participants from various stakeholder groups: general public, animal advocacy group, meat chicken industry-affiliated, and researchers or veterinarians who were not industry-affiliated but had experience with chickens. The aim of this pilot study was to assess reasons for divergence in opinions or conversely agreement between participants, using the topic of the welfare implications of meat chicken farming intensification. Participants also completed a pre- and post-chat survey to evaluate their perceptions and knowledge of chicken farming. Reasons for supporting intensification included perceptions of better health for the chickens and the sustainability of the system. Reasons for opposition included perceptions of the large number of animals kept together, and limited ability to perform natural behaviours. Misunderstandings about current practices were clarified in chats which contained industry-affiliated participants. Participants agreed on the need for enforceable standards and industry transparency. On average, objective knowledge of intensification increased after participating in the chat, but support for intensification did not change over the course of the study, counter to assertions that lack of knowledge results in lack of support for some practices. Engaging stakeholders can provide valuable information to anyone interested in the relationship between perception and knowledge of specific farming practices. Abstract Evidence suggests that there is variation in support for specific chicken farming practices amongst stakeholder groups, and this should be explored in more detail to understand the nature of these differences and work towards convergence. Online focus groups were used to assess attitudes to animal welfare in meat chicken farming in this pilot study. Across six online chats, 25 participants (general public, n = 8; animal advocacy group, n = 11, meat chicken industry, n = 3; research or veterinary practice who had experience with poultry but no declared industry affiliation, n = 3) discussed meat chicken intensification and welfare. Of those, 21 participants completed pre- and post-chat surveys gauging perceptions and objective knowledge about meat chicken management. Main reasons for intensification support were perceptions of improved bird health, and perceptions that it is a cost-effective, sustainable farming system. Reasons for opposition included perceptions that a large number of birds kept are in close proximity and have limited ability to perform natural behaviours. Misunderstandings about current practices were clarified in chats which contained industry representation. Participants agreed on the need for enforceable standards and industry transparency. Industry-affiliated members rated welfare of meat chickens higher, and gave lower ratings for the importance of natural living, than other stakeholder groups (both p = 0.001). On average, while objective knowledge of intensification increased after chat participation (p = 0.03), general welfare ratings and support for intensification did not change over time, counter to assertions that lack of knowledge results in lack of support for some practices. PMID:27801776
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Work Loads and Practice Patterns of General Surgeons in the United States, 1995–1997
Ritchie, Wallace P.; Rhodes, Robert S.; Biester, Thomas W.
1999-01-01
Objective To characterize the work loads and practice patterns of general surgeons in the United States over a 3-year period (1995 to 1997). Methods The surgical operative logs of 2434 “generalist” general surgeons recertifying in surgery form the basis of this report. Selected demographics of the group are as follows: location: 50% Northeast and Southeast, 21% Midwest, 29% West and Southwest; practice type: 45% solo, 40% group, 9% academics; size of practice community: 46% highly urban, 19% rural. Parameters evaluated were the average number of procedures and their distribution by category related to geographic area, practice type, community size, and other parameters. Statistical analysis was accomplished using analysis of variance. Results No significant year-to-year differences were observed between cohorts. The average numbers of procedures per surgeon per year was 398, distributed as follows: abdomen 102, alimentary tract 63, breast 54, endoscopic 51, vascular 39, trauma 6, endocrine 4, and head and neck, 3. Eleven percent of the 398 procedures were performed laparoscopically. Major index cases were largely concentrated with small groups of surgeons representing 5% to 10% of the total. Significant differences were as follows: surgeons in the Northeast and West performed far fewer procedures than those elsewhere. Urban surgeons performed a few more tertiary-type procedures than did rural ones; however, rural surgeons performed many more total procedures, especially in endoscopy, laparoscopy, gynecology, genitourinary, and orthopedics. Academic surgeons performed substantially fewer total procedures as a group than did nonacademic ones and in all categories except liver, transplant, and pancreas. Male surgeons performed more procedures than did female surgeons, except those involving the breast. More procedures were done by surgeons in group practice than by those in solo practice. U.S. medical graduates and international medical graduates had similar work loads but with a different distribution. Conclusions This unique database will be useful in tracking trends over time. More importantly, it demonstrates that general surgery practice in the United States is extremely heterogeneous, a fact that must be acknowledged in any future workforce deliberations. PMID:10522723
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The effect of dyad versus individual simulation-based ultrasound training on skills transfer.
Tolsgaard, Martin G; Madsen, Mette E; Ringsted, Charlotte; Oxlund, Birgitte S; Oldenburg, Anna; Sorensen, Jette L; Ottesen, Bent; Tabor, Ann
2015-03-01
Dyad practice may be as effective as individual practice during clinical skills training, improve students' confidence, and reduce costs of training. However, there is little evidence that dyad training is non-inferior to single-student practice in terms of skills transfer. This study was conducted to compare the effectiveness of simulation-based ultrasound training in pairs (dyad practice) with that of training alone (single-student practice) on skills transfer. In a non-inferiority trial, 30 ultrasound novices were randomised to dyad (n = 16) or single-student (n = 14) practice. All participants completed a 2-hour training programme on a transvaginal ultrasound simulator. Participants in the dyad group practised together and took turns as the active practitioner, whereas participants in the single group practised alone. Performance improvements were evaluated through pre-, post- and transfer tests. The transfer test involved the assessment of a transvaginal ultrasound scan by one of two clinicians using the Objective Structured Assessment of Ultrasound Skills (OSAUS). Thirty participants completed the simulation-based training and 24 of these completed the transfer test. Dyad training was found to be non-inferior to single-student training: transfer test OSAUS scores were significantly higher than the pre-specified non-inferiority margin (delta score 7.8%, 95% confidence interval -3.8-19.6%; p = 0.04). More dyad (71.4%) than single (30.0%) trainees achieved OSAUS scores above a pre-established pass/fail level in the transfer test (p = 0.05). There were significant differences in performance scores before and after training in both groups (pre- versus post-test, p < 0.01) with large effect sizes (Cohen's d = 3.85) and no significant interactions between training type and performance (p = 0.59). The dyad group demonstrated higher training efficiency in terms of simulator score per number of attempts compared with the single-student group (p = 0.03). Dyad practice improves the efficiency of simulation-based training and is non-inferior to individual practice in terms of skills transfer. © 2015 John Wiley & Sons Ltd.
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Potteiger, Kelly; Pitney, William A; Cappaert, Thomas A; Wolfe, Angela
2017-12-01
Environmental sustainability is a critical concern in health care. Similar to other professions, the practice of athletic training necessitates the use of a large quantity of natural and manufactured resources. To examine the perceptions of the waste produced by the practice of athletic training and the green practices currently used by athletic trainers (ATs) to combat this waste. Mixed-methods study. Field setting. A total of 442 ATs completed the study. Sixteen individuals participated in the qualitative portion. Data from sections 2 and 3 of the Athletic Training Environmental Impact Survey were analyzed. Focus groups and individual interviews were used to determine participants' views of waste and the efforts used to combat waste. Descriptive statistics were used to examine types of waste. Independent t tests, χ 2 tests, and 1-way analyses of variance were calculated to identify any differences between the knowledge and use of green techniques. Interviews and focus groups were transcribed verbatim and analyzed inductively. Participants reported moderate knowledge of green techniques (3.18 ± 0.53 on a 5-point Likert scale). Fifty-eight percent (n = 260) of survey participants perceived that a substantial amount of waste was produced by the practice of athletic training. Ninety-two percent (n = 408) admitted they thought about the waste produced in their daily practice. The types of waste reported most frequently were plastics (n = 111, 29%), water (n = 88, 23%), and paper for administrative use (n = 81, 21%). Fifty-two percent (n = 234) agreed this waste directly affected the environment. The qualitative aspect of the study reinforced recognition of the large amount of waste produced by the practice of athletic training. Types of conservation practices used by ATs were also explored. Participants reported concern regarding the waste produced by athletic training. The amount of waste varies depending on practice size and setting. Future researchers should use direct measures to determine the amount of waste created by the practice of athletic training.
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Practice makes perfect in memory recall.
Romani, Sandro; Katkov, Mikhail; Tsodyks, Misha
2016-04-01
A large variability in performance is observed when participants recall briefly presented lists of words. The sources of such variability are not known. Our analysis of a large data set of free recall revealed a small fraction of participants that reached an extremely high performance, including many trials with the recall of complete lists. Moreover, some of them developed a number of consistent input-position-dependent recall strategies, in particular recalling words consecutively ("chaining") or in groups of consecutively presented words ("chunking"). The time course of acquisition and particular choice of positional grouping were variable among participants. Our results show that acquiring positional strategies plays a crucial role in improvement of recall performance. © 2016 Romani et al.; Published by Cold Spring Harbor Laboratory Press.
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Observational analysis of near-peer and faculty tutoring in problem-based learning groups.
Cianciolo, Anna T; Kidd, Bryan; Murray, Sean
2016-07-01
Near-peer and faculty staff tutors may facilitate problem-based learning (PBL) through different means. Near-peer tutors are thought to compensate for their lack of subject matter expertise with greater adeptness at group facilitation and a better understanding of their learners. However, theoretical explanations of tutor effectiveness have been developed largely from recollections of tutor practices gathered through student evaluation surveys, focus groups and interviews. A closer look at what happens during PBL sessions tutored by near-peers and faculty members seems warranted to augment theory from a grounded perspective. We conducted an observational study to explore interactional practices during PBL tutorials at our medical school, at which near-peer tutoring of Year 2 students is an established practice. Between October 2014 and May 2015, video-recordings were made of nine purposively sampled tutor groups using three tutor types (near-peer, clinical faculty and basic science faculty staff) across three systems-based units. An investigator team comprising a Year 2 student, a Year 4 student and a behavioural scientist independently analysed the videos until their observations reached saturation and then met face to face to discuss their detailed field notes. Through constant comparison, narratives of tutor practices and group dynamics were generated for each of the nine tutor groups, representing the collective impressions of the members of the investigator team. Variation was greater within than across tutor types. Tutors' practices idiosyncratically and sometimes substantially diverged from PBL principles, yet all tutors attempted to convey authority or 'insider' status with respect to the short- and long-term goals of medical education. Students prompted these status demonstrations by expressing gratitude, asking questions and exhibiting analogous status demonstrations themselves. Understanding the socio-cognitive nature of tutoring from a grounded perspective may provide a means to develop faculty staff of all types to better meet learner needs in a principled fashion. © 2016 John Wiley & Sons Ltd.
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Yadav, Yad Ram; Parihar, Vijay; Agarwal, Moneet; Bhatele, Pushp Raj
2012-01-01
The management of intraoperative bleeding during removal of a large hyper vascular meningioma is crucial for safe and efficient surgery. Preoperative embolization of meningioma is the best way to reduce vascularity of meningiomas but this technique is not readily available, costly and has its own limitations. The study is aimed to evaluate the use of temporary clamping of external carotid artery to reduce blood loss and operating time during excision of large convexity, parasagittal or temporal base meningiomas. A prospective study of 115 consecutively operated meningiomas of size 5 cms or more were operated from January 2002 to December2010. Temporary clamping of external carotid artery was done in 61 while 51 cases were managed without clamping. There was significant reduction of blood loss, operative time and blood transfusion given in the temporary clipping group compared to non clipping group. There was stitch abscess in two patients each in clamping, and non clamping group. There was no scalp necrosis or mortality in any of the group. Temporary clamping of external carotid artery is a safe, simple and cost-effective alternative to embolization for the surgery of large meningiomas. This can be practiced at all the centers.
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Freire, Wilma B; Waters, William F; Rivas-Mariño, Gabriela
2017-01-01
To analyze awareness, understanding, attitudes, and practices related to the nutritional traffic light system (NTLS) on processed food packaging in Ecuador. 21 discussions were held in focus groups (FG) in populations of various sizes in the coastal, mountainous, and eastern regions. Nine interviews were conducted with key informants (KI) representing large, medium, and small enterprises producing or selling processed foods. There were 171 FG participants, the majority of whom recognized and understood the NTLS. There was a certain amount of discussion around awareness of the NTLS and purchasing attitudes, and other factors such as taste, brand, or accessibility were considered. Attitudes were different between age groups: while the group of five- to nine-year-olds knew little about the NTLS and preferred homemade foods, the group of 15- to 19-year-olds was indifferent to the NTLS information and placed more value on other features, such as taste. Practices related to the purchase and consumption of processed foods highlighted seven different strategies that ranged from replacing the product to ignoring the NTLS information. The KIs did not agree with the policy, but they acknowledged having amended the content of some products to reduce fat, sugar, and salt. The NTLS has had a positive effect on awareness and understanding of the content of processed products. Practices related to purchasing and consuming processed foods would be improved by promotion of the nutritional labeling policy, trade control, and the monitoring and surveillance of its implementation.
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Matsumoto, Masatoshi; Inoue, Kazuo; Kajii, Eiji
2010-01-01
To show the impact of changing the definition of what is "rural" on the outcomes of a rural medical education program. A cross-sectional sample of 643 graduates under obligatory rural service and 1,699 graduates after serving their obligation, all from Jichi Medical University (JMU), a binding rural education program in Japan, were used as the data source. Communities were divided into decile groups according to population density, and the cut-off for "rural/nonrural" was altered in order to study its impact on the data. The rural practice rate of obliged graduates had its peak in the decile groups with the lowest population densities, while the peak rates of postobligation graduates and non-JMU physicians were at the decile groups with the highest population densities. Rural practice rates of all of the 3 groups of physicians increased with the increase in inclusiveness of rural definition. The ratio of rural practice rate of obliged graduates to that of non-JMU physicians ("relative effectiveness") increased remarkably with the increase in exclusiveness of rural definition. The relative effectiveness of postobligation graduates did not substantially increase after the cut-off exceeded a certain point of exclusiveness. Definition of "rural" largely determined the rural practice rate and relative effectiveness of JMU graduates. The results suggest that results of past outcome studies of rural medical education programs are potentially biased depending on how rural is defined.
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The cultural evolution of prosocial religions.
Norenzayan, Ara; Shariff, Azim F; Gervais, Will M; Willard, Aiyana K; McNamara, Rita A; Slingerland, Edward; Henrich, Joseph
2016-01-01
We develop a cultural evolutionary theory of the origins of prosocial religions and apply it to resolve two puzzles in human psychology and cultural history: (1) the rise of large-scale cooperation among strangers and, simultaneously, (2) the spread of prosocial religions in the last 10-12 millennia. We argue that these two developments were importantly linked and mutually energizing. We explain how a package of culturally evolved religious beliefs and practices characterized by increasingly potent, moralizing, supernatural agents, credible displays of faith, and other psychologically active elements conducive to social solidarity promoted high fertility rates and large-scale cooperation with co-religionists, often contributing to success in intergroup competition and conflict. In turn, prosocial religious beliefs and practices spread and aggregated as these successful groups expanded, or were copied by less successful groups. This synthesis is grounded in the idea that although religious beliefs and practices originally arose as nonadaptive by-products of innate cognitive functions, particular cultural variants were then selected for their prosocial effects in a long-term, cultural evolutionary process. This framework (1) reconciles key aspects of the adaptationist and by-product approaches to the origins of religion, (2) explains a variety of empirical observations that have not received adequate attention, and (3) generates novel predictions. Converging lines of evidence drawn from diverse disciplines provide empirical support while at the same time encouraging new research directions and opening up new questions for exploration and debate.
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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].
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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
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Instructor-Created Activities to Engage Undergraduate Nursing Research Students.
Pierce, Linda L; Reuille, Kristina M
2018-03-01
In flipped or blended classrooms, instruction intentionally shifts to a student-centered model for a problem-based learning approach, where class time explores topics in greater depth, creating meaningful learning opportunities. This article describes instructor-created activities focused on research processes linked to evidence-based practice that engage undergraduate nursing research students. In the classroom, these activities include individual and team work to foster critical thinking and stimulate student discussion of topic material. Six activities for small and large student groups are related to quantitative, qualitative, and both research processes, as well as applying research evidence to practice. Positive student outcomes included quantitative success on assignments and robust student topic discussions, along with instructor-noted overall group engagement and interest. Using these activities can result in class time for the construction of meaning, rather than primarily information transmission. Instructors may adopt these activities to involve and stimulate students' critical thinking about research and evidence-based practice. [J Nurs Educ. 2018;57(3):174-177.]. Copyright 2018, SLACK Incorporated.
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To What Extent Do Teachers in European Countries Differ in Their Professional Community Practices?
ERIC Educational Resources Information Center
Lomos, Catalina
2017-01-01
Within comparative school effectiveness research facilitated by large-scale data across countries, this article presents the results of the testing for measurement invariance of the latent concept of Professional Community (PC) across 23 European countries and more than 35,000 teachers in secondary schools. The newly proposed Multiple-Group Factor…
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Can Videos Play a Role in Promoting Good Landscape Management Behaviors?
ERIC Educational Resources Information Center
Warner, Laura A.; Lamm, Alexa J.; Rumble, Joy N.
2018-01-01
This study tested the effect of four short videos appealing to environmental values on home irrigation users' intent to use good irrigation and fertilization practices. The videos were largely ineffective, and there was only a small effect on one of the behaviors within the fertilizer loss treatment group. Implications point to a need for…
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Multiple Complicities: Reliving a Life in the Classroom
ERIC Educational Resources Information Center
Gill, Prue
2016-01-01
In this teaching memoir, time with a group of Ugandan teachers becomes the "awakening" or spur to leaf through memories of more than 40 years of life in the classroom. The moments chosen to relive afresh tell of practices which have largely been erased in curriculum discussion in Australia. Together they add up to an argument, more…
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ERIC Educational Resources Information Center
Salem, Jamie; Fehrmann, Paul
2013-01-01
With the growing population of undergraduate students on our campus and an increased focus on their success, librarians at a large midwestern university were interested in the citation management styles of this university cohort. Our university library spends considerable resources each year to maintain and promote access to the robust…
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Automatic Evaluation of Practices in Moodle for Self Learning in Engineering
ERIC Educational Resources Information Center
Sánchez, Carles; Ramos, Oriol; Márquez, Patricia; Marti, Enric; Rocarias, Jaume; Gil, Debora
2015-01-01
The first years in engineering degree courses are usually made of large groups with a low teacher-student ratio. Overcrowding in classrooms hinders continuous assessment much needed to promote independent learning. Therefore, there is a need to apply some kind of automatic evaluation to facilitate the correction of exercises outside the classroom.…
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No Randomization? No Problem: Experimental Control and Random Assignment in Single Case Research
ERIC Educational Resources Information Center
Ledford, Jennifer R.
2018-01-01
Randomization of large number of participants to different treatment groups is often not a feasible or preferable way to answer questions of immediate interest to professional practice. Single case designs (SCDs) are a class of research designs that are experimental in nature but require only a few participants, all of whom receive the…
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Academic practice groups: strategy for survival.
Rodriguez, J L; Jacobs, D M; Zera, R T; Van Camp, J M; Muehlstedt, S G; West, M A; Bubrick, M P
2000-10-01
The mission of public academic health centers (puAHC) and their affiliated practice groups (APG) focuses on teaching, research, and the clinical care of at-risk populations. Resources to accomplish this mission, however, are becoming scarce. For puAHC to survive and remain competitive, innovative strategies will need to be developed by the APG. We hypothesized that the integration of a surgical academic practice of the APG with a nonacademic integrated health care delivery system (NAIDS) in a managed care environment would benefit all involved. A surgical academic practice was integrated with a NAIDS in a 95% managed care market. Faculty alone provided care the first year, and third-year residents were added the following year. To assess outcome, we collected benefit and cost data for the 1-year period before integration and compared them with the two, 1-year periods after integration. In the second year of integration, revenues from the NAIDS referrals to the puAHC and APG increased 89% and 150%, respectively. The NAIDS' general surgical and endoscopy caseload increased by 25%. Additionally, there was a 92% reduction in operating room technician cost with no increase in operating time per case. Finally, the third-year resident experienced a caseload increase of 163%. In an environment where resources are diminishing and managed care consists of many large NAIDS that drive referrals and revenue, the integration of a surgical academic practice with a NAIDS benefits all shareholders. Academic practice groups that develop strategies that leverage their competitive advantage will have the best chance of surviving in today's turbulent health care market.
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Congdon, Graham; Baker, Tracey; Cheesman, Amanda
2013-03-01
This paper describes a process evaluation project designed to enhance the strategic management of practice learning within a large Hospital in the North of England. The aim of the project was to introduce the role of the Learning Environment Manager with dedicated responsibility for practice learning of undergraduate student nurses within the Hospital's 49 practice-settings. Whilst aspects of this role were already evident in several of these settings, the project sought to locate and standardise responsibilities related to the organisation and management of learning and teaching in practice explicitly within the existing staffing structure of each practice-setting. Focus group interviews were used to explore significant aspects of the project with key stakeholder groups comprising Learning Environment Managers, the Hospital Clinical Educator, Hospital Department Managers, Ward Managers, Mentors, University Link Lecturers and undergraduate Student Nurses. Interview data were analysed using thematic content analysis. The findings of the project suggest that the Learning Environment Manager role affords providers of practice learning with a robust approach to establish organisation-wide benchmarks that standardise the strategic management of practice learning in collaboration with partner Universities. The role incorporated many operational activities previously undertaken by the Hospital Clinical Educator, thus enabling the Hospital Clinical Educator to make a more strategic contribution to the on-going quality monitoring and enhancement of practice learning across the Hospital. The Learning Environment Manager role was found to provide mentors with high levels of support which in turn helped to promote consistent, positive and holistic practice learning experiences for undergraduate student nurses across the Hospital. Importantly, the role offers a potent catalyst for nurses in practice to regain responsibility for practice learning and re-establish the value of practice teaching. Copyright © 2012 Elsevier Ltd. All rights reserved.
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McKissick, Holly D; Cady, Rhonda G; Looman, Wendy S; Finkelstein, Stanley M
The purpose of this analysis was to evaluate the effects of an advanced practice nurse-delivered telehealth intervention on health care use by children with medical complexity (CMC). Because CMC account for a large share of health care use costs, finding effective ways to care for them is an important challenge requiring exploration. This was a secondary analysis of data from a randomized clinical trial with a control group and two intervention groups. The focus of the analysis was planned and unplanned clinical and therapy visits by CMC over a 30-month data collection period. Nonparametric tests were used to compare visit counts among and within the three groups. The number of unplanned visits decreased over time across all groups, with the greatest decrease in the video telehealth intervention group. Planned visits were higher in the video telehealth group across all time periods. Advanced practice registered nurse-delivered telehealth care coordination may support a shift from unplanned to planned health care service use among CMC. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
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Tjoe Nij, Evelyn; Höhr, Doris; Borm, Paul; Burstyn, Igor; Spierings, Judith; Steffens, Friso; Lumens, Mieke; Spee, Ton; Heederik, Dick
2004-03-01
The aims of this study were to determine implications of inter- and intraindividual variation in exposure to respirable (quartz) dust and of heterogeneity in dust characteristics for epidemiologic research in construction workers. Full-shift personal measurements (n = 67) from 34 construction workers were collected. The between-worker and day-to-day variances of quartz and respirable dust exposure were estimated using mixed models. Heterogeneity in dust characteristics was evaluated by electron microscopic analysis and electron spin resonance. A grouping strategy based on job title resulted in a 2- and 3.5-fold reduction in expected attenuation of a hypothetical exposure-response relation for respirable dust and quartz exposure, respectively, compared to an individual based approach. Material worked on explained most of the between-worker variance in respirable dust and quartz exposure. However, for risk assessment in epidemiology, grouping workers based on the materials they work on is not practical. Microscopic characterization of dust samples showed large quantities of aluminum silicates and large quantities of smaller particles, resulting in a D(50) between 1 and 2 microm. For risk analysis, job title can be used to create exposure groups, although error is introduced by the heterogeneity of dust produced by different construction workers activities and by the nonuniformity of exposure groups. A grouping scheme based on materials worked on would be superior, for both exposure and risk assessment, but is not practical when assessing past exposure. In dust from construction sites, factors are present that are capable of influencing the toxicological potency.
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Cell-of-Origin in Diffuse Large B-Cell Lymphoma: Are the Assays Ready for the Clinic?
Scott, David W
2015-01-01
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma worldwide and consists of a heterogeneous group of cancers classified together on the basis of shared morphology, immunophenotype, and aggressive clinical behavior. It is now recognized that this malignancy comprises at least two distinct molecular subtypes identified by gene expression profiling: the activated B-cell-like (ABC) and the germinal center B-cell-like (GCB) groups-the cell-of-origin (COO) classification. These two groups have different genetic mutation landscapes, pathobiology, and outcomes following treatment. Evidence is accumulating that novel agents have selective activity in one or the other COO group, making COO a predictive biomarker. Thus, there is now a pressing need for accurate and robust methods to assign COO, to support clinical trials, and ultimately guide treatment decisions for patients. The "gold standard" methods for COO are based on gene expression profiling (GEP) of RNA from fresh frozen tissue using microarray technology, which is an impractical solution when formalin-fixed paraffin-embedded tissue (FFPET) biopsies are the standard diagnostic material. This review outlines the history of the COO classification before examining the practical implementation of COO assays applicable to FFPET biopsies. The immunohistochemistry (IHC)-based algorithms and gene expression-based assays suitable for the highly degraded RNA from FFPET are discussed. Finally, the technical and practical challenges that still need to be addressed are outlined before robust gene expression-based assays are used in the routine management of patients with DLBCL.
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Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.
Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D
2015-08-01
There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.
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Bioethics consultation practices and procedures: a survey of a large Canadian community of practice.
Greenberg, R A; Anstey, K W; Macri, R; Heesters, A; Bean, S; Zlotnik Shaul, R
2014-06-01
The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.
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Breast health educational interventions. Changes in beliefs and practices of working women.
Thomas, Barbara; Stamler, Lynnette Leeseberg; Lafreniere, Kathryn D; Delahunt, Tabitha D
2002-10-01
Health education programs supported by women's groups or workplaces have been successful in reaching large populations and changing intentions to perform breast health behaviors. This study examined the responses women working in the automotive industry had to two health education interventions, mailed pamphlets, and a combination of mailed material and classes at the worksite compared to a control group. A quasi-experimental design was used. Of the 948 women completing the pre-test, 437 also completed the post-test and were highly representative of the initial sample. The findings suggest that although the mailed information produced some change in practices and intentions, the classes in combination with the mailed pamphlets produced greater change. In addition, confidence in breast self examination as a method of detecting an existing breast lump increased from pre-test to post-test across all age groups. The reported influences on the women's decisions related to breast health varied across the life span. The results of this study can be used to support the development of effective health promotion programs for use at workplaces to increase the likelihood of women engaging in healthy breast practices.
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SRT and SBRT: Current practices for QA dosimetry and 3D
NASA Astrophysics Data System (ADS)
Benedict, S. H.; Cai, J.; Libby, B.; Lovelock, M.; Schlesinger, D.; Sheng, K.; Yang, W.
2010-11-01
The major feature that separates stereotactic radiation therapy (cranial SRT) and stereotactic body radiation therapy (SBRT) from conventional radiation treatment is the delivery of large doses in a few fractions which results in a high biological effective dose (BED). In order to minimize the normal tissue toxicity, quality assurance of the conformation of high doses to the target and rapid fall off doses away from the target is critical. The practice of SRT and SBRT therefore requires a high-level of confidence in the accuracy of the entire treatment delivery process. In SRT and SBRT confidence in this accuracy is accomplished by the integration of modern imaging, simulation, treatment planning and delivery technologies into all phases of the treatment process; from treatment simulation and planning and continuing throughout beam delivery. In this report some of the findings of Task group 101 of the AAPM will be presented which outlines the best-practice guidelines for SBRT. The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information in this task group is provided for establishing an SBRT program, including protocols, equipment, resources, and QA procedures.
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Schoen, E J; Erickson, R J; Barr, G; Allen, H
1973-01-01
A single-mailing questionnaire surveyed attitudes of members of District IX, American Academy of Pediatrics (California) toward the role of the pediatric nurse practitioner (pnp). Responses from 568 members (53%) represented a broad range of age, practice type (58% group, 25% solo, 17% "other"), geographic location, and opinion. The most favorable attitudes toward pnp use were expressed by young pediatricians in large-group and "other" categories; least favorable were solo practitioners older than 60 years. Practice type was more important than age. Most respondents expressed the opinion that a pediatrician-pnp team approach would enrich both professions, and that parental acceptance of the pnp was likely; but that pnp use would not reduce costs. Majorities favored the concept of the pnp as part of the practice team but under constant pediatrician surveillance: seeing the patient for part of the visit and participating under supervision in care for minor illness, but not replacing the pediatrician even in well-child care. Some pnps hope for a more independent role on the pediatrician-pnp team. Modification of both pediatrician and pnp ideas appears requisite to a team approach that will satisfy both professional groups and the public.
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NASA Astrophysics Data System (ADS)
Foster, Jacob G.
This dissertation inserts a new view into an old problem in teacher education. The study explores the theory-practice gap, the large distance between what preservice science teachers experience in schools, are able to enact, and are told they should hold themselves to in their practice. It does so by narrowing the focus of analysis to a secondary science study group and examining how the facilitator uses sociocultural constructivism to promote discussion. The analysis surfaces key communicative moves made by the facilitator and preservice teachers that yield fruitful discussion of theory-practice relationships. Additionally, the study's use of discourse analysis as a methodology and intertextuality as a conceptual framework opens new directions for applied sociolinguistic research and scholarship in science teacher education. Findings from the study focus on what was discussed and how explorations of theory-practice relationships were facilitated. Preservice teachers in the study group engaged in meaningful conversations about constructivist theory and its application to their students and teaching of science. They discussed many science education topics such as planning science lessons that actively engage students, assessment of content understanding, and management of content-based activities. Discussions of broader science education goals, including implementation of inquiry or development of collaborative communities, were not promoted. Examination of the facilitation illuminates a number of strategies found to be helpful in supporting these explorations. This study shows that facilitation can successfully support preservice teachers to construct understanding of social constructivist assumptions underlying the National Science Education Standards (NSES), as well as a few components of the Standards themselves. The focus on the underlying assumptions suggests that science teacher education should focus on these so that preservice teachers can build a strong foundation from which to later implement broader science education reform efforts. The study group serves as a bridging structure between university courses and classroom experiences to support preservice teacher navigation of theory-practice relationships in the context of their classroom teaching. The study group contributes to helping preservice teachers navigate the theory-practice gap by complementing other teacher education structures to achieve this long-standing goal.
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SU-E-I-68: Practical Considerations On Implementation of the Image Gently Pediatric CT Protocols
DOE Office of Scientific and Technical Information (OSTI.GOV)
Zhang, J; Adams, C; Lumby, C
Purpose: One limitation associated with the Image Gently pediatric CT protocols is practical implementation of the recommended manual techniques. Inconsistency as a result of different practice is a possibility among technologist. An additional concern is the added risk of data error that would result in over or underexposure. The Automatic Exposure Control (AEC) features automatically reduce radiation for children. However, they do not work efficiently for the patients of very small size and relative large size. This study aims to implement the Image Gently pediatric CT protocols in the practical setting while maintaining the use of AEC features for pediatricmore » patients of varying size. Methods: Anthropomorphological abdomen phantoms were scanned in a CT scanner using the Image Gently pediatric protocols, the AEC technique with a fixed adult baseline, and automatic protocols with various baselines. The baselines were adjusted corresponding to patient age, weight and posterioranterior thickness to match the Image Gently pediatric CT manual techniques. CTDIvol was recorded for each examination. Image noise was measured and recorded for image quality comparison. Clinical images were evaluated by pediatric radiologists. Results: By adjusting vendor default baselines used in the automatic techniques, radiation dose and image quality can match those of the Image Gently manual techniques. In practice, this can be achieved by dividing pediatric patients into three major groups for technologist reference: infant, small child, and large child. Further division can be done but will increase the number of CT protocols. For each group, AEC can efficiently adjust acquisition techniques for children. This implementation significantly overcomes the limitation of the Image Gently manual techniques. Conclusion: Considering the effectiveness in clinical practice, Image Gently Pediatric CT protocols can be implemented in accordance with AEC techniques, with adjusted baselines, to achieve the goal of providing the most appropriate radiation dose for pediatric patients of varying sizes.« less
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A Campus-Wide Study of STEM Courses: New Perspectives on Teaching Practices and Perceptions
Vinson, Erin L.; Smith, Jeremy A.; Lewin, Justin D.; Stetzer, MacKenzie R.
2014-01-01
At the University of Maine, middle and high school science, technology, engineering, and mathematics (STEM) teachers observed 51 STEM courses across 13 different departments and collected information on the active-engagement nature of instruction. The results of these observations show that faculty members teaching STEM courses cannot simply be classified into two groups, traditional lecturers or instructors who teach in a highly interactive manner, but instead exhibit a continuum of instructional behaviors between these two classifications. In addition, the observation data reveal that student behavior differs greatly in classes with varied levels of lecture. Although faculty members who teach large-enrollment courses are more likely to lecture, we also identified instructors of several large courses using interactive teaching methods. Observed faculty members were also asked to complete a survey about how often they use specific teaching practices, and we find that faculty members are generally self-aware of their own practices. Taken together, these findings provide comprehensive information about the range of STEM teaching practices at a campus-wide level and how such information can be used to design targeted professional development for faculty. PMID:25452485
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Best Practices in Pulic Outreach Events
NASA Astrophysics Data System (ADS)
Cobb, Whitney; Buxner, Sanlyn; Shipp, Stephanie
2015-11-01
IntroductionEach year the National Aeronautics and Space Administration (NASA) sponsors public outreach events designed to increase student, educator, and general public engagement in its missions and goals. NASA SMD Education’s review of large-scale events, “Best Practices in Outreach Events,” highlighted planning and implementation best practices, which were used by the Dawn mission to strategize and implement its Ceres arrival celebration event, i C Ceres.BackgroundThe literature review focused on best identifying practices rising from evaluations of large-scale public outreach events. The following criteria guided the study:* Public, science-related events open to adults and children* Events that occurred during the last 5 years* Evaluations that included information on data collected from visitors and/or volunteers* Evaluations that specified the type of data collected, methodology, and associated resultsBest Practices: Planning and ImplementationThe literature review revealed key considerations for planning implement large-scale events. Best practices included can be pertinent for all event organizers and evaluators regardless of event size. A summary of related best practices is presented below.1) Advertise the event2) Use and advertise access to scientists* Attendees who reported an interaction with a science professional were 15% to 19% more likely to report positive learning impacts, (SFA, 2012, p. 24).3) Recruit scientists using findings such as:* High percentages of scientists (85% to 96%) from most events were interested in participating again (SFA, 2012).4) Ensure that the event is group and, particularly, child friendly5) Target specific event outcomesBest Practices Informing Real-world Planning, Implementation and EvaluationDawn mission’s collaborative design of a series of events, i C Ceres, including in-person, interactive events geared to families and live presentations, will be shared, with focus on the family event, and the evidence that scientist participation was a particular driver for the event’s impact and success.Science Festival Alliance (SFA). (2012). Get inspired: A first look at science festivals. Retrieved from http://sciencefestivals.org/news_item/get-inspired
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Miller, Robert H; Bovbjerg, Randall R
2002-06-01
Medical care should be safer. Inpatient problems and solutions have received the most attention; this outpatient qualitative case study addresses a gap in knowledge. We describe safety improvements among large physician groups, model the key influences on their behavior, and identify beneficial public and private policies. All groups were trying to reduce medical injury, which was part of the sample design. The most commonly targeted problems are those that are similar across groups: shortcomings in diagnosis, abnormal tests follow-up, scope of practice and referral patterns, and continuity of care. Medical group innovators vary greatly, however, in implementation of improvements, that is, in the extent to which they implement process changes that identify events/problems, analyze and track incidents, decide how to change clinical and administrative practices, and monitor impacts of the changes. Our conceptual model identifies key determinants: (1) demand for safety comes from external factors: legal, market, and professional; (2) organizational responses depend on internal factors: group size, scope, and integration; leadership and governance; professional culture; information-system assets; and financial and intellectual capital. Further, safety is an aspect of quality (the same tools, decision making, interventions, and monitoring apply), and safety management benefits from prior efficiency management (similar skills and culture of innovation). Observed variation in even simple safeguards shows that existing safety incentives are too weak. Our model suggests that the biggest improvement would come from boosting the demand for quality and safety from both private and public larger group purchasers. Current policy relies too much on litigation and discipline, which have sometimes helped, but not solved, problems because they are inefficient, tend to drive needed information underground, and complicate needed cultural change. Patients' safety demand is also weak for want of information and market power. Big purchasers' demands, however, quickly influence the internal environment of medical groups, helping managers advance quality safety toward the top of groups' congested decision-making "queues."
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NASA Astrophysics Data System (ADS)
Svenson, Eric Johan
Participants on the Invincible America Assembly in Fairfield, Iowa, and neighboring Maharishi Vedic City, Iowa, practicing Maharishi Transcendental Meditation(TM) (TM) and the TM-Sidhi(TM) programs in large groups, submitted written experiences that they had had during, and in some cases shortly after, their daily practice of the TM and TM-Sidhi programs. Participants were instructed to include in their written experiences only what they observed and to leave out interpretation and analysis. These experiences were then read by the author and compared with principles and phenomena of modern physics, particularly with quantum theory, astrophysics, quantum cosmology, and string theory as well as defining characteristics of higher states of consciousness as described by Maharishi Vedic Science. In all cases, particular principles or phenomena of physics and qualities of higher states of consciousness appeared qualitatively quite similar to the content of the given experience. These experiences are presented in an Appendix, in which the corresponding principles and phenomena of physics are also presented. These physics "commentaries" on the experiences were written largely in layman's terms, without equations, and, in nearly every case, with clear reference to the corresponding sections of the experiences to which a given principle appears to relate. An abundance of similarities were apparent between the subjective experiences during meditation and principles of modern physics. A theoretic framework for understanding these rich similarities may begin with Maharishi's theory of higher states of consciousness provided herein. We conclude that the consistency and richness of detail found in these abundant similarities warrants the further pursuit and development of such a framework.
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Self-insurance and the potential effects of health reform on the small-group market.
Linehan, Kathryn
2010-12-21
The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers--most often those in very large firms--are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure.
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Kubín, V; Jelínková, J; Franêk, J
1977-07-01
The method of counter-immunoelectrophoresis (CIE) was tested for its applicability to group B streptococcus typing. The results obtained were compared with the typing by the ring precipitin test. Identical antigens and identical hyperimmune typing serum batches had been used in both methods. A large majority of 75 freshly isolated strains were typed identically by both methods. Five strains with a weak antigenic outfit were untypable by the ring precipitin test but were typed by CIE owing to a higher sensitivity of CIE method. Two strains were typable by the precipitin test but not by CIE; an explanation for this phenomenon is lacking. The CIE method in group B typing is specific, rapid, highly sensitive and relatively simple. It requires strict maintenance of standard conditions. The method is economical with respect to manipulation and material, requires small amounts of diagnostic antisera. Potent antisera may be used diluted. Moreover, sera for CIE typing need not be absorbed to remove group B antibodies. CIE method is practicable for group B streptococcus typing, especially in laboratories carrying out routine large scale type identification.
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Behavioral school psychology goes outdoors: the effect of organized games on playground aggression.
Murphy, H A; Hutchison, J M; Bailey, J S
1983-01-01
This research focuses on the inappropriate, largely aggressive, behaviors of 344 K-2 children assigned to a playground prior to the beginning of the school day. Initially, a system for observing large numbers of children freely roaming over a large, open area was developed. This observational method was then used to determine the effectiveness of providing organized games for reducing potentially dangerous playground behaviors. Using a reversal (ABAB) design, it was found that the games, rope jumping, and foot racing, along with an infrequently used time-out procedure, significantly reduced the frequency of inappropriate incidents. It is suggested that when dealing with large groups, antecedent environmental manipulations may be more practical than providing consequences for the behaviors exhibited by identified individuals.
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Stress and nurses' horizontal mobbing: moderating effects of group identity and group support.
Topa, Gabriela; Moriano, Juan A
2013-01-01
Horizontal mobbing is a process of systematic and repeated aggression towards a worker by coworkers. Among others, stress has been pointed out as one of the antecedents that favors the onset of horizontal mobbing, whereas group support to the target could act as a buffer. Moreover, the social identity approach emphasizes that group identity is an antecedent of group support. This study explores the interaction of group support and group identity in the explanation of horizontal mobbing in a sample (N = 388) of registered nurses and licensed practical nurses employed at two large hospitals in Madrid and Navarre (Spain). The results show that stress is positively associated to horizontal mobbing, whereas group support and group identity were negative predictors of horizontal mobbing. Furthermore, the combination of low group identity and low group support precipitated HM among nurses. Copyright © 2013 Elsevier Inc. All rights reserved.
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Market Share Matters: Evidence Of Insurer And Provider Bargaining Over Prices.
Roberts, Eric T; Chernew, Michael E; McWilliams, J Michael
2017-01-01
Proposed mergers among large US health insurers and growing consolidation among providers have renewed concerns about the effects of market concentration on commercial health care prices. Using multipayer claims for physician services provided in office settings, we estimated that-within the same provider groups-insurers with market shares of 15 percent or more (average: 24.5 percent), for example, negotiated prices for office visits that were 21 percent lower than prices negotiated by insurers with shares of less than 5 percent. Analyses stratified by provider market share suggested that insurers require greater market shares to negotiate lower prices from large provider groups than they do when negotiating with smaller provider groups. For example, office visit prices for small practices were $88, $72, and $70, for insurers with market shares of <5 percent, ≥5 to <15 percent, and ≥15 percent, respectively, whereas prices for large provider groups were $97, $86, and $76, exhibiting a continued decrease across higher insurer-market-share categories. These results suggest that mergers of health insurers could lower the prices paid to providers, particularly providers large enough to obtain higher prices from insurers with modest market shares. Continued monitoring will be important for determining the net effects of the countervailing trends of insurer and provider consolidation on the affordability of health care. Project HOPE—The People-to-People Health Foundation, Inc.
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Powered lower limb orthoses for gait rehabilitation
Ferris, Daniel P.; Sawicki, Gregory S.; Domingo, Antoinette
2006-01-01
Bodyweight supported treadmill training has become a prominent gait rehabilitation method in leading rehabilitation centers. This type of locomotor training has many functional benefits but the labor costs are considerable. To reduce therapist effort, several groups have developed large robotic devices for assisting treadmill stepping. A complementary approach that has not been adequately explored is to use powered lower limb orthoses for locomotor training. Recent advances in robotic technology have made lightweight powered orthoses feasible and practical. An advantage to using powered orthoses as rehabilitation aids is they allow practice starting, turning, stopping, and avoiding obstacles during overground walking. PMID:16568153
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Elder, D L
1984-01-01
Looking forward to your next round of collection calls? Few of us do, yet collections play a vital role in every group practice, large or small. This crop of practical collection tips is guaranteed to boost the morale of everyone involved in the collection process. Not only are the basics of a good collection call set down, but result-getting responses to frequent debtor excuses are provided. Telephoning the debtor patient need not be a dreaded task. Just have confidence, keep in mind that the patient does owe you for services rendered in good faith, and pick up the phone--it's a snap!
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End-of-life care at academic medical centers: implications for future workforce requirements.
Goodman, David C; Stukel, Thérèse A; Chang, Chiang-hua; Wennberg, John E
2006-01-01
The expansion of U.S. physician workforce training has been justified on the basis of population growth, technological innovation, and economic expansion. Our analyses found threefold differences in physician full-time-equivalent (FTE) inputs for Medicare cohorts cared for at academic medical centers (AMCs); AMC inputs were highly correlated with the number of physician FTEs per Medicare beneficiary in AMC regions. Given the apparent inefficiency of current physician practices, the supply pipeline is sufficient to meet future needs through 2020, with adoption of the workforce deployment patterns now seen among AMCs and regions dominated by large group practices.
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Effective oral presentations: speaking before groups as part of your job.
McConnell, Charles R
2009-01-01
Fear of public speaking is a widespread phenomenon that afflicts a large percentage of the population. Some working people will go to great lengths to avoid having to speak before a group; however, inability or unwillingness to speak in public can contribute to limiting an individual's promotional possibilities and thus capping a career at a level beneath the individual's technical abilities. This can be especially true in an arena such as health care in which oral communication in group settings figures so strongly in work relations. Yet anyone can overcome speaking fear through thorough preparation and practice. It is necessary to research one's topic thoroughly, outline the points the intended talk will cover, study the composition of one's audience, and plan on targeting some specific level of understanding and remaining ever conscious of the few areas in which problems can occur. With conscientious preparation and plenty of practice, anyone can learn to speak before any group of people, although it may mean facing one's fear head-on a number of times before gaining a level of confidence sufficient to control the fear of speaking.
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Hitch, Danielle; Taylor, Michelle; Pepin, Genevieve
2015-05-01
This aim of this study was to obtain a consensus from clinicians regarding occupational therapy for people with depression, for the assessments and practices they use that are not currently supported by research evidence directly related to functional performance. The study also aimed to discover how many of these assessments and practices were currently supported by research evidence. Following a previously reported systematic review of assessments and practices used in occupational therapy for people with depression, a modified nominal group technique was used to discover which assessments and practices occupational therapists currently utilize. Three online surveys gathered initial data on therapeutic options (survey 1), which were then ranked (survey 2) and re-ranked (survey 3) to gain the final consensus. Twelve therapists completed the first survey, whilst 10 clinicians completed both the second and third surveys. Only 30% of the assessments and practices identified by the clinicians were supported by research evidence. A consensus was obtained on a total of 35 other assessments and interventions. These included both occupational-therapy-specific and generic assessments and interventions. Principle conclusion. Very few of the assessments and interventions identified were supported by research evidence directly related to functional performance. While a large number of options were generated, the majority of these were not occupational therapy specific.
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NASA Astrophysics Data System (ADS)
Gerontas, Apostolos
2014-08-01
Chromatographic instrumentation has been really influential in shaping the modern chemical practice, and yet it has been largely overlooked by history of science.Gas chromatography in the 1960s was considered the analytical technique closer to becoming dominant, and being the first automated chromatography set the standards that all the subsequent chromatographic instrumentation had to fulfill. Networks of specialists, groups of actors, corporate strategies and the analytical practice itself, were all affected and in many ways because of the entrance of gas chromatography in the chemical laboratory and in the instrumentation market. This paper gives a view of the early history of the gas chromatography instrumentation, relates it to the broader research-technology phenomenon and discusses issues of education and group reproduction in the case of the groups of technologists of the era. The chaotic elements of knowledge transfer during the instrumentation revolution in chemistry are being highlighted and they are being connected to the observable radical innovation of the period.
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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.
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Nature and Scope of Certified Nurse-Midwifery Practice in One Large State in the United States.
Hastings-Tolsma, Marie; Wilcox Foster, Sarah; Brucker, Mary C; Nodine, Priscilla; Burpo, Rebecca; Camune, Barbara; Griggs, Jackie; Callahan, Tiffany J
2018-04-21
To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. Mixed methods research utilizing prospective descriptive survey and interview. An online survey was administered to nurse-midwives practicing in the state of Texas (N=449) with a subset (n=10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. The survey was completed by 141 midwives with 8 interviewed. Most were older, Caucasian, and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas, and were employed by a hospital or physician-group. Care was most commonly provided for Hispanic and white women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organization or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. An aging midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilized with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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New Best-Practices Guide for Photovoltaic System Operations and Maintenance
DOE Office of Scientific and Technical Information (OSTI.GOV)
Fact sheet summarizing technical report TP-7A40-67553. As solar photovoltaic (PV) systems have continued their transition from niche applications into large, mature markets in the United States, their potential as financial investments has risen accordingly. Mainstream investors, however, need to feel confident about the risk and return of solar photovoltaic (PV) systems before committing funds. A major influence on risk and return for PV is operations and maintenance (O&M) - but O&M practices and costs vary widely across the United States, making these variables difficult for investors to predict. To address this barrier to continued PV investment, the PV O&M Workingmore » Group has developed a new best-practices guide for PV O&M.« less
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The effect of Reiki on work-related stress of the registered nurse.
Cuneo, Charlotte L; Curtis Cooper, Maureen R; Drew, Carolyn S; Naoum-Heffernan, Christine; Sherman, Tricia; Walz, Kathleen; Weinberg, Janice
2011-03-01
The Reiki Master Teacher group at a large academic, urban medical center studied the effects of Reiki on work-related stress in Registered Nurse Reiki I class participants. Research suggests that work-related stress is an influential factor in nursing burn out and retention. Reiki, an ancient form of Oriental "energy work" or healing, has been found to decrease stress. The Perceived Stress Scale tool was administered prior to the Reiki I class and after three weeks of practicing self-Reiki. Seventeen participants returned follow-up data. Results indicated that practicing Reiki more often resulted in reduced perceived stress levels. Data from this small pilot study supports educating nurses about Reiki practice to decrease work-related stress.
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Carr, Katherine Camacho; Brucker, Mary C
2002-12-01
Today, there are more than 7000 CNMs and CMs in the United States, who attend approximately 9% of American births annually in hospitals, birth centers, and homes. Midwives work in a variety of practice models, including group practices with physicians, HMOs, private practices, rural and urban community health centers, and large managed care organizations. CNMs and CMs also serve as administrators, policy makers, and consultants in international maternal and child health. Midwifery education has come a long way since 1931, when the first education program started. The dedication of CNMs to our clients and the midwifery model of care, as well as these midwifery educational innovations, will continue to support the profession's goals of offering humane, holistic, and safe health care to women and their families.
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Gillen, Marion; Kools, Susan; McCall, Cade; Sum, Juliann; Moulden, Kelli
2004-01-01
Despite the institution of explicit safety practices in construction, there continue to be exceedingly high rates of morbidity and mortality from work-related injury. This study's purpose was to identify, compare and contrast views of construction managers from large and small firms regarding construction safety practices. A complementary analysis was conducted with construction workers. A semi-structured interview guide was used to elicit information from construction managers (n = 22) in a series of focus groups. Questions were designed to obtain information on direct safety practices and indirect practices such as communication style, attitude, expectations, and unspoken messages. Data were analyzed using thematic content analysis. Managers identified a broad commitment to safety, worker training, a changing workplace culture, and uniform enforcement as key constructs in maintaining safe worksites. Findings indicate that successful managers need to be involved, principled, flexible, and innovative. Best practices, as well as unsuccessful injury prevention programs, were discussed in detail. Obstacles to consistent safety practice include poor training, production schedules and financial constraints. Construction managers play a pivotal role in the definition and implementation of safety practices in the workplace. In order to succeed in this role, they require a wide variety of management skills, upper management support, and tools that will help them instill and maintain a positive safety culture. Developing and expanding management skills of construction managers may assist them in dealing with the complexity of the construction work environment, as well as providing them with the tools necessary to decrease work-related injuries.
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ERIC Educational Resources Information Center
Knowles, Ryan T.; Di Stefano, Marialuisa
2015-01-01
In November 2015, a group of researchers met to discuss the role of large-scale international studies to inform social studies research and practice. The conversation focused on published analyses of the International Association for the Evaluation of Educational Achievement (IEA) 1999 Civic Education study (CIVED) of 14 year olds in 28 countries,…
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Govender, Linda; Rochat, Tamsen; Richter, Linda; Rollins, Nigel
2006-01-01
Pediatric wards in South Africa are largely occupied by children with AIDS-related illnesses. This study uses qualitative inquiry involving focus groups with nurses into the needs of children, caregivers, and healthcare providers. The findings indicate changes to the nature of nursing practice, knowledge of nursing, and ethics of nursing care.
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ERIC Educational Resources Information Center
de-la-Fuente-Valentin, Luis; Pardo, Abelardo; Kloos, Carlos Delgado
2013-01-01
The acquisition of programming skills specially in introductory programming courses poses an important challenge for freshmen students of engineering programs. These courses require students to devote a sustained effort during the whole course and a failure to do so may contribute to not passing the course. However, it is difficult for the…
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ERIC Educational Resources Information Center
Ong, Jun-Yang; Chan, Shang-Ce; Hoang, Truong-Giang
2018-01-01
A Sonogashira experiment was transformed into a problem-based learning platform for third-year undergraduate students. Given a target that could be synthesized in a single step, students worked in groups to investigate which method was the best for large-scale production. Through this practical scenario, students learn to conduct a literature…
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ERIC Educational Resources Information Center
Hagedorn, Jan
2017-01-01
Within a framework of reflective practice, this dissertation examines the ways in which preservice K-12 world language teachers discuss classroom language use when reflecting with peers on videos of their teaching. Twelve preservice language teachers at a large public university in the United States participated in four meetings of video study…
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The use of virtual reality computer simulation in learning Port-A cath injection.
Tsai, Sing-Ling; Chai, Sin-Kuo; Hsieh, Li-Feng; Lin, Shirling; Taur, Fang-Meei; Sung, Wen-Hsu; Doong, Ji-Liang
2008-03-01
Cost-benefit management trends in Taiwan healthcare settings have led nurses to perform more invasive skills, such as Port-A cath administration of medications. Accordingly, nurses must be well-prepared prior to teaching by the mentor and supervision method. The purpose of the current study was to develop a computer-assisted protocol using virtual reality (VR) in performing Port-A cath as a training program for novice nurses. A pre-tested and post-tested control group experimental design was used in this study. Seventy-seven novice nurses were invited from one large medical center hospital in North Taiwan. Thirty-seven and forty nurses were randomly assigned to experimental and control groups. First, we designed a 40 minute port-A cath injection VR simulation. Then, the experimental group practiced this simulation two times over 3 weeks. The control group attended the traditional class. The post-test 1 was right after completion of the simulation practice. The post-test 2 was after the second simulation practice in 3 weeks. The results showed that most novice nurses lacked Port-A cath experience both in the classroom and during the period of their practice training. The knowledge score regarding the Port-A cath technique was significantly higher in the nurses that participated in the simulation training than in the control group. The novice nurses were most satisfied with the reduction in their fear of performing the Port-A cath technique and their enhanced clinical skills. VR simulation significantly reduced error rates and increased correct equipment selection, showing that nurses who participated in the simulation may be better prepared for inserting Port-A cath.
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Luscombe, Ciara; Montgomery, Julia
2016-07-19
Lectures continue to be an efficient and standardised way to deliver information to large groups of students. It has been well documented that students prefer interactive lectures, based on active learning principles, to didactic teaching in the large group setting. Despite this, it is often the case than many students do not engage with active learning tasks and attempts at interaction. By exploring student experiences, expectations and how they use lectures in their learning we will provide recommendations for faculty to support student learning both in the lecture theatre and during personal study time. This research employed a hermeneutic phenomenological approach. Three focus groups, consisting of 19 students in total, were used to explore the experiences of second year medical students in large group teaching sessions. Using generic thematic data analysis, these accounts have been developed into a meaningful account of experience. This study found there to be a well-established learning culture amongst students and with it, expectations as to the format of teaching sessions. Furthermore, there were set perceptions about the student role within the learning environment which had many implications, including the way that innovative teaching methods were received. Student learning was perceived to take place outside the lecture theatre, with a large emphasis placed on creating resources that can be taken away to use in personal study time. Presented here is a constructive review of reasons for student participation, interaction and engagement in large group teaching sessions. Based on this are recommendations constructed with the view to aid educators in engaging students within this setting. Short term, educators can implement strategies that monopolise on the established learning culture of students to encourage engagement with active learning strategies. Long term, it would be beneficial for educators to consider ways to shift the current student learning culture to one that embraces an active learning curriculum.
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Blue, Christine M.; Funkhouser, D. Ellen; Riggs, Sheila; Rindal, D. Brad; Worley, Donald; Pihlstrom, Daniel J.; Benjamin, Paul; Gilbert, Gregg H.
2014-01-01
Objectives The purpose of this study was to quantify within The National Dental Practice-Based Research Network current utilization of dental hygienists and assistants with expanded functions and quantify network dentists’ attitudes toward a new non-dentist provider model - the dental therapist. Methods Dental practice-based research network practitioner-investigators participated in a single, cross-sectional administration of a questionnaire. Results Current non-dentist providers are not being utilized by network practitioner-investigators to the fullest extent allowed by law. Minnesota practitioners, practitioners in large group practices, and those with prior experience with expanded function non-dentist providers delegate at a higher rate and had more-positive perceptions of the new dental therapist model. Conclusions Expanding scopes of practice for dental hygienists and assistants has not translated to the maximal delegation allowed by law among network practices. This finding may provide insight into dentists’ acceptance of newer non-dentist provider models. PMID:23668892
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Future Organization of Oral Health Services Delivery: From 2012 to 2042.
Brown, L Jackson
2017-09-01
The United States is currently experiencing a vortex of change in both general health and oral health care delivery, the ultimate outcome of which is still not well understood. The specific focus of this article is to examine the future organization of the oral health services delivery system (OHSDS) in the U.S., with special attention given to the role of large group dental practices (LGDPs) in that future. The article describes the various types of LGDPs and their ability to change the economic characteristics of the OHSDS. Large geographically distributed corporate group dental practices (LGDCGDPs) are the type that may expand their market share to the extent that they could change the economic characteristics of the OHSDS. A wide range of scenarios is used to project the expansion of LGDCGDPs into the future. The scenarios modeled are not intended as predictions but rather to present a range of possible OHSDS market structures that may emerge over the next 30 years. The implications of each scenario for the economic competition within the OHSDS are described. Possible implications of these trends for dental education are also discussed. This article was written as part of the project "Advancing Dental Education in the 21 st Century."
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Badger, Gary R; Fryer, Cheryl E S; Giannini, Peter J; Townsend, Janice A; Huja, Sarandeep
2015-12-01
According to the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors, 45.3% of new graduates planned to enter private practice immediately after graduation; of those, while 65% planned to become an associate dentist in a private practice, 28.3% intended to enter a corporate group practice-the only category that saw an increase over the previous year. Current trends indicate that the number of new graduates choosing to enter some form of private practice without further education will continue to remain high, due in large part to the need to repay educational debt. In light of these trends, the question that must be asked is whether dental schools are optimally preparing students to make informed decisions regarding future employment options in the changing dental practice landscape. This article argues that dental schools should review their curricula to ensure graduates are being prepared for this changing environment and the increased business pressures associated with dental practice. Important considerations in preparing dental students to be successful in the process of selecting a practice model are identified.
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Rapaport, Robert; Silverstein, Janet H; Garzarella, Linda; Rosenbloom, Arlan L
2004-06-01
To determine the relative frequency of type 2 diabetes mellitus (DM) in the US, and to assess diabetes practice patterns in the US. A questionnaire regarding pediatric diabetes practice patterns was distributed to the members of the Lawson Wilkins Pediatric Endocrine Society in 1999. Only one member of each practice group was requested to respond. Responses received through early 2000 were analyzed. One hundred and twenty-six practices representing 45% of the members of the Society responded. 11.9% of pediatric patients with DM were considered to have type 2 DM. On average 53 new patients with DM were seen each year. The average practice consisted of 2.5 physicians, 1.5 nurse educators, 1.3 dieticians, 1.0 social workers and 0.5 nurse practitioners. Management practices comply by and large with the recommendations of the American Diabetes Association and reflect a trend toward more intensive treatment and monitoring. Type 2 DM was seen in 11.9% of patients. Most diabetes practices in the US utilize a team approach to the management of youth with DM.
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Evaluation of a youth agency's supervision practices: A mixed-method approach.
Gosselin, Julie; Valiquette-Tessier, Sophie-Claire; Vandette, Marie-Pier; Romano, Elisa
2015-10-01
This research presents the findings from an evaluation and organizational development initiative that was requested by a Canadian youth agency working in a large urban setting. A team of four researchers affiliated with the Center for Research on Educational and Community Services (CRECS) at the University of Ottawa conducted the evaluation. The purpose of the evaluation was to identify the supervision needs and challenges of coordinators and front line staff, assess the efficiency of the current supervision practices, and evaluate the supervisors' and supervisees' satisfaction with these current practices. A literature review was performed to help provide a clear definition of 'supervision' and the different professional roles it encompasses. Additionally, research evidence pertaining both to what contributes to supervision efficacy and supervisor competency was reviewed to distill the most robust findings in the existing literature. The lines of evidence consisted of a document and file review, an online employee survey, group discussions (i.e. focus groups), and interviews with key informants. The results of the evaluation helped the research team formulate recommendations to the agency for the development of enhanced supervision practices across its various service areas. Copyright © 2015 Elsevier Ltd. All rights reserved.
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What Infant Memory Tells Us about Infantile Amnesia: Long-Term Recall and Deferred Imitation
Meltzoff, Andrew N.
2013-01-01
Long-term recall memory was assessed using a nonverbal method requiring subjects to reenact a past event from memory (deferred imitation). A large sample of infants (N = 192), evenly divided between 14- and 16-months old, was tested across two experiments. A delay of 2 months was used in Experiment 1 and a delay of 4 months in Experiment 2. In both experiments two treatment groups were used, In one treatment group, motor practice (immediate imitation) was allowed before the delay was imposed; in the other group, subjects were prevented from motor practice before the delay. Age-matched control groups were used lo assess the spontaneous production of the target acts in the absence of exposure to the model in both experiments. The results demonstrated significant deferred imitation for both treatment groups at both delay intervals, and moreover showed that infants retained and imitated multiple acts. These findings suggest that infants have a nonverbal declarative memory system that supports the recall of past events across long-term delays. The implications of these findings for the multiple memory system debate in cognitive science and neuroscience and for theories of infantile amnesia are considered. PMID:7622990
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NASA Astrophysics Data System (ADS)
Johnson, Joseph A.
2011-12-01
This study involved an intervention in which I explored how the multimodal, inquiry-based teaching strategies from a professional development model could be used to meet the educational needs of a group of middle school students, who were refugees, newly arrived in the United States, now residing in a large urban school district in the northeastern United States, and learning English as a second language. This group remains unmentioned throughout the research literature despite the fact that English Language Learners (ELLs) represent the fastest growing group of K-12 students in the United States. The specific needs of this particular group were explored as I attempted daily to confront a variety of obstacles to their science achievement and help to facilitate the development of a scientific discourse. This research was done in an effort to better address the needs of ELLs in general and to inform best practices for teachers to apply across a variety of different cultural and linguistic subgroups. This study is an autoethnographic case study analysis of the practices of the researcher, working in a science classroom, teaching the described group of students.
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Robot-assisted practice of gait and stair climbing in nonambulatory stroke patients.
Hesse, Stefan; Tomelleri, Christopher; Bardeleben, Anita; Werner, Cordula; Waldner, Andreas
2012-01-01
A novel gait robot enabled nonambulatory patients the repetitive practice of gait and stair climbing. Thirty nonambulatory patients with subacute stroke were allocated to two groups. During 60 min sessions every workday for 4 weeks, the experimental group received 30 min of robot training and 30 min of physiotherapy and the control group received 60 min of physiotherapy. The primary variable was gait and stair climbing ability (Functional Ambulation Categories [FAC] score 0-5); secondary variables were gait velocity, Rivermead Mobility Index (RMI), and leg strength and tone blindly assessed at onset, intervention end, and follow-up. Both groups were comparable at onset and functionally improved over time. The improvements were significantly larger in the experimental group with respect to the FAC, RMI, velocity, and leg strength during the intervention. The FAC gains (mean +/- standard deviation) were 2.4 +/- 1.2 (experimental group) and 1.2 +/- 1.5 (control group), p = 0.01. At the end of the intervention, seven experimental group patients and one control group patient had reached an FAC score of 5, indicating an ability to climb up and down one flight of stairs. At follow-up, this superior gait ability persisted. In conclusion, the therapy on the novel gait robot resulted in a superior gait and stair climbing ability in nonambulatory patients with subacute stroke; a higher training intensity was the most likely explanation. A large randomized controlled trial should follow.
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Essential pediatric hypertension: defining the educational needs of primary care pediatricians.
Cha, Stephen D; Chisolm, Deena J; Mahan, John D
2014-07-27
In order to better understand the educational needs regarding appropriate recognition, diagnosis and management of pediatric hypertension (HTN), we asked practicing pediatricians questions regarding their educational needs and comfort level on this topic. We conducted 4 focus group sessions that included 27 participants representing pediatric residents, adolescent medicine physicians, clinic based pediatricians and office based pediatricians. Each focus group session lasted for approximately an hour and 90 pages of total transcriptions were produced verbatim from audio recordings. Four reviewers read each transcript and themes were elucidated from these transcripts. Overall, 5 major themes related to educational needs and clinical concerns were found: utilization of resources to define blood pressure (BP), correct BP measurement method(s), co-morbidities, barriers to care, and experience level with HTN. Six minor themes were also identified: differences in BP measurement, accuracy of BP, recognition of HTN, practice pattern of care, education of families and patients, and differences in level of training. The focus group participants were also questioned on their preferences regarding educational methods (i.e. e-learning, small group sessions, self-study, large group presentations) and revealed varied teaching and learning preferences. There are multiple methods to approach education regarding pediatric HTN for primary care pediatricians based on provider preferences and multiple educational activities should be pursued to achieve best outcomes. Based on this data, the next direction will be to develop and deliver multiple educational methods and to evaluate the impact on practice patterns of care for children and adolescents with HTN.
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Online Chats to Assess Stakeholder Perceptions of Meat Chicken Intensification and Welfare.
Howell, Tiffani J; Rohlf, Vanessa I; Coleman, Grahame J; Rault, Jean-Loup
2016-10-27
Evidence suggests that there is variation in support for specific chicken farming practices amongst stakeholder groups, and this should be explored in more detail to understand the nature of these differences and work towards convergence. Online focus groups were used to assess attitudes to animal welfare in meat chicken farming in this pilot study. Across six online chats, 25 participants (general public, n = 8; animal advocacy group, n = 11, meat chicken industry, n = 3; research or veterinary practice who had experience with poultry but no declared industry affiliation, n = 3) discussed meat chicken intensification and welfare. Of those, 21 participants completed pre- and post-chat surveys gauging perceptions and objective knowledge about meat chicken management. Main reasons for intensification support were perceptions of improved bird health, and perceptions that it is a cost-effective, sustainable farming system. Reasons for opposition included perceptions that a large number of birds kept are in close proximity and have limited ability to perform natural behaviours. Misunderstandings about current practices were clarified in chats which contained industry representation. Participants agreed on the need for enforceable standards and industry transparency. Industry-affiliated members rated welfare of meat chickens higher, and gave lower ratings for the importance of natural living, than other stakeholder groups (both p = 0.001). On average, while objective knowledge of intensification increased after chat participation (p = 0.03), general welfare ratings and support for intensification did not change over time, counter to assertions that lack of knowledge results in lack of support for some practices.
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Leadership and professionalism curriculum in the Gross Anatomy course.
Pawlina, Wojciech; Hromanik, Michael J; Milanese, Tia R; Dierkhising, Ross; Viggiano, Thomas R; Carmichael, Stephen W
2006-09-01
Today's physicians must demonstrate both professionalism and leadership skills in order to succeed in largely team-based healthcare environments. The purpose of this study was to determine if professionalism attributes, leadership style, and leadership style adaptability are associated with academic performance among first-year students early in their medical curriculum. Students were divided into 4-member dissection groups for the duration of the Gross and Developmental Anatomy course. Leadership responsibility was randomly assigned to a team member on a rotating basis every 5 weeks. After each 5-week block, student performance was measured by written and practical examinations, and each student assessed their leader's or their own professionalism attributes and leadership style using validated survey instruments. Most students demonstrated either a "selling" only (57%) or "participating" only (30%) leadership style with low to moderate leadership adaptability. "Participating" and "delegating" leadership styles have the highest average group written exam scores (89.4%, P <0.008). "Telling" only or "selling" only leaders have the lowest average group exam scores (83.5%, P <0.001). "Selling" and "participating" leaders have significantly lower average group practical exam scores than other styles (81.5%, P <0.007). Positive associations were observed between the written and practical examination scores and the leader's integrity (P = 0.003, P = 0.002) and responsibility (P <0.001, P = 0.037). This study demonstrates that various situational leadership styles and aspects of professionalism are associated with written and practical examination scores in the Gross and Developmental Anatomy course. Furthermore, it demonstrates that first-year medical students are in need of leadership skill development.
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Brandon, Catherine J; Mullan, Patricia B
2013-03-01
To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents' understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice. A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions. Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents' interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses (P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology. Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.
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Peckham, S; Lowery, D; Spencer, S
2015-07-01
While previous research has suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism, few population level studies have been undertaken. In England, approximately 10% of the population live in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. This observational study examines the association between levels of fluoride in water supplies with practice level hypothyroidism prevalence. We used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/2013 Quality and Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner registered patient numbers and 2012 practice level Index of Multiple Deprivation scores. We found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area). In many areas of the world, hypothyroidism is a major health concern and in addition to other factors-such as iodine deficiency-fluoride exposure should be considered as a contributing factor. The findings of the study raise particular concerns about the validity of community fluoridation as a safe public health measure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Ahene, Ago; Calonder, Claudio; Davis, Scott; Kowalchick, Joseph; Nakamura, Takahiro; Nouri, Parya; Vostiar, Igor; Wang, Yang; Wang, Jin
2014-01-01
In recent years, the use of automated sample handling instrumentation has come to the forefront of bioanalytical analysis in order to ensure greater assay consistency and throughput. Since robotic systems are becoming part of everyday analytical procedures, the need for consistent guidance across the pharmaceutical industry has become increasingly important. Pre-existing regulations do not go into sufficient detail in regard to how to handle the use of robotic systems for use with analytical methods, especially large molecule bioanalysis. As a result, Global Bioanalytical Consortium (GBC) Group L5 has put forth specific recommendations for the validation, qualification, and use of robotic systems as part of large molecule bioanalytical analyses in the present white paper. The guidelines presented can be followed to ensure that there is a consistent, transparent methodology that will ensure that robotic systems can be effectively used and documented in a regulated bioanalytical laboratory setting. This will allow for consistent use of robotic sample handling instrumentation as part of large molecule bioanalysis across the globe.
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Change in Practice over Four Decades in the Management of Graves' Disease in Scotland.
Smith, D M; Dutta, S; Ahmed, F; Thaha, M A
2016-01-01
There is continuing debate on the optimal treatment for Grave's thyrotoxicosis with a resultant variation in clinical practice. The present study aimed to ascertain changes in practice in the treatment of Grave's thyrotoxicosis in Tayside, Scotland, over the past four decades. Methods. The "Scottish automated follow-up register" (SAFUR) was queried to identify all patients treated for Grave's thyrotoxicosis from 1968 to 2007 inclusive. Patients were divided into 4 groups (Groups A to D) according to the decades. Demographic profile, treatment modalities, radioactive iodine (RAI) dose, and recurrence rates were studied and outcomes were compared by χ (2) test and ANOVA using SPSS v15.0. A p value of < 0.05 was considered significant. Results. Altogether, 3737 patients were diagnosed with Grave's thyrotoxicosis over the 4 decades. Use of RAI has increased from 43.1% in Group A to 68% in Group D (p < 0.001). The dose of RAI has increased (p < 0.001) and there has been a reduction in recurrence rate with higher dose of RAI. Surgical intervention rates decreased from 55.3% to 12.3% (p < 0.001) over time. Conclusions. Analysis of a large dataset of patients with Grave's thyrotoxicosis suggests increasing use of RAI as the preferred first line of treatment. Furthermore, using a single higher dose of RAI and adoption of total thyroidectomy have decreased recurrence rates.
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Change in Practice over Four Decades in the Management of Graves' Disease in Scotland
Smith, D. M.; Dutta, S.; Ahmed, F.; Thaha, M. A.
2016-01-01
There is continuing debate on the optimal treatment for Grave's thyrotoxicosis with a resultant variation in clinical practice. The present study aimed to ascertain changes in practice in the treatment of Grave's thyrotoxicosis in Tayside, Scotland, over the past four decades. Methods. The “Scottish automated follow-up register” (SAFUR) was queried to identify all patients treated for Grave's thyrotoxicosis from 1968 to 2007 inclusive. Patients were divided into 4 groups (Groups A to D) according to the decades. Demographic profile, treatment modalities, radioactive iodine (RAI) dose, and recurrence rates were studied and outcomes were compared by χ 2 test and ANOVA using SPSS v15.0. A p value of < 0.05 was considered significant. Results. Altogether, 3737 patients were diagnosed with Grave's thyrotoxicosis over the 4 decades. Use of RAI has increased from 43.1% in Group A to 68% in Group D (p < 0.001). The dose of RAI has increased (p < 0.001) and there has been a reduction in recurrence rate with higher dose of RAI. Surgical intervention rates decreased from 55.3% to 12.3% (p < 0.001) over time. Conclusions. Analysis of a large dataset of patients with Grave's thyrotoxicosis suggests increasing use of RAI as the preferred first line of treatment. Furthermore, using a single higher dose of RAI and adoption of total thyroidectomy have decreased recurrence rates. PMID:27313946
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Energy conservation awareness and practice in restaurants of Hennepin County, Minnesota.
Brondum, Jack; Palchick, Susan
2012-12-01
Greenhouse gases result mainly from the combustion of fossil fuels in energy use. Restaurants use large amounts of energy in their operation but systematically gathered information about such use is lacking. Hennepin County Human Services and Public Health Department surveyed owners of licensed restaurants to assess their energy use and awareness of energy conservation measures. Of 434 owners surveyed, 276 (63.6%) returned completed surveys. Responses indicated that large pluralities or majorities of restaurant owners often were aware of energy-efficient methods of operation and the means to achieve greater efficiency but used such means much less frequently. For example, 57% of respondents were familiar with the U.S. Environmental Protection Agency's Energy Star program, but only 33% of this group actually used Energy Star appliances. Given the gap between awareness and practice, opportunities for consultation and outreach to restaurant owners about energy-efficient business operation are manifold.
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Strategies and Exemplars for Public Outreach Events: Planning, Implementation, Evaluation
NASA Astrophysics Data System (ADS)
Cobb, W. H.; Buxner, S.; Shipp, S. S.; Shebby, S.
2015-12-01
IntroductionEach year the National Aeronautics and Space Administration (NASA) sponsors a variety of public outreach events to share information with educators, students, and the general public. These events are designed to increase interest in and awareness of the mission and goals of NASA. Planning and implementation best practices gleaned from the NASA SMD Education's review of large-scale events, "Best Practices in Outreach Events" will be shared. Outcomes from an event, i C Ceres, celebrating the Dawn mission's arrival at dwarf planet Ceres that utilized these strategies will be shared. Best practices included can be pertinent for all event organizers and evaluators regardless of event size. BackgroundThe literature review focused on identifying evaluations of large-scale public outreach events—and, within these evaluations, identifying best practices. The following criteria for identifying journal articles and reports to potentially include: Public, science-related events open to adults and children. Events with more than 1,000 attendees. Events that occurred during the last 5 years. Evaluations that included information on data collected from visitors and/or volunteers. Evaluations that specified the type of data collected, methodology, and associated results. Planning and Implementation Best PracticesThe literature review revealed key considerations for planning and of large-scale events implementing events. A summary of related best practices is presented below. 1) Advertise the event 2) Use and advertise access to scientists 3) Recruit scientists using these findings 4) Ensure that the event is group and particularly child friendly 5) Target specific event outcomes Best Practices Informing Real-world Planning, Implementation and EvaluationDawn mission's collaborative design of a series of events, i C Ceres, including in-person, interactive events geared to families and live presentations will be shared. Outcomes and lessons learned will be imparted rising from these events and their evaluation. There will be a focus on the family event, in particular the evidence that scientist participation was a particular driver for the event's impact and success.
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Goodwin, Nicholas; Mays, Nicholas; McLeod, Hugh; Malbon, Gill; Raftery, James
1998-01-01
Objectives: To evaluate the reported achievements of the 52 first wave total purchasing pilot schemes in 1996-7 and the factors associated with these; and to consider the implications of these findings for the development of the proposed primary care groups. Design: Face to face interviews with lead general practitioners, project managers, and health authority representatives responsible for each pilot; and analysis of hospital episode statistics. Setting: England and Scotland for evaluation of pilots; England only for consideration of implications for primary care groups. Main outcome measures: The ability of total purchasers to achieve their own objectives and their ability specifically to achieve objectives in the service areas beyond fundholding included in total purchasing. Results: The level of achievement between pilots varied widely. Achievement was more likely to be reported in primary than in secondary care. Reported achievements in reducing length of stay and emergency admissions were corroborated by analysis of hospital episode statistics. Single practice and small multipractice pilots were more likely than large multipractice projects to report achieving their objectives. Achievements were also associated with higher direct management costs per head and the ability to undertake independent contracting. Large multipractice pilots required considerable organisational development before progress could be made. Conclusion: The ability to create effective commissioning organisations the size of the proposed primary care groups should not be underestimated. To be effective commissioners, these care groups will need to invest heavily in their organisational development and in the short term are likely to need an additional development budget rather than the reduction in spending on NHS management that is planned by the government. Key messages The level of reported achievement between the total purchasing pilots in 1996-7 varied widely; achievement was more likely to occur in primary than in secondary care Single practice and small multipractice pilots were more likely than large multipractice pilots to report achieving their objectives in 1996/97; achievements were also associated with higher direct management costs per head Large multipractice pilots needed more time for organisational development before progress could be made Difficulties in creating effective commissioning organisations the size of the proposed primary care groups should not be underestimated Primary care groups will need to invest heavily in organisational development and are likely to need an additional development budget in the short term PMID:9677217
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Riley, J L; Richman, Joshua S; Rindal, D Brad; Fellows, Jeffrey L; Qvist, Vibeke; Gilbert, Gregg H; Gordan, Valeria V
2010-01-01
Scientific evidence supports the application of caries-preventive agents in children and adolescents, and this knowledge must be applied to the practice of dentistry. There are few multi-region data that allow for comparisons of practice patterns between types of dental practices and geographical regions. The objective of the present study was to characterise the use of specific caries-preventive agents for paediatric patients in a large multi-region sample of practising clinicians. The present study surveyed clinicians from the Dental Practice-based Research Network who perform restorative dentistry in their practices. The survey consisted of a questionnaire that presented a range of questions about caries risk assessment and the use of preventive techniques in children aged 6 to 18 years. Dental sealants (69%) or in-office fluoride (82%) were the most commonly used caries-preventive agents of the caries preventive regimens. The recommendation of at-home caries-preventive agents ranged from 36% to 7%,with the most commonly used agent being non-prescription fluoride rinse. Clinicians who practised in a large group practice model and clinicians who come from the Scandinavian region use caries risk assessment more frequently compared to clinicians who come from regions that had, predominantly, clinicians in private practice. Whether or not clinicians used caries risk assessment with their paediatric patients was poorly correlated with the likelihood of actually using caries-preventive treatments on patients. Although clinicians reported the use of some form of in-office caries-preventive agent, there was considerable variability across practices. These differences could represent a lack of consensus across practising clinicians about the benefits of caries-preventive agents, or a function of differing financial incentives, or patient pools with differing levels of overall caries risk.
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Factors influencing professional life satisfaction among neurologists.
Teixeira-Poit, Stephanie M; Halpern, Michael T; Kane, Heather L; Keating, Michael; Olmsted, Murrey
2017-06-19
Predicted shortages in the supply of neurologists may limit patients' access to and quality of care for neurological disorders. Retaining neurologists already in practice provides one opportunity to support the overall supply of practicing neurologists. Understanding factors associated with professional life satisfaction (and dissatisfaction) and implementing policies to enhance satisfaction may encourage neurologists to remain in clinical practice. In this paper, we present results from the first study examining factors associated with professional life satisfaction among a large sample of U.S, neurologists. We collaborated with the AAN to survey a sample of U.S. neurologists about their professional life satisfaction. Analyses examined the association of physician and practice characteristics with aspects of professional life satisfaction, including satisfaction with their career in medicine, medical specialty, current position, relationship with colleagues, relationship with patients, work/life balance, and pay. The study population consisted of 625 neurologists. In multivariate regression analyses, no single group or population stratum indicated high (or low) responses to all aspects of satisfaction. Older neurologists reported higher satisfaction with career, specialty, and relationship with patients than younger neurologists. Female neurologists had significantly lower satisfaction with pay than male neurologists. Neurologists who spent more time in research and teaching had greater satisfaction with specialty, relationship with colleagues, and relationship with patients than those spending no time in research. Neurologists who practiced in small cities/rural areas reported lower satisfaction across multiple dimensions than those practicing in large urban areas. Neurologists in solo practice had greater satisfaction with the relationship with their patients, but lower satisfaction with pay. Satisfaction is a multidimensional construct that is associated with physician and practice characteristics. Enhancing professional life satisfaction among neurologists requires multiple strategies, such as promoting comparable wages for men and women, providing collaboration and research opportunities, and providing resources for small and rural practices.
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Sabus, Carla; Spake, Ellen
2016-01-01
Background and purpose New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Design Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. Methods The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Results Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Conclusion Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR. PMID:29355199
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Sabus, Carla; Spake, Ellen
2016-01-01
New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with DOI theory and the CFIR.
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Narratives of neoliberalism: 'clinical labour' in context.
Parry, Bronwyn
2015-06-01
Cross-border reproductive care has been thrust under the international spotlight by a series of recent scandals. These have prompted calls to develop more robust means of assessing the exploitative potential of such practices and the need for overarching and normative forms of national and international regulation. Allied theorisations of the emergence of forms of clinical labour have cast the outsourcing of reproductive services such as gamete donation and gestational surrogacy as artefacts of a wider neoliberalisation of service provision. These accounts share with many other narratives of neoliberalism a number of key assertions that relate to the presumed organisation of labour relations within this paradigm. This article critically engages with four assumptions implicit in these accounts: that clinical labourers constitute a largely homogeneous underclass of workers; that reproductive labour has been contractualised in ways that disembed it from wider social and communal relations; that contractualisation can provide protection for clinical labour lessening the need for formal regulatory oversight; and that the transnationalisation of reproductive service labour is largely unidirectional and characterised by a dynamic of provision in which 'the rest' services 'the West'. Drawing on the first findings of a large-scale ethnographic research project into assisted reproduction in India I provide evidence to refute these assertions. In so doing the article demonstrates that while the outsourcing and contractualisation of reproductive labour may be embedded in a wider neoliberal paradigm these practices cannot be understood nor their impacts be fully assessed in isolation from their social and cultural contexts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Papavasiliou, Evangelia Evie; Chambaere, Kenneth; Deliens, Luc; Brearley, Sarah; Payne, Sheila; Rietjens, Judith; Vander Stichele, Robert; Van den Block, Lieve
2014-06-01
Research on continuous deep sedation until death has focused on estimating prevalence and describing clinical practice across care settings. However, evidence on sedation practices by physician specialty is scarce. To compare and contrast physician-reported practices on continuous deep sedation until death between general practitioners and medical specialists. A secondary analysis drawing upon data from a large-scale, population-based, retrospective survey among physicians in Flanders, Belgium in 2007. Symptom prevalence and characteristics of sedation (drugs used, artificial nutrition and hydration administered, intentions, and decision-making) were measured. Response rate was 58.4%. The frequency of continuous deep sedation until death among all deaths was 11.3% for general practitioners and 18.4% for medical specialists. General practitioners reported significantly higher rates of severity and mean intensity of pain, delirium, dyspnea, and nausea in the last 24 h of life for sedated patients and a higher number of severe symptoms than medical specialists. No differences were found between groups in the drugs used, except in propofol, reported only by medical specialists (in 15.8% of all cases). Artificial nutrition and hydration was withheld or withdrawn in 97.2% of general practitioner and 36.2% of medical specialist cases. Explicit life-shortening intentions were reported by both groups (for 3%-4% of all cases). Continuous deep sedation until death was initiated without consent or request of either the patient or the family in 27.9% (medical specialists) and 4.7% (general practitioners) of the cases reported. Considerable variation, often largely deviating from professional guidelines, was observed in physician-reported performance and decision-making, highlighting the importance of providing clearer guidance on the specific needs of the context in which continuous deep sedation until death is to be performed. © The Author(s) 2014.
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Retention of Mastoidectomy Skills After Virtual Reality Simulation Training.
Andersen, Steven Arild Wuyts; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten
2016-07-01
The ultimate goal of surgical training is consolidated skills with a consistently high performance. However, surgical skills are heterogeneously retained and depend on a variety of factors, including the task, cognitive demands, and organization of practice. Virtual reality (VR) simulation is increasingly being used in surgical skills training, including temporal bone surgery, but there is a gap in knowledge on the retention of mastoidectomy skills after VR simulation training. To determine the retention of mastoidectomy skills after VR simulation training with distributed and massed practice and to investigate participants' cognitive load during retention procedures. A prospective 3-month follow-up study of a VR simulation trial was conducted from February 6 to September 19, 2014, at an academic teaching hospital among 36 medical students: 19 from a cohort trained with distributed practice and 17 from a cohort trained with massed practice. Participants performed 2 virtual mastoidectomies in a VR simulator a mean of 3.2 months (range, 2.4-5.0 months) after completing initial training with 12 repeated procedures. Practice blocks were spaced apart in time (distributed), or all procedures were performed in 1 day (massed). Performance of the virtual mastoidectomy as assessed by 2 masked senior otologists using a modified Welling scale, as well as cognitive load as estimated by reaction time to perform a secondary task. Among 36 participants, mastoidectomy final-product skills were largely retained at 3 months (mean change in score, 0.1 points; P = .89) regardless of practice schedule, but the group trained with massed practice took more time to complete the task. The performance of the massed practice group increased significantly from the first to the second retention procedure (mean change, 1.8 points; P = .001), reflecting that skills were less consolidated. For both groups, increases in reaction times in the secondary task (distributed practice group: mean pretraining relative reaction time, 1.42 [95% CI, 1.37-1.47]; mean end of training relative reaction time, 1.24 [95% CI, 1.16-1.32]; and mean retention relative reaction time, 1.36 [95% CI, 1.30-1.42]; massed practice group: mean pretraining relative reaction time, 1.34 [95% CI, 1.28-1.40]; mean end of training relative reaction time, 1.31 [95% CI, 1.21-1.42]; and mean retention relative reaction time, 1.39 [95% CI, 1.31-1.46]) indicated that cognitive load during the virtual procedures had returned to the pretraining level. Mastoidectomy skills acquired under time-distributed practice conditions were retained better than skills acquired under massed practice conditions. Complex psychomotor skills should be regularly reinforced to consolidate both motor and cognitive aspects. Virtual reality simulation training provides the opportunity for such repeated training and should be integrated into training curricula.
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[Sports, use of performance enhancing drugs and addiction. A conceptual and epidemiological review].
Franques, P; Auriacombe, M; Tignol, J
2001-11-01
Both the general public and non-sports medicine health professionals have recently been made aware of a large use of performance enhancing drugs among sports practicing subjects. It has been suggested that this behavior is similar to that of substance dependence. Also some have reported that practice of a sport could be in itself an addictive behavior. The main objective was to address the following question: is performance enhancing drug use in sports an addictive behavior? Methodology. We first reviewed the definition of performance enhancing drug use in sports and the diagnostic criteria of substance dependence as they are currently accepted and attempted to determine a possible common factor. Secondly we reviewed epidemiological data from the literature according to three approaches: Use of performance enhancing drugs is an important and increasing phenomenon among adolescents. It is sometimes associated to risk taking behaviors for health (syringe use and sharing). Competition participants are at increased risk (up to 20% according to some authors) and some substances (anabolic steroids) are also used by non-sports practicing individuals. It has not been shown that sports practicing subjects were more at risk of using addictive substances compared to non-sports practicing subjects. It is not established that practice of a sport is by itself a risk factor for substance use. However, it could be that a sub-group of individuals that practice certain types of sports in an intensive way, that use both performance enhancing drugs and addictive substances and that engage in health risk taking behaviors have an increased risk for developing a dependence syndrome to both addictive and performance enhancing drugs. This sub-group is even more at risk because some performance enhancing drugs (anabolic steroids) could increase the risk for occurrence of a substance dependence syndrome through neurobiological actions. Yet, the few available clinical studies show that at most only half of regular users actually meet criteria for dependence. Also, one study has reported an overrepresentation of sports professionals among patients seeking treatment for heroin addiction. The large majority of sports practicing subjects have no dependence to either performance enhancing or addictive drugs. However, a subgroup of individuals that practice sports intensely and makes use of both addictive and performance enhancing drugs appear to be at increased risk for developing a substance dependence syndrome.
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Two methods for parameter estimation using multiple-trait models and beef cattle field data.
Bertrand, J K; Kriese, L A
1990-08-01
Two methods are presented for estimating variances and covariances from beef cattle field data using multiple-trait sire models. Both methods require that the first trait have no missing records and that the contemporary groups for the second trait be subsets of the contemporary groups for the first trait; however, the second trait may have missing records. One method uses pseudo expectations involving quadratics composed of the solutions and the right-hand sides of the mixed model equations. The other method is an extension of Henderson's Simple Method to the multiple trait case. Neither of these methods requires any inversions of large matrices in the computation of the parameters; therefore, both methods can handle very large sets of data. Four simulated data sets were generated to evaluate the methods. In general, both methods estimated genetic correlations and heritabilities that were close to the Restricted Maximum Likelihood estimates and the true data set values, even when selection within contemporary groups was practiced. The estimates of residual correlations by both methods, however, were biased by selection. These two methods can be useful in estimating variances and covariances from multiple-trait models in large populations that have undergone a minimal amount of selection within contemporary groups.
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Pilot Trial of a Licensed Practical Nurse Intervention for Hypertension and Depression
Bogner, Hillary R.; de Vries, Heather F.; Kaye, Elise M.; Morales, Knashawn H.
2014-01-01
BACKGROUND AND OBJECTIVES Depression is a risk factor for hypertension, and risk of depression is increased substantially in patients with hypertension. Our objective was to examine whether an intervention carried out by Licensed Practical Nurses (LPNs) integrating depression treatment into care for hypertension improved blood pressure control and depressive symptoms. METHODS In all, 60 patients ages 41 to 92 years with hypertension and depressive symptoms at a large primary care practice in Philadelphia were randomly assigned to an integrated care intervention carried out by LPNs (n=30) or usual care (n=30). Intervention and control groups did not differ statistically on baseline measures. Outcomes assessed at baseline and 12 weeks included standard laboratory procedures to measure blood pressure control and the Patient Health Questionnaire (PHQ-9) to assess depression. RESULTS Patients in the integrated care intervention had lower diastolic blood pressure (intervention 74.2 mmHg versus usual care 82.0 mmHg) and fewer depressive symptoms (PHQ-9 mean scores, intervention 2.4 versus usual care 7.1) compared with patients in the usual care group at 12 weeks after adjustment for baseline values. Patients in the integrated care intervention also had lower systolic blood pressure (intervention 130.0 mmHg versus usual care 140.6 mmHg) compared with patients in the usual care group at 12 weeks although the results approached but did not reach conventional levels of statistical significance. CONCLUSION Training existing primary care practice office staff will facilitate implementation in real world practices with limited resources and competing demands. PMID:23681683
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Triadic Gaze Intervention for Young Children with Physical Disabilities
Olswang, Lesley B.; Dowden, Patricia; Feuerstein, Julie; Greenslade, Kathryn; Pinder, Gay Lloyd; Fleming, Kandace
2018-01-01
Purpose This randomized controlled study investigated whether a supplemental treatment designed to teach triadic gaze (TG) as a signal of coordinated joint attention (CJA) would yield a significantly greater increase in TG in the experimental versus control group. Method Eighteen 10- to 24-month-old children with severe motor impairments were randomly assigned to an experimental (n=9) or control group (n=9). For approximately 29 sessions over 17 weeks, experimental participants received TG treatment twice weekly with a speech-language pathologist (SLP) in addition to standard practice. Controls received only standard practice from birth-to-three therapists. Coders masked to group assignment coded TG productions with an unfamiliar SLP at baseline, every three weeks during the experimental phase, and at the final measurement session. Results TG increased across groups from baseline to final measurement, with the experimental group showing slightly greater change. Performance trends were examined using experimental phase moving averages. Comparisons revealed significant differences between groups at two time points (at 12 weeks, r= .30, a medium effect and at the end of the phase r=.50, large effect). Conclusion Results suggest the promise of a short-term, focused treatment to teach TG as a behavioral manifestation of CJA to children with severe physical disabilities. PMID:24686825
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Lane, Cheryl A; Selleck, Cynthia; Chen, Yuying; Tang, Ying
2016-01-01
The purpose of this study was to evaluate the impact of implementing evidence-based guidelines on smoking cessation in persons with spinal cord injuries and pressure injuries. We also evaluated the impact of smoking on pressure injury healing in this population. The sample population included 158 spinal cord-injured patients with pressure injuries (29 females and 129 males). There were 83 in the control group and 75 in the intervention group, with a mean age of 44 years in both groups. The research setting was an outpatient wound clinic located in a large medical center in the southeastern United States. A retrospective chart review was completed. Data were reviewed 6 months before and 6 months after implementation of the US Department of Health and Human Services Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We evaluated the number and size of wounds, achievement of smoking cessation, and demographic information. Forty-eight percent of the control group participants and 57% of the intervention group participants smoked cigarettes at baseline. Smoking cessation doubled with the use of the clinical practice guidelines (P = .03). Smokers presented with a greater number of pressure injuries than nonsmokers. They experienced a mean increase rather than reduction in wound size. Nearly half (45.5%) of the intervention group participants who desired to have surgery had it performed, compared with only 34.9% of the control group participants (P = .35). Our findings demonstrate a positive influence with use of clinical practice guidelines to help individuals stop smoking. Results also confirm findings of previous studies supporting the negative impact of smoking on pressure injury healing in persons with spinal cord injuries.
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Surveys and questionnaires in nursing research.
Timmins, Fiona
2015-06-17
Surveys and questionnaires are often used in nursing research to elicit the views of large groups of people to develop the nursing knowledge base. This article provides an overview of survey and questionnaire use in nursing research, clarifies the place of the questionnaire as a data collection tool in quantitative research design and provides information and advice about best practice in the development of quantitative surveys and questionnaires.
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2011-01-01
Sources In addition to our longitudinal survey instrument , other data sources include the Standard Inpatient Data Record (SIDR), which is an...therapy, high-dose megavita- min therapy, homeopathic remedies, hypnosis , massage therapy, relaxation, and spiritual healing. For the pur- poses of these...analyses, acupuncture, biofeedback, chiro- practic care, energy healing, folk medicine, hypnosis , and massage therapy were grouped together as practi
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ERIC Educational Resources Information Center
Brotman, Laurie Miller; Calzada, Esther; Huang, Keng-Yen; Kingston, Sharon; Dawson-McClure, Spring; Kamboukos, Dimitra; Rosenfelt, Amanda; Schwab, Amihai; Petkova, Eva
2011-01-01
This study examines the efficacy of "ParentCorps" among 4-year-old children (N = 171) enrolled in prekindergarten in schools in a large urban school district. "ParentCorps" includes a series of 13 group sessions for parents and children held at the school during early evening hours and facilitated by teachers and mental health…
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ERIC Educational Resources Information Center
Holt, Josh E.; Kinchin, Gary; Clarke, Gill
2012-01-01
Background: Coaches developing young talent in team sports must maximise practice and learning of essential game skills and accurately and continuously assess the performance and potential of each player. Relative age effects highlight an erroneous process of initial and on-going player assessment, based largely on subjective opinions of game…
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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.
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Harris, Tim; McDonald, Keith
2014-12-01
To benchmark walk-in presentations to emergency departments (ED) with those presenting to other local acute healthcare facilities. A large teaching hospital with an annual ED census of 140, 000 adult patients and surrounding associated acute healthcare providers. A random sample of 384 patients who self-presented to the ED was obtained. Benchmarking data were drawn from two general practices; the Tower Hamlets Community Services walk-in centre (co-located on-site with the ED) and the GP-run out-of-hours service. The case-mix presenting to the ED was characterised by a higher proportion of injuries and chest pain, but fewer simple infections and non-traumatic musculoskeletal conditions as compared to other acute care facilities in our region. Patients with injuries and possible cardiac chest pain were more likely to attend the ED, and those with infection or musculoskeletal problems less likely, as compared with other acute healthcare facilities. The population presenting to the ED is distinct from that presenting to general practice, out-of-hours clinics, or walk-in centres. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Pickworth, Wallace B; Rosenberry, Zachary R; O'Grady, Kevin E; Koszowski, Bartosz
2017-04-01
Smoking topography variables and toxicant exposure (plasma nicotine and exhaled CO) were examined in 3 groups of study participants that smoked both cigarettes and either filtered little cigars (Winchester), cigarillos (Black & Mild), or large cigars (Phillies Blunt). Laboratory ad lib smoking of the cigar products was collected with a smoking puff analyzer; plasma levels of nicotine and exhaled CO were collected before and after smoking. Although there were no statistically significant differences in demographic and cigarette smoking topography among the groups, there were significant differences in how the different cigar products were smoked. Plasma nicotine boost was similar after all products but exhaled CO was greater after the cigarillo and large cigar than the little cigar. Some of the differences were due to the differences in article size but other differences were apparent even after adjustment for the amount of tobacco burned or the mouth intake (puff volume). The topography findings of differences among products challenge the practice of grouping cigars as a single entity in surveys, regulatory decisions, and discussions of toxicant exposure. The results add to the discussion of distinctions among products in the scientific assessment of public health risk and regulatory decisions.
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[Self-Reflection From Group Dialogue: The Lived Experience of Psychiatric/Mental Health Nurses].
Chiang, Hsien-Hsien
2015-08-01
Self-reflection is an essential element of reflective practice for group facilitators. However, this element typically exists largely at the personal level and is not addressed in group dialogues of nurses. The purpose of this study was to explore the self-reflection of psychiatric nurses in a supervision group. A phenomenological approach was used to investigate the dialogues across 12 sessions in terms of discussion content and the reflective journals of the psychiatric nurse participants. The findings showed that two forms of self-reflection included: Embodied self-reflection derived from the physical sensibility and discursive self-reflection derived from the group dialogues. The embodied and discursive self-reflections promote self-awareness in nurses. The embodiment and initiation in the group facilitates the process of self-becoming through the group dialogue, which promotes self-examination and self-direction in healthcare professionals.
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Dollman, James
2005-01-01
The 'Learning Trail' is an innovative application of peer-mediated instruction designed to enhance student learning in large practical classes. The strategy specifically seeks to improve participants' attention to details of protocol that are often difficult to observe during teacher-centered demonstrations to large groups. Students (n=68) at the University of South Australia trialed this strategy, in which instruction in anthropometric techniques is initiated by an instructor to a group of 3-4 students and then sent in 'waves' from one student group to the next. The final group in the sequence demonstrates the techniques to the instructor, who notes any departures from technical accuracy. As each technical module is flowing from group to group, the instructor initiates the next 'wave' with the first group, and the process is repeated until all of the relevant skills are processed. The final stage is a full class discussion during which sources of technical error are identified and resolved. In this trial, students taught skinfold measurement by the peer instructed method (PI; n=33) were compared with a traditionally instructed group (TI; n=35), in which the instructor was responsible for all information transfer. For each participant, technical errors of measurement (TEM) were calculated; the intra-tester TEM as a measure of reliability, and the inter-tester TEM, in which the student's measures are compared with those of a criterion anthropometrist to give an indication of validity. There were no differences between TI and PI groups on intra-tester TEM (p=0.24), but the PI group had a lower inter-tester TEM for pooled skinfold sites (p=0.006) and for one individual site (triceps; p=0.007), but not the other three sites. The time taken to complete the whole set of instructions did not differ between delivery modes. The results of this trial suggest that the peer-mediated strategy may be more effective than teacher-centered instruction in terms of technical accuracy in anthropometry.
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Cortisol and stress responses during a game and practice in female collegiate soccer players.
Haneishi, Kanae; Fry, Andrew C; Moore, Christopher A; Schilling, Brian K; Li, Yuhua; Fry, Mary D
2007-05-01
The purpose of this study was to compare the cortisol responses from a regular season game and a typical practice session in female National Collegiate Athletic Association Division I collegiate soccer players. Eighteen players were assigned to 2 groups, 10 starters and 8 nonstarters, depending on their playing time. Salivary cortisol concentration, as well as competitive sport anxiety (somatic and cognitive anxiety, self-confidence), was monitored before and after 1 regular season game and 1 typical practice session. Although salivary cortisol levels increased postgame for both starters (+250%) and nonstarters (+140%), they increased to a greater extent for the starters. Practice salivary cortisol did not significantly change (p > 0.05). Cognitive and somatic anxiety was greater pre- and postgame when compared with the pre- and postpractice scores, respectively. These data clearly demonstrate the psychological and physiological differences between soccer competition and practice in collegiate women. It appears that both physiological and psychological variables combine to contribute to the large stress hormone response to an actual competitive game.
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Bertram, Susan; Graham, Deborah; Kurland, Marge; Pace, Wilson; Madison, Suzanne; Yawn, Barbara P
2013-01-01
Effective communication is the foundation of feasibility and fidelity in practice-based pragmatic research studies. Doing a study with practices spread over several states requires long-distance communication strategies, including E-mails, faxes, telephone calls, conference calls, and texting. Compared with face-to-face communication, distance communication strategies are less familiar to most study coordinators and research teams. Developing and ensuring comfort with distance communications requires additional time and use of different talents and expertise than those required for face-to-face communication. It is necessary to make sure that messages are appropriate for the medium, clearly crafted, and presented in a manner that facilitates practices receiving and understanding the information. This discussion is based on extensive experience of 2 groups who have worked collaboratively on several large, federally funded, pragmatic trials in a practice-based research network. The goal of this article is to summarize lessons learned to facilitate the work of other research teams.
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Interoperation transfer in Chinese-English bilinguals' arithmetic.
Campbell, Jamie I D; Dowd, Roxanne R
2012-10-01
We examined interoperation transfer of practice in adult Chinese-English bilinguals' memory for simple multiplication (6 × 8 = 48) and addition (6 + 8 = 14) facts. The purpose was to determine whether they possessed distinct number-fact representations in both Chinese (L1) and English (L2). Participants repeatedly practiced multiplication problems (e.g., 4 × 5 = ?), answering a subset in L1 and another subset in L2. Then separate groups answered corresponding addition problems (4 + 5 = ?) and control addition problems in either L1 (N = 24) or L2 (N = 24). The results demonstrated language-specific negative transfer of multiplication practice to corresponding addition problems. Specifically, large simple addition problems (sum > 10) presented a significant response time cost (i.e., retrieval-induced forgetting) after their multiplication counterparts were practiced in the same language, relative to practice in the other language. The results indicate that our Chinese-English bilinguals had multiplication and addition facts represented in distinct language-specific memory stores.
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Geritalk: communication skills training for geriatric and palliative medicine fellows.
Kelley, Amy S; Back, Anthony L; Arnold, Robert M; Goldberg, Gabrielle R; Lim, Betty B; Litrivis, Evgenia; Smith, Cardinale B; O'Neill, Lynn B
2012-02-01
Expert communication is essential to high-quality care for older patients with serious illness. Although the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatric and palliative medicine fellows is often inadequate or unavailable. The current study drew upon the educational principles and format of an evidence-based, interactive teaching method to develop an intensive communication skills training course designed specifically to address the common communication challenges that geriatric and palliative medicine fellows face. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques before the course. Geriatric and palliative medicine fellows were recruited to participate in the course and 100% (n = 18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on a 5-point scale). After the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, P < .001). Two months after the course, fellows reported a high level of sustained skills practice (mean 4.3 on 5-point scale). In sum, the intensive communication skills program, customized for the specific needs of geriatric and palliative medicine fellows, improved fellows' self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. © 2012, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.
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Working Memory Capacity Limits Motor Learning When Implementing Multiple Instructions
Buszard, Tim; Farrow, Damian; Verswijveren, Simone J. J. M.; Reid, Machar; Williams, Jacqueline; Polman, Remco; Ling, Fiona Chun Man; Masters, Rich S. W.
2017-01-01
Although it is generally accepted that certain practice conditions can place large demands on working memory (WM) when performing and learning a motor skill, the influence that WM capacity has on the acquisition of motor skills remains unsubstantiated. This study examined the role of WM capacity in a motor skill practice context that promoted WM involvement through the provision of explicit instructions. A cohort of 90 children aged 8 to 10 years were assessed on measures of WM capacity and attention. Children who scored in the lowest and highest thirds on the WM tasks were allocated to lower WM capacity (n = 24) and higher WM capacity (n = 24) groups, respectively. The remaining 42 participants did not participate in the motor task. The motor task required children to practice basketball shooting for 240 trials in blocks of 20 shots, with pre- and post-tests occurring before and after the intervention. A retention test was administered 1 week after the post-test. Prior to every practice block, children were provided with five explicit instructions that were specific to the technique of shooting a basketball. Results revealed that the higher WM capacity group displayed consistent improvements from pre- to post-test and through to the retention test, while the opposite effect occurred in the lower WM capacity group. This implies that the explicit instructions had a negative influence on learning by the lower WM capacity children. Results are discussed in relation to strategy selection for dealing with instructions and the role of attention control. PMID:28878701
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Geritalk: Communication Skills Training for Geriatrics and Palliative Medicine Fellows
Kelley, Amy S.; Back, Anthony L.; Arnold, Robert M.; Goldberg, Gabrielle R.; Lim, Betty B.; Litrivis, Evgenia; Smith, Cardinale B.; O’Neill, Lynn B.
2011-01-01
Expert communication is essential to high quality care for older patients with serious illness. While the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatrics and palliative medicine fellows is often inadequate or unavailable. We drew upon the educational principles and format of an evidence-based, interactive teaching method, to develop an intensive communication skills training course designed specifically to address the common communication challenges faced by geriatrics and palliative medicine fellows. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques prior to the course. Geriatrics and palliative medicine fellows were recruited to participate in the course and 100% (n=18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on 5-point scale). Compared to before the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, p<0.01). Two months after the course, fellows reported a high level of sustained skills practice (mean 4.3 on 5-point scale). In sum, the intensive communication skills program, tailored to the specific needs of geriatrics and palliative medicine fellows, improved fellows’ self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. PMID:22211768
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Aarts, S; van den Akker, M; van Boxtel, M P J; Jolles, J; Winkens, B; Metsemakers, J F M
2009-01-01
The aim of the present study was to determine whether a diagnosis of diabetes mellitus (DM) in a primary setting is associated with an increased risk of subsequent depression. A retrospective cohort design was used based on the Registration Network Family Practice (RNH) database. Patients diagnosed with diabetes mellitus at or after the age of 40 and who were diagnosed between 01-01-1980 and 01-01-2007 (N = 6,140), were compared with age-matched controls from a reference group (N = 18,416) without a history of diabetes. Both groups were followed for an emerging first diagnosis of depression (and/or depressive feelings) until January 1, 2008. 2.0% of the people diagnosed with diabetes mellitus developed a depressive disorder, compared to 1.6% of the reference group. After statistical correction for confounding factors diabetes mellitus was associated with an increased risk of developing subsequent depression (HR 1.26; 95% CI: 1.12-1.42) and/or depressive feelings (HR 1.33; 95% CI: 1.18-1.46). After statistical adjustment practice identification code, age and depression preceding diabetes, were significantly related to a diagnosis of depression. Patients with diabetes mellitus are more likely to develop subsequent depression than persons without a history of diabetes. Results from this large longitudinal study based on a general practice population indicate that this association is weaker than previously found in cross-sectional research using self-report surveys. Several explanations for this dissimilarity are discussed
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On the derivation of a full life table from mortality data recorded in five-year age groups.
Pollard, J H
1989-01-01
Mortality data are often gathered using 5-year age groups rather than individual years of life. Furthermore, it is common practice to use a large open-ended interval (such as 85 and over) for mortality data at the older ages. These limitations of the data pose problems for the actuary or demographer who wishes to compile a full and accurate life table using individual years of life. The author devises formulae which handle these problems. He also devises methods for handling mortality during the 1st year of life and for dealing with other technical problems which arise in the compilation of the full life table from grouped data.
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Zwarenstein, Merrick; Hux, Janet E; Kelsall, Diane; Paterson, Michael; Grimshaw, Jeremy; Davis, Dave; Laupacis, Andreas; Evans, Michael; Austin, Peter C; Slaughter, Pamela M; Shiller, Susan K; Croxford, Ruth; Tu, Karen
2007-01-01
Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be used to study patterns in physician-prescribing quality over four quarters, before and after each of the three interventions. Subgroup analyses will be performed to assess the association between the characteristics of the physician's place of practice and target behaviours. A further analysis of the immediate and delayed impacts of the PEMs will be performed using time-series analysis and interventional, auto-regressive, integrated moving average modeling. Trial registration number Current controlled trial ISRCTN72772651. PMID:18039361
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Griffiths, Roland R; Johnson, Matthew W; Richards, William A; Richards, Brian D; Jesse, Robert; MacLean, Katherine A; Barrett, Frederick S; Cosimano, Mary P; Klinedinst, Maggie A
2018-01-01
Psilocybin can occasion mystical-type experiences with participant-attributed increases in well-being. However, little research has examined enduring changes in traits. This study administered psilocybin to participants who undertook a program of meditation/spiritual practices. Healthy participants were randomized to three groups (25 each): (1) very low-dose (1 mg/70 kg on sessions 1 and 2) with moderate-level ("standard") support for spiritual-practice (LD-SS); (2) high-dose (20 and 30 mg/70 kg on sessions 1 and 2, respectively) with standard support (HD-SS); and (3) high-dose (20 and 30 mg/70kg on sessions 1 and 2, respectively) with high support for spiritual practice (HD-HS). Psilocybin was administered double-blind and instructions to participants/staff minimized expectancy confounds. Psilocybin was administered 1 and 2 months after spiritual-practice initiation. Outcomes at 6 months included rates of spiritual practice and persisting effects of psilocybin. Compared with low-dose, high-dose psilocybin produced greater acute and persisting effects. At 6 months, compared with LD-SS, both high-dose groups showed large significant positive changes on longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping, and community observer ratings. Determinants of enduring effects were psilocybin-occasioned mystical-type experience and rates of meditation/spiritual practices. Psilocybin can occasion enduring trait-level increases in prosocial attitudes/behaviors and in healthy psychological functioning. Trial Registration ClinicalTrials.gov Identifier NCT00802282.
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Griffiths, Roland R; Johnson, Matthew W; Richards, William A; Richards, Brian D; Jesse, Robert; MacLean, Katherine A; Barrett, Frederick S; Cosimano, Mary P; Klinedinst, Maggie A
2017-01-01
Psilocybin can occasion mystical-type experiences with participant-attributed increases in well-being. However, little research has examined enduring changes in traits. This study administered psilocybin to participants who undertook a program of meditation/spiritual practices. Healthy participants were randomized to three groups (25 each): (1) very low-dose (1 mg/70 kg on sessions 1 and 2) with moderate-level (“standard”) support for spiritual-practice (LD-SS); (2) high-dose (20 and 30 mg/70 kg on sessions 1 and 2, respectively) with standard support (HD-SS); and (3) high-dose (20 and 30 mg/70kg on sessions 1 and 2, respectively) with high support for spiritual practice (HD-HS). Psilocybin was administered double-blind and instructions to participants/staff minimized expectancy confounds. Psilocybin was administered 1 and 2 months after spiritual-practice initiation. Outcomes at 6 months included rates of spiritual practice and persisting effects of psilocybin. Compared with low-dose, high-dose psilocybin produced greater acute and persisting effects. At 6 months, compared with LD-SS, both high-dose groups showed large significant positive changes on longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping, and community observer ratings. Determinants of enduring effects were psilocybin-occasioned mystical-type experience and rates of meditation/spiritual practices. Psilocybin can occasion enduring trait-level increases in prosocial attitudes/behaviors and in healthy psychological functioning. Trial Registration ClinicalTrials.gov Identifier NCT00802282 PMID:29020861
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Kai, Joe; Middleton, Lee; Daniels, Jane; Pattison, Helen; Tryposkiadis, Konstantinos; Gupta, Janesh
2016-12-01
Heavy menstrual bleeding (HMB) is a common, chronic problem affecting women and health services. However, long-term evidence on treatment in primary care is lacking. To assess the effectiveness of commencing the levonorgestrel-releasing intrauterine system (LNG-IUS) or usual medical treatments for women presenting with HMB in general practice. A pragmatic, multicentre, parallel, open-label, long term, randomised controlled trial in 63 primary care practices across the English Midlands. In total, 571 women aged 25-50 years, with HMB were randomised to LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen-progestogen, or progesterone alone). The primary outcome was the patient reported Menorrhagia Multi-Attribute Scale (MMAS, measuring effect of HMB on practical difficulties, social life, psychological and physical health, and work and family life; scores from 0 to 100). Secondary outcomes included surgical intervention (endometrial ablation/hysterectomy), general quality of life, sexual activity, and safety. At 5 years post-randomisation, 424 (74%) women provided data. While the difference between LNG-IUS and usual treatment groups was not significant (3.9 points; 95% confidence interval = -0.6 to 8.3; P = 0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; P<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; hazard ratio 0.90; 95% CI = 0.62 to 1.31; P = 0.6). There was no difference in generic quality of life, sexual activity scores, or serious adverse events. Large improvements in symptom relief across both groups show treatment for HMB can be successfully initiated with long-term benefit and with only modest need for surgery. © British Journal of General Practice 2016.
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Essential pediatric hypertension: defining the educational needs of primary care pediatricians
2014-01-01
Background In order to better understand the educational needs regarding appropriate recognition, diagnosis and management of pediatric hypertension (HTN), we asked practicing pediatricians questions regarding their educational needs and comfort level on this topic. Methods We conducted 4 focus group sessions that included 27 participants representing pediatric residents, adolescent medicine physicians, clinic based pediatricians and office based pediatricians. Each focus group session lasted for approximately an hour and 90 pages of total transcriptions were produced verbatim from audio recordings. Results Four reviewers read each transcript and themes were elucidated from these transcripts. Overall, 5 major themes related to educational needs and clinical concerns were found: utilization of resources to define blood pressure (BP), correct BP measurement method(s), co-morbidities, barriers to care, and experience level with HTN. Six minor themes were also identified: differences in BP measurement, accuracy of BP, recognition of HTN, practice pattern of care, education of families and patients, and differences in level of training. The focus group participants were also questioned on their preferences regarding educational methods (i.e. e-learning, small group sessions, self-study, large group presentations) and revealed varied teaching and learning preferences. Conclusions There are multiple methods to approach education regarding pediatric HTN for primary care pediatricians based on provider preferences and multiple educational activities should be pursued to achieve best outcomes. Based on this data, the next direction will be to develop and deliver multiple educational methods and to evaluate the impact on practice patterns of care for children and adolescents with HTN. PMID:25063988
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Radiology system evolution in the new millennium.
Nauert, R C
2001-01-01
For many decades the practice of radiology grew slowly in America and was largely a secondary function under the control of hospitals. In more recent times it has vastly expanded its array of diagnostic, interventional, and therapeutic abilities. There is increasing consumer logic for direct access. Motivations have grown to create large independent entities with broadly diverse capabilities in order to succeed in the new millennium. Most regional markets are evolving rapidly in terms of managed care penetration, health system formation, physician practice consolidation and aggressive purchaser behavior by employers and consumers. To understand the enormity of healthcare evolution, it is useful to look at the industry's paradigm shifts in recent decades. Virtually every aspect of organizational infrastructure, delivery approaches, and the business environment has evolved markedly during the past fifty years. These changes will accelerate. To succeed financially, radiology groups must strengthen their market positions, technical capabilities, continuums of care and geographic dominance. Equally important is the wisdom of diversifying incomes into related services and businesses that provide additional related revenues. Key factors for successful development include facility market growth, full coverage of managed care contracts, high efficiency and aggressive diversification. A fully evolved system generates significant revenues and profitability by protecting and strengthening its financial position in this environment. That is accomplished through the development of strategically located radiology groups, aggressive alliances with medical practices in allied disciplines, and managed radiology departments and facilities for partner health systems. Organizational success ultimately depends on the ability to accept capitated payments under risk-bearing arrangements. The strategic business plan should be organized with the appropriate levels of detail needed to establish executive focus and priorities. These should be woven into operational and capital budgets to reflect expectations of the revenues, expenses and investments tied to the plan. While formidable, all of these objectives are realistic and can be accomplished if the right decisions are made. Initially, the entity's principle business objective is to formulate and begin implementation of methodical yet aggressive strategies for growth that are sensitive to sustaining high levels of quality patient care. The next phase features mergers with large, independent radiology practices in key geographic areas and successful acquisition of smaller practices. The objective of the final phase is to aggressively expand into select metropolitan areas with regional coverage and full teleradiology capabilities. High levels of market strength and financial performance are necessary to succeed. Passive limitations to small geographic areas and narrow practices will undermine their market position and dissolve financial strength with no hope of recovery. Only the dominant systems will survive and prosper.
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Klemenc-Ketis, Zalika; Deilkås, Ellen Tveter; Hofoss, Dag; Bondevik, Gunnar Tschudi
2017-01-01
Purpose To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). Results The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9±15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4±0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8±0.9). Conclusion Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided. PMID:29184416
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The role of domain-specific practice, handedness, and starting age in chess.
Gobet, Fernand; Campitelli, Guillermo
2007-01-01
The respective roles of the environment and innate talent have been a recurrent question for research into expertise. The authors investigated markers of talent, environment, and critical period for the acquisition of expert performance in chess. Argentinian chess players (N = 104), ranging from weak amateurs to grandmasters, completed a questionnaire measuring variables including individual and group practice, starting age, and handedness. The study reaffirms the importance of practice for reaching high levels of performance, but it also indicates a large variability: The slower player needed 8 times as much practice to reach master level than the faster player. Additional results show a correlation between skill and starting age and indicate that players are more likely to be mixed-handed than individuals in the general population; however, there was no correlation between handedness and skill within the sample of chess players. Together, these results suggest that practice is a necessary but not sufficient condition for the acquisition of expertise, that some additional factors may differentiate chessplayers and nonchessplayers, and that starting age of practice is important. Copyright 2006 APA, all rights reserved.
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NASA Astrophysics Data System (ADS)
Goldberg, Fred; Price, Edward; Robinson, Stephen; Boyd-Harlow, Danielle; McKean, Michael
2012-06-01
We report on the adaptation of the small enrollment, lab and discussion based physical science course, Physical Science and Everyday Thinking (PSET), for a large-enrollment, lecture-style setting. Like PSET, the new Learning Physical Science (LEPS) curriculum was designed around specific principles based on research on learning to meet the needs of nonscience students, especially prospective and practicing elementary and middle school teachers. We describe the structure of the two curricula and the adaptation process, including a detailed comparison of similar activities from the two curricula and a case study of a LEPS classroom implementation. In LEPS, short instructor-guided lessons replace lengthier small group activities, and movies, rather than hands-on investigations, provide the evidence used to support and test ideas. LEPS promotes student peer interaction as an important part of sense making via “clicker” questions, rather than small group and whole class discussions typical of PSET. Examples of student dialog indicate that this format is capable of generating substantive student discussion and successfully enacting the design principles. Field-test data show similar student content learning gains with the two curricula. Nevertheless, because of classroom constraints, some important practices of science that were an integral part of PSET were not included in LEPS.
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Chyou, Po-Huang; Scheuer, David; Linneman, James G.
2006-01-01
Objective: We evaluated the short-term effect of a worksite-based walking incentive program to promote physical activity and well-being in employees of a private healthcare clinic. Design: A prospective, observational follow-up study. Setting: The study was conducted at Marshfield Clinic, a large private multispecialty group practice healthcare institution in Marshfield,Wisconsin, USA. Patients: Subjects for this study were Marshfield Clinic physicians and staff. Methods: From March 31, 2005 to August 20, 2005, physical activity level, body mass index (BMI) and other well-being characteristics were observed pre- and post-program among 191 female participants from the Marshfield Clinic. A brief Web site-accessible, self-reported survey assessed the effectiveness of the exercise program. Results: Our data show a statistically significant (p <0.0001) increase in participants’ physical activity level, while a significant (p = 0.021) decrease in mean BMI was observed. However, there was no evidence of our incentive program reducing participants’ blood pressure. Conclusion: Preliminary findings of our study suggest that the goal of worksite programs designed to support employees in their efforts to improve or maintain their level of wellness is potentially achievable. Continuing research is needed to further assess whether persistent health benefits can be induced by worksite wellness programs. PMID:17210975
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Bridging the Science/Policy Gap through Boundary Chain Partnerships and Communities of Practice
NASA Astrophysics Data System (ADS)
Kalafatis, S.
2014-12-01
Generating the capacity to facilitate the informed usage of climate change science by decision makers on a large scale is fast becoming an area of great concern. While research demonstrates that sustained interactions between producers of such information and potential users can overcome barriers to information usage, it also demonstrates the high resource demand of these efforts. Our social science work at Great Lakes Integrated Sciences and Assessments (GLISA) sheds light on scaling up the usability of climate science through two research areas. The first focuses on partnerships with other boundary organizations that GLISA has leveraged - the "boundary chains" approach. These partnerships reduce the transaction costs involved with outreach and have enhanced the scope of GLISA's climate service efforts to encompass new users such as First Nations groups in Wisconsin and Michigan and underserved neighborhoods in St. Paul, Minnesota. The second research area looks at the development of information usability across the regional scale of the eight Great Lakes states. It has identified the critical role that communities of practice are playing in making information usable to large groups of users who work in similar contexts and have similar information needs. Both these research areas demonstrate the emerging potential of flexible knowledge networks to enhance society's ability to prepare for the impacts of climate change.
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Murray, Timothy G; Tornambe, Paul; Dugel, Pravin; Tong, Kuo Bianchini
2011-01-01
Background The purpose of this study is to report the use of activity-based cost analysis to identify areas of practice efficiencies and inefficiencies within a large academic retinal center and a small single-specialty group. This analysis establishes a framework for evaluating rapidly shifting clinical practices (anti-vascular endothelial growth factor therapy, microincisional vitrectomy surgery) and incorporating changing reimbursements for care delivery (intravitreal injections, optical coherence tomography [OCT]) to determine the impact on practice profitability. Pro forma modeling targeted the impact of declining reimbursement for OCT imaging and intravitreal injection using a strategy that incorporates activity-based cost analysis into a direct evaluation schema for clinical operations management. Methods Activity-based costing analyses were performed at two different types of retinal practices in the US, ie, a small single-specialty group practice and an academic hospital-based practice (Bascom Palmer Eye Institute). Retrospective claims data were utilized to identify all procedures performed and billed, submitted charges, allowed charges, and net collections from each of these two practices for the calendar years 2005–2006 and 2007–2008. A pro forma analysis utilizing current reimbursement profiles was performed to determine the impact of altered reimbursement on practice profitability. All analyses were performed by a third party consulting firm. Results The small single-specialty group practice outperformed the academic hospital-based practice on almost all markers of efficiency. In the academic hospital-based practice, only four service lines were profitable, ie, nonlaser surgery, laser surgery, non-OCT diagnostics, and injections. Profit margin varied from 62% for nonlaser surgery to 1% for intravitreal injections. Largest negative profit contributions were associated with office visits and OCT imaging. Conclusion Activity-based cost analysis is a powerful tool to evaluate retinal practice efficiencies. These two distinct practices were able to provide significant increases in clinical care (office visits, ophthalmic imaging, and patient procedures) through maintaining efficiencies of care. Pro forma analysis of 2011 data noted that OCT payments to facilities and physicians continue to decrease dramatically and that this payment decrease further reduced the profitability for the two largest aspects of these retinal practices, ie, intravitreal injections and OCT retinal imaging. Ultimately, all retinal practices are at risk for significant shifts in financial health related to rapidly evolving changes in patterns of care and reimbursement associated with providing outstanding clinical care. PMID:21792278
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Horlick-Jones, Tom; Prades, Ana
2015-10-01
A large international literature on how lay citizens make sense of various aspects of science and technology has been generated by investigations which utilise small group methods. Within that literature, focus group and other group-based methods have come to co-exist, and to some extent, hybridise, with the use of small groups in citizen engagement initiatives. In this article, we report on how we drew upon these methodological developments in the design and operationalisation of a policymaking support tool (STAVE). This tool has been developed to gain insight, in a relatively speedy and cost-effective way, into practical details of the everyday lived experience of people's lives, as relating to the sustainability of corresponding practices. An important challenge we faced was how, in Kuhn's terms, to 'translate' between the forms of life corresponding to the world of policymaking and the world of everyday domestic life. We examine conceptual and methodological aspects of how the tool was designed and assembled, and then trialled in the context of active real-world collaborations with policymaking organisations. These trials were implemented in six European countries, where they were used to support work on live policy issues concerned with sustainable consumption. © The Author(s) 2014.
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Practice Makes Perfect?: Effective Practice Instruction in Large Ensembles
ERIC Educational Resources Information Center
Prichard, Stephanie
2012-01-01
Helping young musicians learn how to practice effectively is a challenge faced by all music educators. This article presents a system of individual music practice instruction that can be seamlessly integrated within large-ensemble rehearsals. Using a step-by-step approach, large-ensemble conductors can teach students to identify and isolate…
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Lamb, Geoffrey C.; Smith, Maureen; Weeks, William B.; Queram, Christopher
2014-01-01
Public reporting of performance on quality measures is increasingly common but little is known about the impact, especially among physician groups. The Wisconsin Collaborative for Healthcare Quality (Collaborative) is a voluntary consortium of physician groups which has publicly reported quality measures since 2004, providing an opportunity to study the effect of this effort on participating groups. Analyses included member performance on 14 ambulatory measures from 2004–2009, a survey regarding reporting and its relationship to improvement efforts, and use of Medicare billing data to independently compare Collaborative members to the rest of Wisconsin, neighboring states and the rest of the United States. Faced with limited resources, groups prioritized their efforts based on the nature of the measure and their performance compared to others. The outcomes demonstrated that public reporting was associated with improvement in health quality and that large physician group practices will engage in improvement efforts in response. PMID:23459733
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Vidoni, Eric D; Boyd, Lara A
2007-09-01
Two major memory and learning systems operate in the brain: one for facts and ideas (ie, the declarative or explicit system), one for habits and behaviors (ie, the procedural or implicit system). Broadly speaking these two memory systems can operate either in concert or entirely independently of one another during the performance and learning of skilled motor behaviors. This Special Issue article has two parts. In the first, we present a review of implicit motor skill learning that is largely centered on the interactions between declarative and procedural learning and memory. Because distinct neuroanatomical substrates support unique aspects of learning and memory and thus focal injury can cause impairments that are dependent on lesion location, we also broadly consider which brain regions mediate implicit and explicit learning and memory. In the second part of this article, the interactive nature of these two memory systems is illustrated by the presentation of new data that reveal that both learning implicitly and acquiring explicit knowledge through physical practice lead to motor sequence learning. In our new data, we discovered that for healthy individuals use of the implicit versus explicit memory system differently affected variability of performance during acquisition practice; variability was higher early in practice for the implicit group and later in practice for the acquired explicit group. Despite the difference in performance variability, by retention both groups demonstrated comparable change in tracking accuracy and thus, motor sequence learning. Clinicians should be aware of the potential effects of implicit and explicit interactions when designing rehabilitation interventions, particularly when delivering explicit instructions before task practice, working with individuals with focal brain damage, and/or adjusting therapeutic parameters based on acquisition performance variability.
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Ruikes, Franca G H; Zuidema, Sytse U; Akkermans, Reinier P; Assendelft, Willem J J; Schers, Henk J; Koopmans, Raymond T C M
2016-01-01
The increasing number of community-dwelling frail elderly people poses a challenge to general practice. We evaluated the effectiveness of a general practitioner-led extensive, multicomponent program integrating cure, care, and welfare for the prevention of functional decline. We performed a cluster controlled trial in 12 general practices in Nijmegen, the Netherlands. Community-dwelling frail elderly people aged ≥70 years were identified with the EASY-Care two-step older persons screening instrument. In 6 general practices, 287 frail elderly received care according to the CareWell primary care program. This consisted of proactive care planning, case management, medication reviews, and multidisciplinary team meetings with a general practitioner, practice and/or community nurse, elderly care physician, and social worker. In another 6 general practices, 249 participants received care as usual. The primary outcome was independence in functioning during (instrumental) activities of daily living (Katz-15 index). Secondary outcomes were quality of life [EuroQol (EQ5D+C) instrument], mental health and health-related social functioning (36-item RAND Short Form survey instrument), institutionalization, hospitalization, and mortality. Outcomes were assessed at baseline and at 12 months, and were analyzed with linear mixed-model analyses. A total of 204 participants (71.1%) in the intervention group and 165 participants (66.3%) in the control group completed the study. No differences between groups regarding independence in functioning and secondary outcomes were found. We found no evidence for the effectiveness of a multifaceted integrated care program in the prevention of adverse outcomes in community-dwelling frail elderly people. Large-scale implementation of this program is not advocated. © Copyright 2016 by the American Board of Family Medicine.
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Patel, Rashmi; Jayatilleke, Nishamali; Broadbent, Matthew; Chang, Chin-Kuo; Foskett, Nadia; Gorrell, Genevieve; Hayes, Richard D; Jackson, Richard; Johnston, Caroline; Shetty, Hitesh; Roberts, Angus; McGuire, Philip; Stewart, Robert
2015-09-07
To identify negative symptoms in the clinical records of a large sample of patients with schizophrenia using natural language processing and assess their relationship with clinical outcomes. Observational study using an anonymised electronic health record case register. South London and Maudsley NHS Trust (SLaM), a large provider of inpatient and community mental healthcare in the UK. 7678 patients with schizophrenia receiving care during 2011. Hospital admission, readmission and duration of admission. 10 different negative symptoms were ascertained with precision statistics above 0.80. 41% of patients had 2 or more negative symptoms. Negative symptoms were associated with younger age, male gender and single marital status, and with increased likelihood of hospital admission (OR 1.24, 95% CI 1.10 to 1.39), longer duration of admission (β-coefficient 20.5 days, 7.6-33.5), and increased likelihood of readmission following discharge (OR 1.58, 1.28 to 1.95). Negative symptoms were common and associated with adverse clinical outcomes, consistent with evidence that these symptoms account for much of the disability associated with schizophrenia. Natural language processing provides a means of conducting research in large representative samples of patients, using data recorded during routine clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Quintana-Hernández, Domingo J; Miró-Barrachina, María T; Ibáñez-Fernández, Ignacio J; Pino, Angelo Santana-Del; Quintana-Montesdeoca, María P; Rodríguez-de Vera, Bienvenida; Morales-Casanova, David; Pérez-Vieitez, María Del Carmen; Rodríguez-García, Javier; Bravo-Caraduje, Noelia
2016-01-01
The Canary Islands longitudinal study on non-pharmacological treatments showed the overall effectiveness of mindfulness in Alzheimer's disease (AD). However, no specific data on the maintenance of cognitive capacities were presented. To determine whether the practice of mindfulness modifies the course of cognitive impairment in AD. Longitudinal, non-inferiority and equivalence, randomized clinical trial, repeated-measures design, with three experimental groups and one control group. Patients with AD who voluntarily attended the Lidia García Foundation (n = 502). Only those who were treated with donepezil and MMSE ≥18 were included (n = 120). Over a two-year period, each group carried out three weekly sessions of stimulation based on mindfulness, cognitive stimulation therapy, and progressive muscle relaxation. Cognitive assessment CAMDEX-R (MMSE and CAMCOG). Repeated-measures ANOVA (p < 0.05) and the effect size Cohen's d were performed. The mindfulness group showed significant scores compared with the control and muscle relaxation groups (p < 0.05), while mindfulness and cognitive stimulation therapy were equivalent (p≥0.05). Group cognitive stimulation evolved better than the control (p < 0.05) group but not better than the muscle relaxation group (p≥0.05). The effect size compared over two years was large for the mindfulness group (p≥0.80), moderate for the relaxation group (p≥0.50), and low for the cognitive stimulation group (p≥0.20). The practice of mindfulness maintained cognitive function over a period of two years. This longitudinal study suggests that mindfulness can be used as a non-pharmacological treatment to slow cognitive impairment in AD.
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Web-based proactive system to improve breast cancer screening: a randomized controlled trial.
Chaudhry, Rajeev; Scheitel, Sidna M; McMurtry, Erin K; Leutink, Dorinda J; Cabanela, Rosa L; Naessens, James M; Rahman, Ahmed S; Davis, Lynn A; Stroebel, Robert J
2007-03-26
Screening mammography is recommended for early detection of breast cancer but screening rates remain suboptimal. A primary care portal for a large academic primary practice was developed for all preventive services. Another Web-based system (PRECARES [PREventive CAre REminder System]) was developed for appointment secretaries to manage proactive breast cancer screening. Female patients aged 40 to 75 years were randomly assigned to a control group (usual care) and an intervention group. For the intervention group, 2 monthly letters inviting patients to undergo mammography were sent starting 3 months before they were due for annual screening, followed by a telephone call to nonresponding patients. A subgroup of women employees was further randomized to receive a reminder by either US mail or e-mail. Of the total eligible population of 6665 women identified as having consented to participate in research, 3339 were randomly assigned to the control group and 3326 to the intervention group. The screening rate for annual mammography was 64.3% for the intervention group and 55.3% for the control group (P <.001). There were no significant differences between the 2 groups for any of the other adult preventive services. For the employee subgroup, the screening rate was 57.5% for the control group, 68.1% for the US mail group, and 72.2% for the e-mail group (intervention vs control, P <.001; e-mail vs US mail; P = .24). The breast cancer screening rate improved significantly with the practice redesign of having appointment secretaries proactively manage breast cancer screening needs.
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Evidence-Based Practice Beliefs and Implementation in Doctor of Nursing Practice Students.
Singleton, Joanne K
2017-10-01
Doctors of Nursing Practice focus on leadership in evidence-based practice (EBP). EBP is influenced by one's beliefs in and implementation of EBP. Little is known to date about the EBP beliefs and implementation of Doctor of Nursing Practice students and outcomes of Doctor of Nursing Practice education. Guided by the Advancing Research and Clinical practice through close Collaboration (ARCC) Model, the Evidence-Based Practice Beliefs (EBPB) and Implementation (EBPI) tools were used to assess the impact of EBP as a program pillar, curricular thread, and content area on EBPB and EBPI of Doctor of Nursing Practice-Family Nurse Practitioner students. Five cohorts who completed the same curriculum were studied. Fifty-four of the 89 students across the five cohorts began and completed the study. Paired t-test for group effects showed statistical significance from pre- to post-measure in students overall EBPB, t = 4.4 (52), p < .001, and EBPI, t = 8.4 (52), p < .001. A large effect size of .75 standard deviation (SD) gain above the mean for EBPB, and a very large effect size of 1 SD gain above the mean for EBPI were observed. Repeated measures ANOVA showed that all cohorts made gains across the curriculum. Effect sizes for EBPB ranged from .25 to 1 SD above the mean, and .75 to 1.5 for EBPI. DNP students who are educated to be EBP leaders must have a curriculum that supports them in the knowledge and skill-set needed to translate evidence into practice. The ARCC Model can guide faculty in EBP curriculum development. EBPB and EBPI are valid and reliable measures to assess for gains across a curriculum. Through educational outcomes, educators can assess desired student outcomes for EBP across a curriculum and can build an evidence base for ongoing curriculum development. © 2017 Sigma Theta Tau International.
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Bimodal Programming: A Survey of Current Clinical Practice.
Siburt, Hannah W; Holmes, Alice E
2015-06-01
The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.
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Mori, Mihoko; Hoshiko, Michiko; Hara, Kunio; Ishitake, Tatsuya; Saga, Tsuyoshi; Yamaki, Koichi
2012-01-01
To examine the effect of large-scale repair work on indoor formaldehyde (FA) levels and subjective symptoms in medical students during a gross anatomy dissection course. We measured the indoor FA levels, room air temperature, and room humidity during a gross anatomy dissection course. In addition, the prevalence of subjective symptoms, keeping allergy state, and wearing personal protective equipment were surveyed in two groups of students using a self-administered questionnaire. The mean indoor FA levels before and after repair work were 1.22 ppm and 0.14 ppm, respectively. The mean indoor FA level significantly decreased after repair work. The prevalences of most subjective symptoms before the anatomy practice were similar before and after the repair work. However, the prevalences of most subjective symptoms during the anatomy practice were lower after the repair work. The mean indoor FA levels and prevalences of subjective symptoms decreased after the repair work. We have to continuously monitor indoor FA levels, carry out private countermeasures to minimize exposure to FA, and maintain equipment for ventilation to be able to conduct practice in a comfortable environment.
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[Back to units for nursing students' education? The Dedicated Education Units (DEU)].
Randon, Giulia; Bortolami, Elena; Grosso, Silvia
2017-01-01
. Back to units for nursing students' education? The Dedicated Education Units (DEU). The reorganization and rationalization of resources and cost containment in health care put a strain on the sustainability of practical training of student nurses. The Dedicated Education Units (DEU), where ward staff, in collaboration with university teachers, receive large numbers of students, integrating the caring and teaching missions, are a possible answer. To describe the main characteristics of DEUs. A literature search was conducted in Pubmed with the following key-words Dedicated Education Unit, Education Unit and Nursing Education, up to January 30, 2017. Several models of DEU were identified with differences in contexts, professional roles involved, type of organizations (number of students, length of practical training). The students perceive a welcoming climate that promotes learning and allows time and space for reflection; they develop a professional group identity and learn to recognize and implement the presponsibilities related to the professional role. The students express satisfaction for the relationship with professionals involved in their education due to the clear definition of roles and responsibilities, of their learning needs and feel supported in the connections of theory and practice. The DEU, receiving large number of students optimize the use of resources. The DEU represent one of the possible models of organization of the practical training, able to ensure a high quality learning environment. The practical implications of its implementation in the italian context on skills acquisition and sustainability need a thorough assessment.
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Cameron, Kenzie A; Engel, Kirsten G; McCarthy, Danielle M; Buckley, Barbara A; Mercer Kollar, Laura Min; Donlan, Sarah M; Pang, Peter S; Makoul, Gregory; Tanabe, Paula; Gisondi, Michael A; Adams, James G
2010-12-01
We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED). ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop was offered 6 times and involved: (1) large group discussion to review the importance of communication within the ED and discuss findings from a recent survey of patient perceptions of ED-team communication; (2) small group discussions eliciting staff perceptions of communication barriers and best practices/strategies to address these challenges; and (3) large group discussions sharing and refining emergent themes and suggested strategies. Three coders analyzed summaries from group discussions by using latent content and constant comparative analysis to identify focal themes. A total of 127 staff members, including attending physicians, residents, nurses, ED assistants, and secretaries, participated in the workshop (overall participation rate 59.6%; range 46.7% to 73.3% by staff type). Coders identified a framework of 4 themes describing barriers and proposed interventions: (1) greeting and initial interaction, (2) setting realistic expectations, (3) team communication and respect, and (4) information provision and delivery. The majority of participants (81.4%) reported that their participation would cause them to make changes in their clinical practice. Involving staff in discussing barriers and facilitators to communication within the ED can result in a meaningful process of empowerment, as well as the identification of feasible strategies and solutions at both the individual and system levels. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
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[Good professional practices of French CICs - version # 2].
Chevassus, Hugues; Duchesne, Charlène; Sailly, Annabelle; Vigouroux, Céline; Foulon, Christine; Kubiak, Christine; Binquet, Christine; Felin, Alexandra Lamotte; Chaud, Pascal; Thalamas, Claire; Cornu, Catherine
2017-10-01
French clinical investigation centers (CICs) are academic platforms dedicated to clinical research. The QUALI-CIC working group helps to improve and harmonize practices within the CIC network. After some years of implementation, the manual of good professional practices of CICs (MGPP CIC) completed in 2010, needed to be revised to best fit with the large panel of CIC activities. The aim was also to make it more accurate and to reinforce requirements about participants safety and data security. In its second version published in the present article, the MGPP CIC includes 255 items divided into 15 chapters. An explanatory document, currently being drafted, will complete the manual to facilitate its implementation. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.
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Changing personnel behavior to promote quality care practices in an intensive care unit
Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh
2005-01-01
The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574
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Tracy, Jessica L; Robins, Richard W; Sherman, Jeffrey W
2009-06-01
The present research surveyed a group of editors and editorial board members of personality and social psychology journals to examine the practice of psychological science in their field. Findings demonstrate that (a) although personality and social researchers tend to use many of the same approaches, methods, and procedures, they nonetheless show average differences in each of these domains, as well as in their overarching theoretical aims and perspectives; (b) these average differences largely conform to social and personality researchers' stereotypes about each subgroup; (c) despite their methodological and philosophical differences, the 2 subgroups study many of the same research topics; and (d) the structure of social-personality research practices can be characterized as having 2 independent factors, which closely correspond to L. J. Cronbach's (1957) correlational and experimental "streams of research."
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Focus group discussion in built environment qualitative research practice
NASA Astrophysics Data System (ADS)
Omar, D.
2018-02-01
Focus groups discussion is a useful way in built environment for qualitative research practice. Drawing upon recent reviews of focus group discussion and examples of how focus group discussions have been used by researchers and educators, this paper provides what actually happens in focus group discussion as practiced. There is difference between group of people and topic of interest. This article examines the focus group discussions as practiced in built environment. Thus, there is broad form of focus group discussions as practiced in built environment and the applications are varied.
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42 CFR 411.352 - Group practice.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 2 2014-10-01 2014-10-01 false Group practice. 411.352 Section 411.352 Public... Entities Furnishing Designated Health Services § 411.352 Group practice. For purposes of this subpart, a group practice is a physician practice that meets the following conditions: (a) Single legal entity. The...
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42 CFR 411.352 - Group practice.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 2 2013-10-01 2013-10-01 false Group practice. 411.352 Section 411.352 Public... Entities Furnishing Designated Health Services § 411.352 Group practice. For purposes of this subpart, a group practice is a physician practice that meets the following conditions: (a) Single legal entity. The...
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Rawat, Rahul; Nguyen, Phuong Hong; Tran, Lan Mai; Hajeebhoy, Nemat; Nguyen, Huan Van; Baker, Jean; Frongillo, Edward A; Ruel, Marie T; Menon, Purnima
2017-01-01
Background: Rigorous evaluations of health system–based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM). Objective: We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators. Methods: A cluster-randomized, nonblinded evaluation design with cross-sectional surveys (n = ∼500 children aged 6–23.9 mo and ∼1000 children aged 24–59.9 mo/group) implemented at baseline (2010) and endline (2014) was used. Difference-in-difference estimates (DDEs) of impact were calculated for intent-to-treat (ITT) analyses and modified per-protocol analyses (MPAs; mothers who attended the social franchising at least once: 62%). Results: Groups were similar at baseline. In ITT analyses, there were no significant differences between groups in changes in CF practices over time. In the MPAs, greater improvements in the intensive than in the nonintensive group were seen for minimum dietary diversity [DDE: 6.4 percentage points (pps); P < 0.05] and minimum acceptable diet (8.0 pps; P < 0.05). Significant stunting declines occurred in both intensive (7.1 pps) and nonintensive (5.4 pps) groups among children aged 24–59.9 mo, with no differential decline. Conclusions: When combined with MM and CM, an at-scale social franchising approach to improve IPC, delivered through the existing health care system, significantly improved CF practices, but not child growth, among mothers who used counseling services at least once. A greater impact may be achieved with strategies designed to increase service utilization. This trial was registered at clinicaltrials.gov as NCT01676623. PMID:28179488
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Rawat, Rahul; Nguyen, Phuong Hong; Tran, Lan Mai; Hajeebhoy, Nemat; Nguyen, Huan Van; Baker, Jean; Frongillo, Edward A; Ruel, Marie T; Menon, Purnima
2017-04-01
Background: Rigorous evaluations of health system-based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM). Objective: We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators. Methods: A cluster-randomized, nonblinded evaluation design with cross-sectional surveys ( n = ∼500 children aged 6-23.9 mo and ∼1000 children aged 24-59.9 mo/group) implemented at baseline (2010) and endline (2014) was used. Difference-in-difference estimates (DDEs) of impact were calculated for intent-to-treat (ITT) analyses and modified per-protocol analyses (MPAs; mothers who attended the social franchising at least once: 62%). Results: Groups were similar at baseline. In ITT analyses, there were no significant differences between groups in changes in CF practices over time. In the MPAs, greater improvements in the intensive than in the nonintensive group were seen for minimum dietary diversity [DDE: 6.4 percentage points (pps); P < 0.05] and minimum acceptable diet (8.0 pps; P < 0.05). Significant stunting declines occurred in both intensive (7.1 pps) and nonintensive (5.4 pps) groups among children aged 24-59.9 mo, with no differential decline. Conclusions: When combined with MM and CM, an at-scale social franchising approach to improve IPC, delivered through the existing health care system, significantly improved CF practices, but not child growth, among mothers who used counseling services at least once. A greater impact may be achieved with strategies designed to increase service utilization. This trial was registered at clinicaltrials.gov as NCT01676623.
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Are larger dental practices more efficient? An analysis of dental services production.
Lipscomb, J; Douglass, C W
1986-01-01
Whether cost-efficiency in dental services production increases with firm size is investigated through application of an activity analysis production function methodology to data from a national survey of dental practices. Under this approach, service delivery in a dental practice is modeled as a linear programming problem that acknowledges distinct input-output relationships for each service. These service-specific relationships are then combined to yield projections of overall dental practice productivity, subject to technical and organizational constraints. The activity analysis reported here represents arguably the most detailed evaluation yet of the relationship between dental practice size and cost-efficiency, controlling for such confounding factors as fee and service-mix differences across firms. We conclude that cost-efficiency does increase with practice size, over the range from solo to four-dentist practices. Largely because of data limitations, we were unable to test satisfactorily for scale economies in practices with five or more dentists. Within their limits, our findings are generally consistent with results from the neoclassical production function literature. From the standpoint of consumer welfare, the critical question raised (but not resolved) here is whether these apparent production efficiencies of group practice are ultimately translated by the market into lower fees, shorter queues, or other nonprice benefits. PMID:3102404
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Thamuku, Masego; Daniel, Marguerite
2013-01-01
In the context of AIDS, the Botswana Government has adopted a group therapy program to help large numbers of orphaned children cope with bereavement. This study explores the effectiveness of the therapy and examines how it interacts with cultural attitudes and practices concerning death. Ten orphaned children were involved in five rounds of data collection during a therapeutic retreat; eight social workers completed questionnaires concerning the effectiveness of the therapy. Most children were able to come to terms with their loss, face problems in their home and school environments, and envision ways of solving problems. All the children described benefits of group formation and the support it would provide when they returned to their home situations.
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Thackeray, Rosemary; Keller, Heidi; Heilbronner, Jennifer Messenger; Dellinger, Laura K Lee
2011-03-01
Since its inception in 2005, articles in Health Promotion Practice's social marketing department have focused on describing social marketing's unique contributions and the application of each to the practice of health promotion. This article provides a brief review of six unique features (marketing mix, consumer orientation, segmentation, exchange, competition, and continuous monitoring) and then presents two case studies-one on reducing stigma related to mental health and the other a large-scale campaign focused on increasing HIV testing among African American youth. The two successful case studies show that social marketing principles can be applied to a wide variety of topics among various population groups.
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Religion, spirituality and mental health in the West and the Middle East.
Koenig, Harold G; Zaben, Faten Al; Khalifa, Doaa Ahmed
2012-06-01
Research on religion, spirituality and mental health has been rapidly accumulating from Western countries and now increasingly from the Middle East. We review here the latest research on this topic from these two areas of the world, one largely Christian and the other largely Muslim, after discussing similarities and differences in these faith traditions. Contrary to popular thought, there is considerable overlap between these religious groups in beliefs, practices of worship, moral beliefs and values, and emphasis on family life (although also some distinct differences). Because of the similarity in belief and practice, it is not surprising that research on mental health and devout religious involvement in both these religious traditions has tended to produce similar results. Religious psychotherapies within these faith traditions have been developed and are now being refined and used in clinical trials to determine if integrating patients' religious resources into therapy is more or less effective than conventional therapies in relieving the symptoms of depression and anxiety. Copyright © 2012 Elsevier B.V. All rights reserved.
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Nestel, Debra; Kidd, Jane
2006-01-01
Abstract Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview Background Communication programmes are well established in nurse education. The focus of programmes is most often on communicating with patients with less attention paid to inter-professional communication or skills essential for working in specialised settings. Although there are many anecdotal reports of communication within the operating theatre, there are few empirical studies. This paper explores communication behaviours for effective practice in the operating theatre as perceived by nurses and serves as a basis for developing training. Methods A focus group interview was conducted with seven experienced theatre nurses from a large London teaching hospital. The interview explored their perceptions of the key as well as unique features of effective communication skills in the operating theatre. Data was transcribed and thematically analysed until agreement was achieved by the two authors. Results There was largely consensus on the skills deemed necessary for effective practice including listening, clarity of speech and being polite. Significant influences on the nature of communication included conflict in role perception and organisational issues. Nurses were often expected to work outside of their role which either directly or indirectly created barriers for effective communication. Perceptions of a lack of collaborative team effort also influenced communication. Conclusion Although fundamental communication skills were identified for effective practice in the operating theatre, there were significant barriers to their use because of confusion over clarity of roles (especially nurses' roles) and the implications for teamwork. Nurses were dissatisfied with several aspects of communication. Future studies should explore the breadth and depth of this dissatisfaction in other operating theatres, its impact on morale and importantly on patient safety. Interprofessional communication training for operating theatre staff based in part on the key issues identified in this study may help to create clarity in roles and focus attention on effective teamwork and promote clinical safety. PMID:16466581
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Taylor, Vanessa; Ashelford, Sarah; Fell, Patricia; Goacher, Penelope J
2015-10-01
This study aims to review the biosciences component of preregistration nursing programmes in higher education institutions across the UK through the experiences and perceptions of lecturers involved in nursing education. Studies suggest that some qualified nurses lack confidence in explaining the bio-scientific rationale for their clinical practice. Biosciences can be difficult to understand and integrate into clinical decision-making and require protected time within preregistration nurse education. In the absence of explicit national guidelines, it is unclear as to the depth and extent biosciences are taught across different institutions and the level achieved at the point of registration. A survey approach was adopted to generate quantitative and qualitative feedback. Data were collected using a semi-structured questionnaire seeking the experiences and views of lecturers involved in teaching biosciences to nursing students across the UK. Data received from 10 institutions were analysed using descriptive statistics and thematic analysis. Lecturers reported that the hours of taught biosciences ranged from 20-113 hours, principally within the first year. This represents between 0·4-2·4% of time within a preregistration nursing programme (4600 hours). Large group lectures predominate, supplemented by smaller group or practical work, and online materials. The biosciences are assessed specifically in half the institutions surveyed and as part of integrated assessments in the rest. In relation to student feedback, all respondents stated that students consistently requested more time and greater priority for biosciences in their programme. This survey suggests that the number of hours spent teaching biosciences is minimal and varies widely between higher education institutions. All respondents expressed concern about the challenges of teaching difficult bio-scientific concepts to large groups in such a limited time and called for greater clarity in national guidelines to ensure that all nurses are adequately educated and assessed in bioscience subjects. Failure to understand the biosciences underpinning care has implications for safe and competent nursing. © 2015 John Wiley & Sons Ltd.
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Early experience with pay-for-performance: from concept to practice.
Rosenthal, Meredith B; Frank, Richard G; Li, Zhonghe; Epstein, Arnold M
2005-10-12
The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. To evaluate the impact of a prototypical physician pay-for-performance program on quality of care. We evaluated a natural experiment with pay-for-performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. Three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing. Improvements in clinical quality scores were as follows: for cervical cancer screening, 5.3% for California vs 1.7% for Pacific Northwest; for mammography, 1.9% vs 0.2%; and for hemoglobin A1c, 2.1% vs 2.1%. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement [P = .02]). In total, the plan awarded 3.4 million dollars (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments. Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.
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Doebler, Stefanie
2015-01-01
This paper examines relationships between religion and two forms of homonegativity across 43 European countries using a bivariate response binary logistic multilevel model. The model analyzes effects of religious believing, belonging and practice on two response variables: a) a moral rejection of homosexuality as a practice and b) intolerance toward homosexuals as a group. The findings indicate that both forms of homonegativity are prevalent in Europe. Traditional doctrinal religious believing (belief in a personal God) is positively related to a moral rejection of homosexuality but to a much lesser extent associated with intolerance toward homosexuals as a group. Members of religious denominations are more likely than non-members to reject homosexuality as morally wrong and to reject homosexuals as neighbors. The analysis found significant differences between denominations that are likely context-dependent. Attendance at religious services is positively related to homonegativity in a majority of countries. The findings vary considerably across countries: Religion is more strongly related to homonegativity in Western than in Eastern Europe. In the post-soviet countries homonegativity appears to be largely a secular phenomenon. National contexts of high religiosity, high perceived government corruption, high income inequality and shortcomings in the implementation of gay rights in the countries' legislations are statistically related to higher levels of both moralistic homonegativity and intolerance toward homosexuals as a group.
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Doebler, Stefanie
2015-01-01
This paper examines relationships between religion and two forms of homonegativity across 43 European countries using a bivariate response binary logistic multilevel model. The model analyzes effects of religious believing, belonging and practice on two response variables: a) a moral rejection of homosexuality as a practice and b) intolerance toward homosexuals as a group. The findings indicate that both forms of homonegativity are prevalent in Europe. Traditional doctrinal religious believing (belief in a personal God) is positively related to a moral rejection of homosexuality but to a much lesser extent associated with intolerance toward homosexuals as a group. Members of religious denominations are more likely than non-members to reject homosexuality as morally wrong and to reject homosexuals as neighbors. The analysis found significant differences between denominations that are likely context-dependent. Attendance at religious services is positively related to homonegativity in a majority of countries. The findings vary considerably across countries: Religion is more strongly related to homonegativity in Western than in Eastern Europe. In the post-soviet countries homonegativity appears to be largely a secular phenomenon. National contexts of high religiosity, high perceived government corruption, high income inequality and shortcomings in the implementation of gay rights in the countries’ legislations are statistically related to higher levels of both moralistic homonegativity and intolerance toward homosexuals as a group. PMID:26247352
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Strategic planning and radiology practice management in the new health care environment.
Sharpe, Richard E; Mehta, Tejas S; Eisenberg, Ronald L; Kruskal, Jonathan B
2015-01-01
Current comprehensive health care reform in the United States demands that policy makers, insurers, providers, and patients work in reshaping the health care system to deliver care that is both more affordable and of higher quality. A tectonic shift is under way that runs contrary to the traditional goal of radiology groups to perform and interpret large numbers of imaging examinations. In fact, radiology service requisitions now must be evaluated for their appropriateness, possibly resulting in a reduction in the number of imaging studies performed. To be successful, radiology groups will have to restructure their business practices and strategies to align with the emerging health care paradigm. This article outlines a four-stage strategic framework that has aided corporations in achieving their goals and that can be readily adapted and applied by radiologists. The four stages are (a) definition and articulation of a purpose, (b) clear definition of strategic goals, (c) prioritization of specific strategic enablers, and (d) implementation of processes for tracking progress and enabling continuous adaptation. The authors provide practical guidance for applying specific tools such as analyses of strengths, weaknesses, opportunities, and threats (so-called SWOT analyses), prioritization matrices, and balanced scorecards to accomplish each stage. By adopting and applying these tools within the strategic framework outlined, radiology groups can position themselves to succeed in the evolving health care environment. RSNA, 2015
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The Coast Artillery Journal. Volume 79, Number 2, March-April 1936
1936-04-01
communications, field telephones and wire laying. 4. Tables of Organization and Equipment. For preliminary training, a binaural trainer and an over...with a normal binaural sense and especially acute hearing. After a sufficiently large group of these men has been selected to provide for ex- pected...casualties, they should be given special instruction and practice on the binaural trainer, using a moving sound source. This sound source may be easily
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GUIDING PRINCIPLES FOR GOOD PRACTICES IN HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT UNITS.
Sampietro-Colom, Laura; Lach, Krzysztof; Pasternack, Iris; Wasserfallen, Jean-Blaise; Cicchetti, Americo; Marchetti, Marco; Kidholm, Kristian; Arentz-Hansen, Helene; Rosenmöller, Magdalene; Wild, Claudia; Kahveci, Rabia; Ulst, Margus
2015-01-01
Health technology assessment (HTA) carried out for policy decision making has well-established principles unlike hospital-based HTA (HB-HTA), which differs from the former in the context characteristics and ways of operation. This study proposes principles for good practices in HB-HTA units. A framework for good practice criteria was built inspired by the EFQM excellence business model and information from six literature reviews, 107 face-to-face interviews, forty case studies, large-scale survey, focus group, Delphi survey, as well as local and international validation. In total, 385 people from twenty countries have participated in defining the principles for good practices in HB-HTA units. Fifteen guiding principles for good practices in HB-HTA units are grouped in four dimensions. Dimension 1 deals with principles of the assessment process aimed at providing contextualized information for hospital decision makers. Dimension 2 describes leadership, strategy and partnerships of HB-HTA units which govern and facilitate the assessment process. Dimension 3 focuses on adequate resources that ensure the operation of HB-HTA units. Dimension 4 deals with measuring the short- and long-term impact of the overall performance of HB-HTA units. Finally, nine core guiding principles were selected as essential requirements for HB-HTA units based on the expertise of the HB-HTA units participating in the project. Guiding principles for good practices set up a benchmark for HB-HTA because they represent the ideal performance of HB-HTA units; nevertheless, when performing HTA at hospital level, context also matters; therefore, they should be adapted to ensure their applicability in the local context.
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Improving nutritional care: innovation and good practice.
Chapman, Carol; Barker, Mary; Lawrence, Wendy
2015-04-01
This paper presents examples of good practice in nutritional screening and care and identifies methods used to overcome contextual constraints and discusses the implications for nursing practice in hospitals. Nutritional screening is an important step in identifying those at risk of malnutrition, but does not produce improved nutritional care unless it results in a care plan that is acted on. The importance of nutrition and implications for clinical care make it imperative to improve practice. Qualitative investigation. Between January 2011-February 2012, focus groups were held using a semi-structured discussion guide with nine groups of health professionals (n = 80) from one hospital: four with nurses, three with doctors and two with dietitians. Discussions were audio-recorded, transcribed and coded into themes and sub-themes, which were then depicted in a thematic map and illustrated with verbatim quotes. Three strategies for sustaining effective nutritional practice emerged: establishing routines to ensure screening was undertaken; re-organizing aspects of care to promote good practice; developing innovative approaches. Issues to be addressed were the perceived disconnection between mandatory screening and the delivery of effective care, a requirement for nutrition education, organizational constraints of a large university hospital and the complexities of multidisciplinary working. Professionals seeking to improve nutritional care in hospitals need to understand the interaction of system and person to facilitate change. Nursing staff need to be able to exercise autonomy and the hospital system must offer enough flexibility to allow wards to organize nutritional screening and care in a way that meets the needs of individual patients. © 2014 John Wiley & Sons Ltd.
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Takahashi, Yusuke; Okada, Kensuke; Hoshino, Takahiro; Anme, Tokie
2015-01-01
This study used data from a nationwide survey in Japan to model the developmental course of social skills during early childhood. The goals of this study were to identify longitudinal profiles of social skills between 2 and 5 years of age using a group-based trajectory approach, and to investigate whether and to what extent parenting practices at 2 years of age predicted developmental trajectories of social skills during the preschool period. A relatively large sample of boys and girls (N > 1,000) was assessed on three social skill dimensions (Cooperation, Self-control, and Assertion) at four time points (ages 2, 3, 4, and 5), and on four parenting practices (cognitive and emotional involvement, avoidance of restriction and punishment, social stimulation, and social support for parenting) at age 2. The results indicated that for each social skill dimension, group-based trajectory models identified three distinct trajectories: low, moderate, and high. Multinomial regression analysis revealed that parenting practice variables showed differential contributions to development of child social skills. Specifically, Cooperation and Assertion were promoted by cognitive and emotional involvement, Self-control by social stimulation, and Assertion by avoidance of restriction and punishment. Abundant social support for parenting was not associated with higher child social skills trajectories. We found heterogeneity in developmental profiles of social skills during the preschool ages, and we identified parenting practices that contributed to different patterns of social skills development. We discussed the implications of higher-quality parenting practices on the improvement of child social skills across early childhood.
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Takahashi, Yusuke; Okada, Kensuke; Hoshino, Takahiro; Anme, Tokie
2015-01-01
This study used data from a nationwide survey in Japan to model the developmental course of social skills during early childhood. The goals of this study were to identify longitudinal profiles of social skills between 2 and 5 years of age using a group-based trajectory approach, and to investigate whether and to what extent parenting practices at 2 years of age predicted developmental trajectories of social skills during the preschool period. A relatively large sample of boys and girls (N > 1,000) was assessed on three social skill dimensions (Cooperation, Self-control, and Assertion) at four time points (ages 2, 3, 4, and 5), and on four parenting practices (cognitive and emotional involvement, avoidance of restriction and punishment, social stimulation, and social support for parenting) at age 2. The results indicated that for each social skill dimension, group-based trajectory models identified three distinct trajectories: low, moderate, and high. Multinomial regression analysis revealed that parenting practice variables showed differential contributions to development of child social skills. Specifically, Cooperation and Assertion were promoted by cognitive and emotional involvement, Self-control by social stimulation, and Assertion by avoidance of restriction and punishment. Abundant social support for parenting was not associated with higher child social skills trajectories. We found heterogeneity in developmental profiles of social skills during the preschool ages, and we identified parenting practices that contributed to different patterns of social skills development. We discussed the implications of higher-quality parenting practices on the improvement of child social skills across early childhood. PMID:26267439
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Schippke, J; Provvidenza, C; Kingsnorth, S
2017-11-01
Benefits of peer support interventions for families of children with disabilities and complex medical needs have been described in the literature. An opportunity to create an evidence-informed resource to synthesize best practices in peer support for program providers was identified. The objective of this paper is to describe the key activities used to develop and disseminate the Peer Support Best Practice Toolkit. This project was led by a team of knowledge translation experts at a large pediatric rehabilitation hospital using a knowledge exchange framework. An integrated knowledge translation approach was used to engage stakeholders in the development process through focus groups and a working group. To capture best practices in peer support, a rapid evidence review and review of related resources were completed. Case studies were also included to showcase practice-based evidence. The toolkit is freely available online for download and is structured into four sections: (a) background and models of peer support, (b) case studies of programs, (c) resources, and (d) rapid evidence review. A communications plan was developed to disseminate the resource and generate awareness through presentations, social media, and champion engagement. Eight months postlaunch, the peer support website received more than 2,400 webpage hits. Early indicators suggest high relevance of this resource among stakeholders. The toolkit format was valuable to synthesize and share best practices in peer support. Strengths of the work include the integrated approach used to develop the toolkit and the inclusion of both the published research literature and experiential evidence. © 2017 John Wiley & Sons Ltd.
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Holographic renormalization group and cosmology in theories with quasilocalized gravity
NASA Astrophysics Data System (ADS)
Csáki, Csaba; Erlich, Joshua; Hollowood, Timothy J.; Terning, John
2001-03-01
We study the long distance behavior of brane theories with quasilocalized gravity. The five-dimensional (5D) effective theory at large scales follows from a holographic renormalization group flow. As intuitively expected, the graviton is effectively four dimensional at intermediate scales and becomes five dimensional at large scales. However, in the holographic effective theory the essentially 4D radion dominates at long distances and gives rise to scalar antigravity. The holographic description shows that at large distances the Gregory-Rubakov-Sibiryakov (GRS) model is equivalent to the model recently proposed by Dvali, Gabadadze, and Porrati (DGP), where a tensionless brane is embedded into 5D Minkowski space, with an additional induced 4D Einstein-Hilbert term on the brane. In the holographic description the radion of the GRS model is automatically localized on the tensionless brane, and provides the ghostlike field necessary to cancel the extra graviton polarization of the DGP model. Thus, there is a holographic duality between these theories. This analysis provides physical insight into how the GRS model works at intermediate scales; in particular it sheds light on the size of the width of the graviton resonance, and also demonstrates how the holographic renormalization group can be used as a practical tool for calculations.
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Holographic renormalization group and cosmology in theories with quasilocalized gravity
DOE Office of Scientific and Technical Information (OSTI.GOV)
Csaki, Csaba; Erlich, Joshua; Hollowood, Timothy J.
2001-03-15
We study the long distance behavior of brane theories with quasilocalized gravity. The five-dimensional (5D) effective theory at large scales follows from a holographic renormalization group flow. As intuitively expected, the graviton is effectively four dimensional at intermediate scales and becomes five dimensional at large scales. However, in the holographic effective theory the essentially 4D radion dominates at long distances and gives rise to scalar antigravity. The holographic description shows that at large distances the Gregory-Rubakov-Sibiryakov (GRS) model is equivalent to the model recently proposed by Dvali, Gabadadze, and Porrati (DGP), where a tensionless brane is embedded into 5D Minkowskimore » space, with an additional induced 4D Einstein-Hilbert term on the brane. In the holographic description the radion of the GRS model is automatically localized on the tensionless brane, and provides the ghostlike field necessary to cancel the extra graviton polarization of the DGP model. Thus, there is a holographic duality between these theories. This analysis provides physical insight into how the GRS model works at intermediate scales; in particular it sheds light on the size of the width of the graviton resonance, and also demonstrates how the holographic renormalization group can be used as a practical tool for calculations.« less
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Pickworth, Wallace B.; Rosenberry, Zachary R.; O’Grady, Kevin E.; Koszowski, Bartosz
2017-01-01
Objective Smoking topography variables and toxicant exposure (plasma nicotine and exhaled CO) were examined in 3 groups of study participants that smoked both cigarettes and either filtered little cigars (Winchester), cigarillos (Black & Mild), or large cigars (Phillies Blunt). Methods Laboratory ad lib smoking of the cigar products was collected with a smoking puff analyzer; plasma levels of nicotine and exhaled CO were collected before and after smoking. Results Although there were no statistically significant differences in demographic and cigarette smoking topography among the groups, there were significant differences in how the different cigar products were smoked. Plasma nicotine boost was similar after all products but exhaled CO was greater after the cigarillo and large cigar than the little cigar. Some of the differences were due to the differences in article size but other differences were apparent even after adjustment for the amount of tobacco burned or the mouth intake (puff volume). Conclusions The topography findings of differences among products challenge the practice of grouping cigars as a single entity in surveys, regulatory decisions, and discussions of toxicant exposure. The results add to the discussion of distinctions among products in the scientific assessment of public health risk and regulatory decisions. PMID:28966952
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Lai, Agnes Y.; Mui, Moses W.; Wan, Alice; Stewart, Sunita M.; Yew, Carol; Lam, Tai-hing; Chan, Sophia S.
2016-01-01
Evidence-based practice and capacity-building approaches are essential for large-scale health promotion interventions. However, there are few models in the literature to guide and evaluate training of social service workers in community settings. This paper presents the development and evaluation of the “train-the-trainer” workshop (TTT) for the first large scale, community-based, family intervention projects, entitled “Happy Family Kitchen Project” (HFK) under the FAMILY project, a Hong Kong Jockey Club Initiative for a Harmonious Society. The workshop aimed to enhance social workers’ competence and performance in applying positive psychology constructs in their family interventions under HFK to improve family well-being of the community they served. The two-day TTT was developed and implemented by a multidisciplinary team in partnership with community agencies to 50 social workers (64% women). It focused on the enhancement of knowledge, attitude, and practice of five specific positive psychology themes, which were the basis for the subsequent development of the 23 family interventions for 1419 participants. Acceptability and applicability were enhanced by completing a needs assessment prior to the training. The TTT was evaluated by trainees’ reactions to the training content and design, changes in learners (trainees) and benefits to the service organizations. Focus group interviews to evaluate the workshop at three months after the training, and questionnaire survey at pre-training, immediately after, six months, one year and two years after training were conducted. There were statistically significant increases with large to moderate effect size in perceived knowledge, self-efficacy and practice after training, which sustained to 2-year follow-up. Furthermore, there were statistically significant improvements in family communication and well-being of the participants in the HFK interventions they implemented after training. This paper offers a practical example of development, implementation and model-based evaluation of training programs, which may be helpful to others seeking to develop such programs in diverse communities. PMID:26808541
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Lai, Agnes Y; Mui, Moses W; Wan, Alice; Stewart, Sunita M; Yew, Carol; Lam, Tai-Hing; Chan, Sophia S
2016-01-01
Evidence-based practice and capacity-building approaches are essential for large-scale health promotion interventions. However, there are few models in the literature to guide and evaluate training of social service workers in community settings. This paper presents the development and evaluation of the "train-the-trainer" workshop (TTT) for the first large scale, community-based, family intervention projects, entitled "Happy Family Kitchen Project" (HFK) under the FAMILY project, a Hong Kong Jockey Club Initiative for a Harmonious Society. The workshop aimed to enhance social workers' competence and performance in applying positive psychology constructs in their family interventions under HFK to improve family well-being of the community they served. The two-day TTT was developed and implemented by a multidisciplinary team in partnership with community agencies to 50 social workers (64% women). It focused on the enhancement of knowledge, attitude, and practice of five specific positive psychology themes, which were the basis for the subsequent development of the 23 family interventions for 1419 participants. Acceptability and applicability were enhanced by completing a needs assessment prior to the training. The TTT was evaluated by trainees' reactions to the training content and design, changes in learners (trainees) and benefits to the service organizations. Focus group interviews to evaluate the workshop at three months after the training, and questionnaire survey at pre-training, immediately after, six months, one year and two years after training were conducted. There were statistically significant increases with large to moderate effect size in perceived knowledge, self-efficacy and practice after training, which sustained to 2-year follow-up. Furthermore, there were statistically significant improvements in family communication and well-being of the participants in the HFK interventions they implemented after training. This paper offers a practical example of development, implementation and model-based evaluation of training programs, which may be helpful to others seeking to develop such programs in diverse communities.
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Antonova, Elena; Chadwick, Paul; Kumari, Veena
2015-01-01
Mindfulness as a mode of sustained and receptive attention promotes openness to each incoming stimulus, even if repetitive and/or aversive. Mindful attention has been shown to attenuate sensory habituation in expert meditators; however, others were not able to replicate this effect. The present study used acoustic startle reflex to investigate the effect of mindfulness practice intensity on sensory habituation. Auditory Startle Response (ASR) to 36 startling probes (12 trials x 3 block with 40 ms inter-block intervals), was measured using electromyography (EMG) in three groups of participants (N = 12/group): meditation-naïve, moderate practice, and intensive practice. Intensive practice group showed attenuated startle habituation as evidenced by significantly less habituation over the entire experiment relative to the meditation-naïve and moderate practice groups. Furthermore, there was a significant linear effect showing between-block habituation in meditation-naïve and moderate practice groups, but not in the intensive practice group. However, the Block x Group interaction between the intensive practice and the meditation-naive groups was not significant. Moderate practice group was not significantly different from the meditation-naïve in the overall measure of habituation, but showed significantly stronger habituation than both meditation-naïve and intensive practice groups in Block 1. Greater practice intensity was significantly correlated with slower overall habituation and habituation rate in Blocks 2 and 3 in the intensive, but not in the moderate, practice group. The study provides tentative evidence that intensive mindfulness practice attenuates acoustic startle habituation as measured by EMG, but the effect is modest.Moderate practice, on the other hand, appears to enhance habituation, suggesting the effect of mindfulness practice on startle habituation might be non-linear [corrected] . Better understanding of the effect of mindful attention on startle habituation may shed new light on sensory information processing capacity of the human brain and its potential for de-automatisation of hard-wired processes.
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Test result communication in primary care: a survey of current practice.
Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila
2015-11-01
The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the handling of samples and the reporting of results. Our findings will inform our continuing work with patients and staff to develop, implement and evaluate improvements to existing systems of managing the testing and result communication process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Renolen, Åste; Høye, Sevald; Hjälmhult, Esther; Danbolt, Lars Johan; Kirkevold, Marit
2018-01-01
Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed. The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work. We used Glaser's classical grounded theory methodology to generate a substantive theory. The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented. A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling. Data were collected during 90h of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65min. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method. "Keeping on track" emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence-based practices into their daily work: "task juggling", "pausing for considering" and "struggling along with quality improvement". The "keeping on track" theory contributes to the body of knowledge regarding clinical nurses' experiences with evidence-based practice integration. The nurses endeavoured to minimize workflow interruptions to avoid decreasing the quality of patient care provided, and evidence-based practices were seen as a consideration that was outside of their ordinary work duties. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Globus Nexus: A Platform-as-a-Service Provider of Research Identity, Profile, and Group Management.
Chard, Kyle; Lidman, Mattias; McCollam, Brendan; Bryan, Josh; Ananthakrishnan, Rachana; Tuecke, Steven; Foster, Ian
2016-03-01
Globus Nexus is a professionally hosted Platform-as-a-Service that provides identity, profile and group management functionality for the research community. Many collaborative e-Science applications need to manage large numbers of user identities, profiles, and groups. However, developing and maintaining such capabilities is often challenging given the complexity of modern security protocols and requirements for scalable, robust, and highly available implementations. By outsourcing this functionality to Globus Nexus, developers can leverage best-practice implementations without incurring development and operations overhead. Users benefit from enhanced capabilities such as identity federation, flexible profile management, and user-oriented group management. In this paper we present Globus Nexus, describe its capabilities and architecture, summarize how several e-Science applications leverage these capabilities, and present results that characterize its scalability, reliability, and availability.
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Globus Nexus: A Platform-as-a-Service provider of research identity, profile, and group management
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chard, Kyle; Lidman, Mattias; McCollam, Brendan
Globus Nexus is a professionally hosted Platform-as-a-Service that provides identity, profile and group management functionality for the research community. Many collaborative e-Science applications need to manage large numbers of user identities, profiles, and groups. However, developing and maintaining such capabilities is often challenging given the complexity of modern security protocols and requirements for scalable, robust, and highly available implementations. By outsourcing this functionality to Globus Nexus, developers can leverage best-practice implementations without incurring development and operations overhead. Users benefit from enhanced capabilities such as identity federation, flexible profile management, and user-oriented group management. In this paper we present Globus Nexus,more » describe its capabilities and architecture, summarize how several e-Science applications leverage these capabilities, and present results that characterize its scalability, reliability, and availability.« less
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Globus Nexus: A Platform-as-a-Service Provider of Research Identity, Profile, and Group Management
Lidman, Mattias; McCollam, Brendan; Bryan, Josh; Ananthakrishnan, Rachana; Tuecke, Steven; Foster, Ian
2015-01-01
Globus Nexus is a professionally hosted Platform-as-a-Service that provides identity, profile and group management functionality for the research community. Many collaborative e-Science applications need to manage large numbers of user identities, profiles, and groups. However, developing and maintaining such capabilities is often challenging given the complexity of modern security protocols and requirements for scalable, robust, and highly available implementations. By outsourcing this functionality to Globus Nexus, developers can leverage best-practice implementations without incurring development and operations overhead. Users benefit from enhanced capabilities such as identity federation, flexible profile management, and user-oriented group management. In this paper we present Globus Nexus, describe its capabilities and architecture, summarize how several e-Science applications leverage these capabilities, and present results that characterize its scalability, reliability, and availability. PMID:26688598
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Application of neural networks to group technology
NASA Astrophysics Data System (ADS)
Caudell, Thomas P.; Smith, Scott D. G.; Johnson, G. C.; Wunsch, Donald C., II
1991-08-01
Adaptive resonance theory (ART) neural networks are being developed for application to the industrial engineering problem of group technology--the reuse of engineering designs. Two- and three-dimensional representations of engineering designs are input to ART-1 neural networks to produce groups or families of similar parts. These representations, in their basic form, amount to bit maps of the part, and can become very large when the part is represented in high resolution. This paper describes an enhancement to an algorithmic form of ART-1 that allows it to operate directly on compressed input representations and to generate compressed memory templates. The performance of this compressed algorithm is compared to that of the regular algorithm on real engineering designs and a significant savings in memory storage as well as a speed up in execution is observed. In additions, a `neural database'' system under development is described. This system demonstrates the feasibility of training an ART-1 network to first cluster designs into families, and then to recall the family when presented a similar design. This application is of large practical value to industry, making it possible to avoid duplication of design efforts.
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Shirazi, M; Zeinaloo, A A; Parikh, S V; Sadeghi, M; Taghva, A; Arbabi, M; Kashani, A Sabouri; Alaeddini, F; Lonka, K; Wahlström, R
2008-04-01
The Prochaska model of readiness to change has been proposed to be used in educational interventions to improve medical care. To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME). This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was the The final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P < 0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P < 0.001) and 50% points (P < 0.001) in the large and small group setting, respectively. Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.
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Schmidt, Ricarda; Richter, Robert; Brauhardt, Anne; Hiemisch, Andreas; Kiess, Wieland; Hilbert, Anja
2017-02-01
The Child Feeding Questionnaire (CFQ) is a self-report questionnaire for assessing parental attitudes to child weight and parental feeding practices. Previous evaluations of its psychometric properties were conducted primarily with small to medium-sized samples (N < 500) and a small range of children's age. The present study aims to analyze the psychometric properties of the CFQ in a large German community sample and, for the first time, to establish normative data. Within the population-based LIFE Child study, the CFQ was administered to N = 982 mothers of 2- to 13-year-old children. Psychometric analyses on item statistics and internal consistency were conducted. Using structural equation modeling, four empirically-based factorial models of the CFQ were evaluated, and measurement invariance across child age groups and sex was examined. Age-specific norms for the CFQ subscales were computed. Item statistics were highly favorable for the majority of items, but floor and ceiling effects were found for 14 of 31 items. Internal consistency of the CFQ subscales ranged from acceptable to excellent (0.71 ≤ α ≤ 0.91), except for the subscale Perceived Responsibility (α = 0.65). Regarding factorial validity, an eight-factor model with the newly created Reward subscale provided the best fit to the data. This model was factorial invariant across child sex and adjacent age groups. Maternal and child weight status showed large effects on CFQ subscale scores. The analyses established good psychometric properties for the German version of the CFQ and confirmed an eight-factor model. The provided norms allow for the comparison of individual parental feeding practices and change over time. The CFQ's sensitivity to change and longitudinal associations of parental feeding practices and child weight status warrant further research. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Terto, Veriano
2015-09-01
On the basis of an ethnographic narrative on sexual interactions observed in urban parks in large Brazilian cities, the article discusses the adoption of new strategies and methods for AIDS prevention in vulnerable populations, especially in men who have sex with men (MSM). By following some guiding questions, the text debates when, why, with whom, and in which context the new prevention methods should be adopted. It emphasizes, in agreement to the initial narrative, the importance of taking into account the prevention strategies created by the population itself to manage HIV risk infection. It also addresses how prevention practices and messages are adapted and recreated by individuals and groups in an attempt to suit them to their sexual desires, practices, and choices. In this perspective, the article recommends the inclusion of the experiences and voices of individuals and groups considered vulnerable in the new AIDS prevention methods and programs targeted to them.
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Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder
Otto, Michael W.; Hinton, Devon E.
2009-01-01
Cambodian refugees represent a severely traumatized population living in the United States. In this paper, we describe the modification of a cognitive-behavior therapy program to facilitate delivery of an exposure-based treatment for posttraumatic stress disorder while addressing some of the challenges brought by differences in language and culture between providers and patients. Our treatment modifications include the use of metaphors and culturally relevant examples to aid the communication of core concepts by interpreters, an emphasis on teaching the “process” of exposure therapy rather than relying on specific exposure practice in the group setting, a focus on interoceptive exposure to allow more effective group practice and to address culturally specific symptom interpretations, attention to the way in which treatment procedures interacted with culturally specific beliefs, and efforts to integrate treatment services within the community. Although data are limited, results to date suggest that this modified treatment was acceptable to patients and offered benefits on the order of large effect sizes. PMID:20072706
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Tzialla, Chryssoula; Berardi, Alberto; Farina, Claudio; Clerici, Pierangelo; Borghesi, Alessandro; Viora, Elsa; Scollo, Paolo; Stronati, Mauro
2017-11-02
There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility. All respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines. The screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations.
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Beliefs about menopause of general practitioners and mid-aged women.
Liao, K; Hunter, M S; White, P
1994-12-01
Recent general population studies suggest that experience of the normal menopause transition is relatively unremarkable for the majority of women, but negative stereotyped beliefs about menopause remain pervasive. This study explored GPs' beliefs and opinions about menopause in general, and compared the GPs' beliefs with those of their mid-aged female patients. All GPs at five general practices (n = 24) and 101 45-year-old women registered at the same practices took part. Large proportions of both groups believed that most women experience somatic and psychological difficulties during menopause. GPs expressed more negative beliefs than patients but were also more likely to express positive/neutral beliefs. Some causal attributions of menopausal problems were shared by the two groups, but they differed on others. When both GPs and patients hold negative social stereotypes about menopause, problems of mid-aged women may be misattributed to menopause. Health information on menopause may be biased towards negative images of menopause and of aging women.
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Marbach-Ad, Gili; Rietschel, Carly; Thompson, Katerina V.
2016-01-01
We present a novel assessment tool for measuring biology students’ values and experiences across their undergraduate degree program. Our Survey of Teaching Beliefs and Practices for Undergraduates (STEP-U) assesses the extent to which students value skills needed for the workplace (e.g., ability to work in groups) and their experiences with teaching practices purported to promote such skills (e.g., group work). The survey was validated through factor analyses in a large sample of biology seniors (n = 1389) and through response process analyses (five interviewees). The STEP-U skills items were characterized by two underlying factors: retention (e.g., memorization) and transfer (e.g., knowledge application). Multiple linear regression models were used to examine relationships between classroom experiences, values, and student characteristics (e.g., gender, cumulative grade point average [GPA], and research experience). Student demographic and experiential factors predicted the extent to which students valued particular skills. Students with lower GPAs valued retention skills more than those with higher GPAs. Students with research experience placed greater value on scientific writing and interdisciplinary understanding. Greater experience with specific teaching practices was associated with valuing the corresponding skills more highly. The STEP-U can provide feedback vital for designing curricula that better prepare students for their intended postgraduate careers. PMID:27856547
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Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Nurse Practices
Murtaugh, Christopher M; Pezzin, Liliana E; McDonald, Margaret V; Feldman, Penny H; Peng, Timothy R
2005-01-01
Objective To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients. Data Sources/Study Setting Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban, nonprofit home care agency. Study Design The study employed a randomized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient. The basic intervention was a one-time e-mail reminder highlighting six HF-specific clinical recommendations. The augmented intervention consisted of the initial e-mail reminder supplemented by provider prompts, patient education material, and clinical nurse specialist outreach. Data Collection At each home health visit provided by a study nurse to an eligible HF patient during the 45-day follow-up period, a structured chart abstraction tool was used to collect information on whether the nurse provided the care practices highlighted in the e-mail reminder. Principal Findings Both the basic and the augmented interventions greatly increased the practice of evidence-based care, according to patient records, in the areas of patient assessment and instructions about HF disease management. While not all results were statistically significant at conventional levels, intervention effects were positive in virtually all cases and effect magnitudes frequently were large. Conclusions The results of this randomized trial strongly support the efficacy of just-in-time evidence-based reminders as a means of changing clinical practice among home health nurses who are geographically dispersed and spend much of their time in the field. PMID:15960694
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Sharma, Sheetal; van Teijlingen, Edwin; Hundley, Vanora; Angell, Catherine; Simkhada, Padam
2016-07-05
Pregnancy and childbirth are socio-cultural events that carry varying meanings across different societies and cultures. These are often translated into social expectations of what a particular society expects women to do (or not to do) during pregnancy, birth and/or the postnatal period. This paper reports a study exploring beliefs around childbirth in Nepal, a low-income country with a largely Hindu population. The paper then sets these findings in the context of the wider global literature around issues such as periods where women are viewed as polluted (or dirty even) after childbirth. A qualitative study comprising five in-depth face-to-face interviews and 14 focus group discussions with mainly women, but also men and health service providers. The qualitative findings in Nepal were compared and contrasted with the literature on practices and cultural beliefs related to the pregnancy and childbirth period across the globe and at different times in history. The themes that emerged from the analysis included: (a) cord cutting & placenta rituals; (b) rest & seclusion; (c) purification, naming & weaning ceremonies and (d) nutrition and breastfeeding. Physiological changes in mother and baby may underpin the various beliefs, ritual and practices in the postnatal period. These practices often mean women do not access postnatal health services. The cultural practices, taboos and beliefs during pregnancy and around childbirth found in Nepal largely resonate with those reported across the globe. This paper stresses that local people's beliefs and practices offer both opportunities and barriers to health service providers. Maternity care providers need to be aware of local values, beliefs and traditions to anticipate and meet the needs of women, gain their trust and work with them.
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Wilson, Anne; Whitaker, Nancy; Whitford, Deirdre
2012-05-31
Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.
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Tafuri, Mary Anne; Zangrando, Atilio Francisco Javier; Tessone, Augusto; Kochi, Sayuri; Moggi Cecchi, Jacopo; Di Vincenzo, Fabio; Profico, Antonio; Manzi, Giorgio
2017-01-01
The native groups of Patagonia have relied on a hunter-gatherer economy well after the first Europeans and North Americans reached this part of the world. The large exploitation of marine mammals (i.e., seals) by such allochthonous groups has had a strong impact on the local ecology in a way that might have forced the natives to adjust their subsistence strategies. Similarly, the introduction of new foods might have changed local diet. These are the premises of our isotopic-based analysis. There is a large set of paleonutritional investigations through isotopic analysis on Fuegians groups, however a systematic exploration of food practices across time in relation to possible pre- and post-contact changes is still lacking. In this paper we investigate dietary variation in hunter-gatherer groups of Tierra del Fuego in a diachronic perspective, through measuring the isotopic ratio of carbon (∂13C) and nitrogen (∂15N) in the bone collagen of human and a selection of terrestrial and marine animal samples. The data obtained reveal an unexpected isotopic uniformity across prehistoric and recent groups, with little variation in both carbon and nitrogen mean values, which we interpret as the possible evidence of resilience among these groups and persistence of subsistence strategies, allowing inferences on the dramatic contraction (and extinction) of Fuegian populations.
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Passey, Megan E; Laws, Rachel A; Jayasinghe, Upali W; Fanaian, Mahnaz; McKenzie, Suzanne; Powell-Davies, Gawaine; Lyle, David; Harris, Mark F
2012-08-03
Cardiovascular disease accounts for a large burden of disease, but is amenable to prevention through lifestyle modification. This paper examines patient and practice predictors of referral to a lifestyle modification program (LMP) offered as part of a cluster randomised controlled trial (RCT) of prevention of vascular disease in primary care. Data from the intervention arm of a cluster RCT which recruited 36 practices through two rural and three urban primary care organisations were used. In each practice, 160 eligible high risk patients were invited to participate. Practices were randomly allocated to intervention or control groups. Intervention practice staff were trained in screening, motivational interviewing and counselling and encouraged to refer high risk patients to a LMP involving individual and group sessions. Data include patient surveys; clinical audit; practice survey on capacity for preventive care; referral records from the LMP. Predictors of referral were examined using multi-level logistic regression modelling after adjustment for confounding factors. Of 301 eligible patients, 190 (63.1%) were referred to the LMP. Independent predictors of referral were baseline BMI ≥ 25 (OR 2.87 95%CI:1.10, 7.47), physical inactivity (OR 2.90 95%CI:1.36,6.14), contemplation/preparation/action stage of change for physical activity (OR 2.75 95%CI:1.07, 7.03), rural location (OR 12.50 95%CI:1.43, 109.7) and smaller practice size (1-3 GPs) (OR 16.05 95%CI:2.74, 94.24). Providing a well-structured evidence-based lifestyle intervention, free of charge to patients, with coordination and support for referral processes resulted in over 60% of participating high risk patients being referred for disease prevention. Contrary to expectations, referrals were more frequent from rural and smaller practices suggesting that these practices may be more ready to engage with these programs. ACTRN12607000423415.
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Lenarduzzi, Roland; Sheppard, Guy A; Slater, Margaret R
2009-01-01
Concerns about a shortage of large and mixed-animal veterinarians have been discussed in the profession. To better understand veterinary career choices among currently enrolled veterinary students (classes of 2007-2010) and recent graduate veterinarians in Texas (classes of 2002-2006), an online survey was developed. The objectives were to examine: (1) the respondents' backgrounds, demographic data, and experiences; (2) the respondents' working conditions and rural lifestyle considerations; (3) the respondents' perceptions of large/mixed-animal practice; and (4) the factors that have influenced respondents' career choices. The response rate was 37% (390/1,042). Overall, 72% of students and 55% of recent graduates were interested in large/mixed-animal practice. More than 70% of respondents indicated that veterinary practitioners had the strongest personal influence on career choices. Respondents who were no longer interested in large/mixed-animal practice, or who had never been interested, reported no experience with large animals (42% and 64%, respectively) as the most common reason for their lack of interest. Previous and current interest in large/mixed-animal practice were associated with working in a large/mixed-animal practice, any agricultural experience, and working for at least 6 months on a farm or ranch. Any 4-H experience increased the likelihood of previous interest, while being married decreased the likelihood of current interest. Student contact with practitioners (82%) and financial considerations (77%) were most commonly cited as factors that would make a career in large/mixed-animal practice more attractive. Rural lifestyle drawbacks influenced respondents' career choices. Many forms of agricultural experience may expose and encourage students to consider large/mixed-animal practice.
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Klein, Angela S; Skinner, Jeremy B; Hawley, Kristin M
2013-12-01
The current study examined two condensed adaptations of dialectical behavior therapy (DBT) for binge eating. Women with full- or sub-threshold variants of either binge eating disorder or bulimia nervosa were randomly assigned to individually supported self-monitoring using adapted DBT diary cards (DC) or group-based DBT, each 15 sessions over 16 weeks. DC sessions focused on problem-solving diary card completion issues, praising diary card completion, and supporting nonjudgmental awareness of eating-related habits and urges, but not formally teaching DBT skills. Group-based DBT included eating mindfulness, progressing through graded exposure; mindfulness, emotion regulation, and distress tolerance skills; and coaching calls between sessions. Both treatments evidenced large and significant improvements in binge eating, bulimic symptoms, and interoceptive awareness. For group-based DBT, ineffectiveness, drive for thinness, body dissatisfaction, and perfectionism also decreased significantly, with medium to large effect sizes. For DC, results were not significant but large in effect size for body dissatisfaction and medium in effect size for ineffectiveness and drive for thinness. Retention for both treatments was higher than recent trends for eating disorder treatment in fee-for-service practice and for similar clinic settings, but favored DC, with the greater attrition of group-based DBT primarily attributed to its more intensive and time-consuming nature, and dropout overall associated with less pretreatment impairment and greater interoceptive awareness. This preliminary investigation suggests that with both abbreviated DBT-based treatments, substantial improvement in core binge eating symptoms is possible, enhancing potential avenues for implementation beyond more time-intensive DBT.
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The value of job analysis, job description and performance.
Wolfe, M N; Coggins, S
1997-01-01
All companies, regardless of size, are faced with the same employment concerns. Efficient personnel management requires the use of three human resource techniques--job analysis, job description and performance appraisal. These techniques and tools are not for large practices only. Small groups can obtain the same benefits by employing these performance control measures. Job analysis allows for the development of a compensation system. Job descriptions summarize the most important duties. Performance appraisals help reward outstanding work.
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Inhaled budesonide for the prevention of bronchopulmonary dysplasia.
Bassler, Dirk
2017-10-01
Theoretically, administration of inhaled corticosteroids may allow for beneficial effects on the pulmonary system of infants with evolving or established bronchopulmonary dysplasia (BPD) with a lower risk of undesirable side effects compared to systemic corticosteroids. However, before deciding whether to use inhaled corticosteroids for BPD in routine clinical practice, the available randomized study data need to be considered. Currently published systematic reviews from the Cochrane Collaboration conclude that there is no role for inhaled corticosteroids in neither prevention nor treatment of BPD outside clinical trials. In contrast multiple observational studies indicate that a large number of preterm infants in Europe, North America and East Asia receive inhaled corticosteroids for this indication in routine clinical care. This discrepancy between evidence and practice prompted a large randomized controlled trial (RCT) investigating the role of inhaled budesonide for the prevention of BPD which was recently published and showed a significant reduction in the incidence of BPD. However, the primary outcome (a composite of death or BPD at 36 weeks postmenstrual age) was only of borderline significance as a result of a non-significant trend to increased mortality in the budesonide group. Results of the long-term follow up from this study should be considered when defining the future role of inhaled corticosteroids for BPD. Additionally, updated systematic reviews will help to determine whether the observed mortality difference between the two comparison groups represents truth or artifact.
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Saliba, M-L; Arnaud, S; Souville, M; Viau, A; François, G; Verger, P
2013-04-01
Continued employment of people with health problems that reduce their ability to work is a major social issue. The French measures to optimize job retention are characterized by a multiplicity of participants, and their efficacy depends largely on the capacity of these different participants to work together. The objective of this study was to document the perceived role, attitudes and practices of participants involved in these job retention measures and of general practitioners, as well as their difficulties in this domain. In 2009, 15 semi-directive interviews were conducted in the region of Provence-Alpes-Côte d'Azur (PACA) of occupational physicians, general practitioners, and other participants involved in the occupational reclassification of workers no longer completely fit for their job. The data collected were analyzed from a thematic perspective. The different groups of professionals questioned agreed on the primacy of the role of the occupational physician, on the importance of early consideration of each worker's case, and on the need to work together as partners to optimize the prospects of job retention. This study nonetheless showed numerous communication difficulties between the various professionals: although informal exchanges have developed over time, the efficacy of the system seems to be limited by a lack of clarity about the role of each institution, divergences of opinions on some key points including the role of the physicians caring for the patient, and, more largely, lack of information about the tools for job retention. The distribution of homogeneous knowledge, the development of multidisciplinary collaborative practices and the pooling of the lessons of experience between the different groups of participants are essential for the success of job retention procedures. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
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Takenouchi, Toshiki; Iwata, Osuke; Nabetani, Makoto; Tamura, Masanori
2012-02-01
Neonatal encephalopathy (NE) secondary to intrapartum asphyxia remains a major cause of post-natal death and permanent neurological deficits worldwide. Supportive therapy has been the mainstay of the treatment until recent series of large clinical trials demonstrating benefit of therapeutic hypothermia (TH) in this high risk population. Now the International Liaison Committee on Resuscitation (ILCOR) recommends TH as a standard of care with the protocols used in the large clinical trials as tentative standard protocols. Our goal is to develop a nationwide consensus practice guideline not only consistent with the international standard protocols but also practical and compatible with the current medical system in Japan. In summary, TH should be offered to newborn infants born ≥36 weeks gestational age and birth weight ≥1800 g exhibiting clinical signs of moderate to severe NE as well as evidence of hypoxia-ischemia, i.e. 10 min Apgar score ≤5, a need for resuscitation at 10 min, blood pH<7.00, or base deficit ≥16 mmol/L. TH should be conducted in the NICUs capable of multidisciplinary care and under the standard protocols, i.e. utilization of cooling device, target (rectal or esophageal) temperatures at 33.5±0.5 and 34.5±0.5°C for whole body and selective head cooling respectively, duration of TH for 72 h, gradual rewarming not exceeding the rate of 0.5°C/h. Long term follow-up with multidisciplinary approach including standardized psychological assessment is warranted. Copyright © 2011 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.
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Effectiveness of motor practice in lucid dreams: a comparison with physical and mental practice.
Stumbrys, Tadas; Erlacher, Daniel; Schredl, Michael
2016-01-01
Motor practice in lucid dreams is a form of mental rehearsal where the dreamer can consciously rehearse motor skills in the dream state while being physically asleep. A previous pilot study showed that practice in lucid dreams can improve subsequent performance. This study aimed to replicate those findings with a different task (finger-tapping) and compare the effectiveness of lucid dream practice (LDP) not only to physical but also to mental practice (MP) in wakefulness. An online experiment was completed by 68 participants within four groups: LDP group, MP group, physical practice (PP) group and control (no practice) group. Pre-test was accomplished in the evening, post-test in the next morning, while the practice was done during the night. All three practice groups significantly improved their performance from pre-test to post-test, but no significant improvements were observed for the control group. Subjective sleep quality was not affected by night practice. This study thus corroborates the previous findings that practice in lucid dreams is effective in improving performance. Its effects seem to be similar to actual PP and MP in wakefulness. Future studies should establish reliable techniques for lucid dream induction and verify the effects of LDP in sleep laboratory conditions.
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Carter, Mary; Fletcher, Emily; Sansom, Anna; Warren, Fiona C; Campbell, John L
2018-02-15
To evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices. Mixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews. General practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group's area approximately 6 months after implementing webGP (February-July 2016). Six practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed. Attitudes and experiences of practice staff and patients regarding webGP. WebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices.GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients.81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them.From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems. There is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Preferences for intervention among Peruvian women in intimate partner violence relationships.
Cripe, Swee May; Espinoza, Damarys; Rondon, Marta B; Jimenez, Maria Luisa; Sanchez, Elena; Ojeda, Nely; Sanchez, Sixto; Williams, Michelle A
2015-01-01
We sought to identify what abused Peruvian women want or need as intervention strategies. We conducted five focus groups with 30 women with prior or current experience with intimate partner violence. Participants noted that abused women need compassionate support, professional counseling, and informational and practical (e.g., work skills training, employment, shelter, financial support) interventions. We propose a 2-tiered intervention strategy that includes community support groups and individual professional counseling. This strategy is intended to offer broad coverage, meeting the needs of large groups of women who experience abuse, whereas providing specialized counseling for those requiring intensive support. Respect for each woman's autonomy in the decision-making process is a priority. Interventions targeted toward women and men should address structural factors that contribute to violence against women.
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Kniffin, Kevin M.; Wansink, Brian; Devine, Carol M.; Sobal, Jeffery
2015-01-01
Cooperative activities among coworkers can provide valuable group-level benefits; however, previous research has often focused on artificial activities that require extraordinary efforts away from the worksite. We investigate organizational benefits that firms might obtain through various supports for coworkers to engage in commensality (i.e., eating together). We conducted field research within firehouses in a large city to explore the role that interacting over food might have for work-group performance. Using a mix of qualitative and quantitative methods, our field research shows a significant positive association between commensality and work-group performance. Our findings establish a basis for research and practice that focuses on ways that firms can enhance team performance by leveraging the mundane and powerful activity of eating. PMID:27226698
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Preferences for Intervention Among Peruvian Women in Intimate Partner Violence Relationships
Cripe, Swee May; Espinoza, Damarys; Rondon, Marta B.; Jimenez, Maria Luisa; Sanchez, Elena; Ojeda, Nely; Sanchez, Sixto; Williams, Michelle A.
2015-01-01
We sought to identify what abused Peruvian women want or need as intervention strategies. We conducted five focus groups with thirty women with prior or current experience with intimate partner violence. Participants noted that abused women need compassionate support, professional counseling, informational and practical (e.g., work skills training, employment, shelter, financial support) interventions. We propose a two-tiered intervention strategy that includes community support groups and individual professional counseling. This strategy is intended to offer broad coverage, meeting the needs of large groups of women who experience abuse, while providing specialized counseling for those requiring intensive support. Respect for each woman’s autonomy in the decision-making process is a priority. Interventions targeted towards women and men should address structural factors that contribute to violence against women. PMID:25741931
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Management Information Task Group
2002-12-18
Defense Business Practice Implementation Board Management Information Task Group Report...Std Z39-18 Defense Business Practice Implementation Board Management Information Task Group... Business Practice Implementation Board Management Information Task Group Report FY02-2 3
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Mamatya, A; Prajapati, R; Yadav, R
2012-12-01
College students form a large and important group of population eligible for blood donation. Studies report that students do not donate much, and medical students' blood donation rate is less as compared to non-medical students. To assess and compare the knowledge, attitude, and practice of blood donation among medical and non-medical Nepalese students. A cross-sectional descriptive study using structured self-administered questionnaire was conducted in students of medical (MBBS) and non-medical programs of different colleges of Nepal. Total 456 students, 177 non-medical and 279 medical, participated; 28.5% students were donors. More medical students donated blood, more often, and were more knowledgeable in all aspects of blood and blood donation related knowledge (p values 0.01 or less). In both groups, proportionately more boys donated than girls. Common reasons for not donating included no request, medically unfit, no information about blood collection services, fear of weakness, and fear related to venepuncture. Moral satisfaction was the commonest reason to donate. Among Nepalese students, medical students donate more and are more knowledgeable than non-medical students. Lack of information and lack of direct requests are important causes of fewer donors in the non-medical group and girls.
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ERIC Educational Resources Information Center
Berah, Ellen F.
1981-01-01
Explored the applicability of laboratory findings on the effects of massed versus distributed practice to an applied situation. Four groups were compared: massed practice, distributed practice, combination massed and distributed practice assertion-training groups, and no-treatment control groups. No differences between the different types of…
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Masaku, Janet; Mwende, Faith; Odhiambo, Gladys; Musuva, Rosemary; Matey, Elizabeth; Kihara, Jimmy H; Thuita, Isaac G; Njomo, Doris W
2017-03-01
Soil-transmitted helminthes (STHs) are common human parasitic diseases in most of the developing world particularly in Kenya. The ongoing National School-Based Deworming Programme (NSBDP) was launched in 2012 and is currently targeting 28 of the 47 endemic Counties. In an effort to improve treatment intervention strategies among Pre-School Age Children (PSAC) attending Early Childhood Development Centres (ECDC), we sought to assess parents' knowledge, perceptions and practices on worm infection. We conducted a qualitative cross-sectional study in four endemic sub-counties of two counties of coastal region of Kenya. A total of 20 focus group discussions (FGDs) categorized by gender were conducted among parents of pre-school age children. Participants were purposively selected based on homogenous characteristics with the saturation model determining the number of focus group discussions conducted. The data collected was analyzed manually by study themes. The majority of the parents had knowledge on worms and modes of transmission of the parasitic infections among the pre-school children. Also, most of the participants knew the causes of worm infection and the pre- disposing factors mentioned included poor hygiene and sanitation practices. Due to poor knowledge of signs and symptoms, misconceptions about the drugs administered during the NSBDP were common with a large majority of the parents indicating that the drugs were ineffective in worm control. The findings also indicated that most of the participants sought medical care on the onset of the signs and symptoms of worm infestation and preferred services provided at public health facilities as opposed to private health facilities or buying drugs from the local market citing mistrust of such services. Cultural beliefs, high cost of building and availability of vast pieces of land for human waste disposal were factors that contributed to low or lack of latrine ownership and usage by a large majority of the respondents. Our results show that to a large extent the parents of the pre-school age children have information on worm infections. However, some cultural beliefs and practices on the pathology and mode of transmission mentioned could be a hindrance to prevention and control efforts. There is need to implement health promotion campaigns to strengthen the impact of control strategies and reduce infection.
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Mwende, Faith; Odhiambo, Gladys; Musuva, Rosemary; Matey, Elizabeth; Kihara, Jimmy H.; Thuita, Isaac G.; Njomo, Doris W.
2017-01-01
Background Soil-transmitted helminthes (STHs) are common human parasitic diseases in most of the developing world particularly in Kenya. The ongoing National School-Based Deworming Programme (NSBDP) was launched in 2012 and is currently targeting 28 of the 47 endemic Counties. In an effort to improve treatment intervention strategies among Pre-School Age Children (PSAC) attending Early Childhood Development Centres (ECDC), we sought to assess parents’ knowledge, perceptions and practices on worm infection. Methodology We conducted a qualitative cross-sectional study in four endemic sub-counties of two counties of coastal region of Kenya. A total of 20 focus group discussions (FGDs) categorized by gender were conducted among parents of pre-school age children. Participants were purposively selected based on homogenous characteristics with the saturation model determining the number of focus group discussions conducted. The data collected was analyzed manually by study themes. Findings The majority of the parents had knowledge on worms and modes of transmission of the parasitic infections among the pre-school children. Also, most of the participants knew the causes of worm infection and the pre- disposing factors mentioned included poor hygiene and sanitation practices. Due to poor knowledge of signs and symptoms, misconceptions about the drugs administered during the NSBDP were common with a large majority of the parents indicating that the drugs were ineffective in worm control. The findings also indicated that most of the participants sought medical care on the onset of the signs and symptoms of worm infestation and preferred services provided at public health facilities as opposed to private health facilities or buying drugs from the local market citing mistrust of such services. Cultural beliefs, high cost of building and availability of vast pieces of land for human waste disposal were factors that contributed to low or lack of latrine ownership and usage by a large majority of the respondents. Conclusions Our results show that to a large extent the parents of the pre-school age children have information on worm infections. However, some cultural beliefs and practices on the pathology and mode of transmission mentioned could be a hindrance to prevention and control efforts. There is need to implement health promotion campaigns to strengthen the impact of control strategies and reduce infection. PMID:28358802
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Shenkin, Susan D.; Pernet, Cyril; Nichols, Thomas E.; Poline, Jean-Baptiste; Matthews, Paul M.; van der Lugt, Aad; Mackay, Clare; Lanyon, Linda; Mazoyer, Bernard; Boardman, James P.; Thompson, Paul M.; Fox, Nick; Marcus, Daniel S.; Sheikh, Aziz; Cox, Simon R.; Anblagan, Devasuda; Job, Dominic E.; Dickie, David Alexander; Rodriguez, David; Wardlaw, Joanna M.
2017-01-01
Brain imaging is now ubiquitous in clinical practice and research. The case for bringing together large amounts of image data from well-characterised healthy subjects and those with a range of common brain diseases across the life course is now compelling. This report follows a meeting of international experts from multiple disciplines, all interested in brain image biobanking. The meeting included neuroimaging experts (clinical and non-clinical), computer scientists, epidemiologists, clinicians, ethicists, and lawyers involved in creating brain image banks. The meeting followed a structured format to discuss current and emerging brain image banks; applications such as atlases; conceptual and statistical problems (e.g. defining ‘normality’); legal, ethical and technological issues (e.g. consents, potential for data linkage, data security, harmonisation, data storage and enabling of research data sharing). We summarise the lessons learned from the experiences of a wide range of individual image banks, and provide practical recommendations to enhance creation, use and reuse of neuroimaging data. Our aim is to maximise the benefit of the image data, provided voluntarily by research participants and funded by many organisations, for human health. Our ultimate vision is of a federated network of brain image biobanks accessible for large studies of brain structure and function. PMID:28232121
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Clinical benchmarking enabled by the digital health record.
Ricciardi, T N; Masarie, F E; Middleton, B
2001-01-01
Office-based physicians are often ill equipped to report aggregate information about their patients and practice of medicine, since their practices have relied upon paper records for the management of clinical information. Physicians who do not have access to large-scale information technology support can now benefit from low-cost clinical documentation and reporting tools. We developed a hosted clinical data mart for users of a web-enabled charting tool, targeting the solo or small group practice. The system uses secure Java Server Pages with a dashboard-like menu to provide point-and-click access to simple reports such as case mix, medications, utilization, productivity, and patient demographics in its first release. The system automatically normalizes user-entered clinical terms to enhance the quality of structured data. Individual providers benefit from rapid patient identification for disease management, quality of care self-assessments, drug recalls, and compliance with clinical guidelines. The system provides knowledge integration by linking to trusted sources of online medical information in context. Information derived from the clinical record is clinically more accurate than billing data. Provider self-assessment and benchmarking empowers physicians, who may resent "being profiled" by external entities. In contrast to large-scale data warehouse projects, the current system delivers immediate value to individual physicians who choose an electronic clinical documentation tool.
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Shenkin, Susan D; Pernet, Cyril; Nichols, Thomas E; Poline, Jean-Baptiste; Matthews, Paul M; van der Lugt, Aad; Mackay, Clare; Lanyon, Linda; Mazoyer, Bernard; Boardman, James P; Thompson, Paul M; Fox, Nick; Marcus, Daniel S; Sheikh, Aziz; Cox, Simon R; Anblagan, Devasuda; Job, Dominic E; Dickie, David Alexander; Rodriguez, David; Wardlaw, Joanna M
2017-06-01
Brain imaging is now ubiquitous in clinical practice and research. The case for bringing together large amounts of image data from well-characterised healthy subjects and those with a range of common brain diseases across the life course is now compelling. This report follows a meeting of international experts from multiple disciplines, all interested in brain image biobanking. The meeting included neuroimaging experts (clinical and non-clinical), computer scientists, epidemiologists, clinicians, ethicists, and lawyers involved in creating brain image banks. The meeting followed a structured format to discuss current and emerging brain image banks; applications such as atlases; conceptual and statistical problems (e.g. defining 'normality'); legal, ethical and technological issues (e.g. consents, potential for data linkage, data security, harmonisation, data storage and enabling of research data sharing). We summarise the lessons learned from the experiences of a wide range of individual image banks, and provide practical recommendations to enhance creation, use and reuse of neuroimaging data. Our aim is to maximise the benefit of the image data, provided voluntarily by research participants and funded by many organisations, for human health. Our ultimate vision is of a federated network of brain image biobanks accessible for large studies of brain structure and function. Copyright © 2017 Elsevier Inc. All rights reserved.
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A pilot study of the experience of participating in a Therapeutic Touch practice group.
Moore, Theresa; Ting, Brigid; Rossiter-Thornton, Maria
2008-09-01
This pilot study explored the experience of participating in a Therapeutic Touch practice group. A qualitative descriptive-exploratory method was used, involving 12 members of practice groups in Ontario and British Columbia, Canada. Analysis of the data using an extraction-synthesis process yielded four themes: (a) learning with others through sharing and hands-on experience is valued; (b) connecting with a network of supportive relationships that sustain self and Therapeutic Touch practice; (c) comfort-discomfort arising with self, others, or ideas; and (d) meaningful changes emerge while experiencing group energy and Therapeutic Touch. The findings expand current knowledge about the positive aspects of participating in practice groups and provide a beginning understanding of member discomfort, which had not been previously reported. This knowledge will be useful to Therapeutic Touch organizations, practice group leaders, and group members. It will also guide health care agencies and practitioners of other healing modalities who may be considering establishing practice groups.
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Kwon, Yong Hyun; Kwon, Jung Won; Lee, Myoung Hee
2015-01-01
[Purpose] The purpose of the current study was to compare the effectiveness of motor sequential learning according to two different types of practice schedules, distributed practice schedule (two 12-hour inter-trial intervals) and massed practice schedule (two 10-minute inter-trial intervals) using a serial reaction time (SRT) task. [Subjects and Methods] Thirty healthy subjects were recruited and then randomly and evenly assigned to either the distributed practice group or the massed practice group. All subjects performed three consecutive sessions of the SRT task following one of the two different types of practice schedules. Distributed practice was scheduled for two 12-hour inter-session intervals including sleeping time, whereas massed practice was administered for two 10-minute inter-session intervals. Response time (RT) and response accuracy (RA) were measured in at pre-test, mid-test, and post-test. [Results] For RT, univariate analysis demonstrated significant main effects in the within-group comparison of the three tests as well as the interaction effect of two groups × three tests, whereas the between-group comparison showed no significant effect. The results for RA showed no significant differences in neither the between-group comparison nor the interaction effect of two groups × three tests, whereas the within-group comparison of the three tests showed a significant main effect. [Conclusion] Distributed practice led to enhancement of motor skill acquisition at the first inter-session interval as well as at the second inter-interval the following day, compared to massed practice. Consequentially, the results of this study suggest that a distributed practice schedule can enhance the effectiveness of motor sequential learning in 1-day learning as well as for two days learning formats compared to massed practice. PMID:25931727
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Using baby books to increase new mothers' safety practices.
Reich, Stephanie M; Penner, Emily K; Duncan, Greg J
2011-01-01
To determine whether educational baby books are an effective method for increasing low-income, first-time mothers' safety practices during their child's first 18 months. Primiparous women (n = 167) were randomly assigned to 1 of 3 groups: an educational book group, a noneducational book group, or a no-book group. Home visits and interviews measured safety practices when women were in their third trimester of pregnancy (baseline) and when their children were 2, 4, 6, 9, 12, and 18 months of age. Women in the educational book group had fewer risks in their homes and exercised more safety practices than the no-book group (- 20% risk reduction; effect size = -.30). When the safety practices involved little time or expense (eg, putting away sharp objects), the educational book group was significantly more likely to engage in these behaviors than the no-book group (40% higher practices; effect size = 0.19) or noneducational book group (27% higher practices; effect size = 0.13). However, no differences were found between groups for behaviors that required high effort in time, money, or hassle (eg, installing latches on cabinets). Educational baby books appear to be an easy and low-cost way to increase the safety practices of new mothers, especially if the practices involve little to no time, money, or hassle. Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
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Interdisciplinary Interactions During R&D and Early Design of Large Engineered Systems
NASA Technical Reports Server (NTRS)
McGowan, Anna-Maria Rivas
2014-01-01
Designing Large-Scale Complex Engineered Systems (LaCES) such as aircraft and submarines requires the input of thousands of engineers and scientists whose work is proximate in neither time nor space. Comprehensive knowledge of the system is dispersed among specialists whose expertise is in typically one system component or discipline. This study examined the interactive work practices among such specialists seeking to improve engineering practice through a rigorous and theoretical understanding of current practice. This research explored current interdisciplinary practices and perspectives during R&D and early LaCES design and identified why these practices and perspectives prevail and persist. The research design consisted of a three-fold, integrative approach that combined an open-ended survey, semi-structured interviews, and ethnography. Significant empirical data from experienced engineers and scientists in a large engineering organization were obtained and integrated with theories from organization science and engineering. Qualitative analysis was used to obtain a holistic, contextualized understanding. The over-arching finding is that issues related to cognition, organization, and social interrelations mostly dominate interactions across disciplines. Engineering issues, such as the integration of hardware or physics-based models, are not as significant. For example, organization culture is an important underlying factor that guided researchers more toward individual sovereignty over cross-disciplinarity. The organization structure and the engineered system architecture also serve as constraints to the engineering work. Many differences in work practices were observed, including frequency and depth of interactions, definition or co-construction of requirements, clarity or creation of the system architecture, work group proximity, and cognitive challenges. Practitioners are often unaware of these differences resulting in confusion and incorrect assumptions regarding work expectations. Cognitively, the enactment and coconstruction of knowledge are the fundamental tasks of the interdisciplinary interactions. Distributed and collective cognition represent most of the efforts. Argument, ignorance, learning, and creativity are interrelated aspects of the interactions that cause discomfort but yield benefits such as problem mitigation, broader understanding, and improved system design and performance. The quality and quantity of social interrelations are central to all work across disciplines with reciprocity, respectful engagement, and heedful interrelations being significant to the effectiveness of the engineering and scientific work.
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Speech sequence skill learning in adults who stutter.
Bauerly, Kim R; De Nil, Luc F
2011-12-01
The present study compared the ability of 12 people who stutter (PWS) and 12 people who do not stutter (PNS) to consolidate a novel sequential speech task. Participants practiced 100 repetitions of a single, monosyllabic, nonsense word sequence during an initial practice session and returned 24-h later to perform an additional 50 repetitions. Results showed significantly slower sequence durations in the PWS compared to PNS following extensive practice and consolidation. However, the hypothesis that poor performance gains in PWS compared to PNS during practice would be maintained following a 24-h consolidation period was not supported. Further descriptive analysis revealed large within group differences in PWS which to some extent were attributed to a subgroup of PWS who failed to show any improvements in performance following practice or consolidation. The results and the possible presence of subgroups of PWS are discussed with regard to their limitations in motor learning abilities. The reader will be able to (1) explain the difference between practice and learning, (2) define consolidation and explain the importance of measuring performance following a consolidation period, (3) understand past research on PWS' performance during both speech and nonspeech motor tasks, and (4) explain why individual differences in practice effects and learning may have important implications for client variability in treatment outcome. Copyright © 2011 Elsevier Inc. All rights reserved.
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Sabus, Carla; Spake, Ellen
2018-01-01
The ability to innovate and adapt practice is a requirement of the progressive healthcare provider. Innovative practice by rehabilitation providers has largely been approached as personal professional development; this study extends that perspective by examining innovation uptake from the organizational level. The varied professions can be expected to have distinct qualities of innovation adoption that reflect professional norms, values, and expectations. The purpose of this qualitative study was to describe the organizational processes of innovation uptake in outpatient physical therapy practice. Through nomination, two outpatient, privately owned physical therapy clinics were identified as innovation practices. Eighteen physical therapists, three owners, and a manager participated in the study. The two clinics served as case studies within a grounded theory approach. Data were collected through observation, unstructured questioning, work flow analysis, focus group sessions, and artifact analysis. Data were analyzed and coded among the investigators. A theoretical model of the innovation adoption process in outpatient physical therapy practice was developed. Elements of the model included (1) change grounded in relationship-centered care, (2) clinic readiness to accept change, and (3) clinic adaptability and resilience. A social paradigm of innovation adoption informed through this research complements the concentration on personal professional development.
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Meeting the challenge of a group practice turnaround.
Porn, L M
2001-03-01
Many healthcare organizations that acquired group practices to enhance their market share have found that the practices have not met their financial goals. Turning around a financially troubled, hospital-owned group practice is challenging but not impossible for healthcare organizations that take certain basic actions. Direction, data, desire, dedication, and drive must be present to effect the financial turnaround of a group practice. The healthcare organization needs to evaluate the practice's strategy and operations and identify the issues that are hindering the practice's ability to optimize revenues. Efforts to achieve profitable operations have to be ongoing.
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Kiderman, A; Furst, A; Stewart, B; Greenbaum, E; Morag, A; Zakay-Rones, Z
2001-02-01
Influenza is responsible for considerable morbidity not only among older people but in younger age groups as well. However, most large-scale anti-influenza vaccination campaigns are still aimed principally at the elderly using injectable vaccines. Until now there has been much less emphasis on targeting younger populations or using intra-nasal vaccines in mass anti-influenza immunisation programmes. To assess the immunogenicity of a new inactivated intra-nasal anti-influenza vaccine and to measure its effect on respiratory morbidity in a volunteer general practice population. A prospective, double-blind, placebo-controlled trial using the new vaccine was carried out over the winter of 1997-98 on 274 healthy patients aged 12-60 from three Israeli general practices, 182 in the vaccine group and 92 in the placebo group. Following vaccination the changes in the antigen levels and episodes of respiratory illness in the vaccine and placebo groups were measured. Protective antibody levels occurred after a single dose of vaccine [influenza H1N1, 41% immune pre-vaccination to 73% post-vaccination; influenza H3N2, 35-66%; influenza B, 27-64%]. Between January and March 1998, when influenza activity was at a peak in Israel, the average number of respiratory illness events in the vaccine group [14 events/100 subjects per month] was significantly less than in the placebo group [22 events/100 subjects per month]; similarly, the average number of respiratory illness days in the vaccine group over the same period [69 days/100 subjects per month] was significantly less than in the placebo group [117 days/100 subjects per month]. The new vaccine possessed significant immunogenicity and was associated with a significant reduction in respiratory morbidity among a group of healthy older children and adults. Since intra-nasal vaccines are simpler to administer and more acceptable to the public than injections the vaccine's potential for use in routine anti-influenza vaccination campaigns seems promising, especially if its beneficial effects are also reproducible in more medically vulnerable populations.
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Jeub, Lucas G S; Balachandran, Prakash; Porter, Mason A; Mucha, Peter J; Mahoney, Michael W
2015-01-01
It is common in the study of networks to investigate intermediate-sized (or "meso-scale") features to try to gain an understanding of network structure and function. For example, numerous algorithms have been developed to try to identify "communities," which are typically construed as sets of nodes with denser connections internally than with the remainder of a network. In this paper, we adopt a complementary perspective that communities are associated with bottlenecks of locally biased dynamical processes that begin at seed sets of nodes, and we employ several different community-identification procedures (using diffusion-based and geodesic-based dynamics) to investigate community quality as a function of community size. Using several empirical and synthetic networks, we identify several distinct scenarios for "size-resolved community structure" that can arise in real (and realistic) networks: (1) the best small groups of nodes can be better than the best large groups (for a given formulation of the idea of a good community); (2) the best small groups can have a quality that is comparable to the best medium-sized and large groups; and (3) the best small groups of nodes can be worse than the best large groups. As we discuss in detail, which of these three cases holds for a given network can make an enormous difference when investigating and making claims about network community structure, and it is important to take this into account to obtain reliable downstream conclusions. Depending on which scenario holds, one may or may not be able to successfully identify "good" communities in a given network (and good communities might not even exist for a given community quality measure), the manner in which different small communities fit together to form meso-scale network structures can be very different, and processes such as viral propagation and information diffusion can exhibit very different dynamics. In addition, our results suggest that, for many large realistic networks, the output of locally biased methods that focus on communities that are centered around a given seed node (or set of seed nodes) might have better conceptual grounding and greater practical utility than the output of global community-detection methods. They also illustrate structural properties that are important to consider in the development of better benchmark networks to test methods for community detection.
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Jeub, Lucas G. S.; Balachandran, Prakash; Porter, Mason A.; Mucha, Peter J.; Mahoney, Michael W.
2016-01-01
It is common in the study of networks to investigate intermediate-sized (or “meso-scale”) features to try to gain an understanding of network structure and function. For example, numerous algorithms have been developed to try to identify “communities,” which are typically construed as sets of nodes with denser connections internally than with the remainder of a network. In this paper, we adopt a complementary perspective that “communities” are associated with bottlenecks of locally-biased dynamical processes that begin at seed sets of nodes, and we employ several different community-identification procedures (using diffusion-based and geodesic-based dynamics) to investigate community quality as a function of community size. Using several empirical and synthetic networks, we identify several distinct scenarios for “size-resolved community structure” that can arise in real (and realistic) networks: (i) the best small groups of nodes can be better than the best large groups (for a given formulation of the idea of a good community); (ii) the best small groups can have a quality that is comparable to the best medium-sized and large groups; and (iii) the best small groups of nodes can be worse than the best large groups. As we discuss in detail, which of these three cases holds for a given network can make an enormous difference when investigating and making claims about network community structure, and it is important to take this into account to obtain reliable downstream conclusions. Depending on which scenario holds, one may or may not be able to successfully identify “good” communities in a given network (and good communities might not even exist for a given community quality measure), the manner in which different small communities fit together to form meso-scale network structures can be very different, and processes such as viral propagation and information diffusion can exhibit very different dynamics. In addition, our results suggest that, for many large realistic networks, the output of locally-biased methods that focus on communities that are centered around a given seed node might have better conceptual grounding and greater practical utility than the output of global community-detection methods. They also illustrate subtler structural properties that are important to consider in the development of better benchmark networks to test methods for community detection. PMID:25679670
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NASA Astrophysics Data System (ADS)
Jeub, Lucas G. S.; Balachandran, Prakash; Porter, Mason A.; Mucha, Peter J.; Mahoney, Michael W.
2015-01-01
It is common in the study of networks to investigate intermediate-sized (or "meso-scale") features to try to gain an understanding of network structure and function. For example, numerous algorithms have been developed to try to identify "communities," which are typically construed as sets of nodes with denser connections internally than with the remainder of a network. In this paper, we adopt a complementary perspective that communities are associated with bottlenecks of locally biased dynamical processes that begin at seed sets of nodes, and we employ several different community-identification procedures (using diffusion-based and geodesic-based dynamics) to investigate community quality as a function of community size. Using several empirical and synthetic networks, we identify several distinct scenarios for "size-resolved community structure" that can arise in real (and realistic) networks: (1) the best small groups of nodes can be better than the best large groups (for a given formulation of the idea of a good community); (2) the best small groups can have a quality that is comparable to the best medium-sized and large groups; and (3) the best small groups of nodes can be worse than the best large groups. As we discuss in detail, which of these three cases holds for a given network can make an enormous difference when investigating and making claims about network community structure, and it is important to take this into account to obtain reliable downstream conclusions. Depending on which scenario holds, one may or may not be able to successfully identify "good" communities in a given network (and good communities might not even exist for a given community quality measure), the manner in which different small communities fit together to form meso-scale network structures can be very different, and processes such as viral propagation and information diffusion can exhibit very different dynamics. In addition, our results suggest that, for many large realistic networks, the output of locally biased methods that focus on communities that are centered around a given seed node (or set of seed nodes) might have better conceptual grounding and greater practical utility than the output of global community-detection methods. They also illustrate structural properties that are important to consider in the development of better benchmark networks to test methods for community detection.
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Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen
2006-01-01
Background Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial. PMID:16646967
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Park, Min-Sun; Lim, Sun-Young; Kim, Eun-Young; Lee, Su-Jung; Chang, Sung-Ok
2018-01-01
The bedridden elderly with moderate-to-severe dementia account for a large proportion of the residents in nursing homes and form a specialized group requiring customized care in order to encourage their remaining functions, which determine the quality of their residual life. The purpose of this study was to search for ways to invigorate and foster the remaining functions of this complex-disability group, based on practical nursing strategies in nursing homes. The qualitative thematic analysis was done by conducting in-depth interviews with 29 nurses working at 11 different nursing homes in South Korea. This study proposed four main themes and 19 sub themes as keys for providing specialized nursing care to the elderly with physical and cognitive disabilities. The main themes encourage the residents' remaining functions: (i) accurate identification of an elderly resident's physical, cognitive, and behavioral baseline is necessary in order to determine their functional levels; (ii) nurses provide meticulous management to support the remaining functions in order to prevent further deterioration; (iii) optimized know-how, based on accumulated experience and knowledge, is reflected in nursing strategies that maximize the effects of nursing interventions; and (iv) steady compliance with nursing guidelines and standards in nursing homes creates the best therapeutic environment and brings unexpected positive changes in the elderly's status. A practical nursing strategy to target the group with a demented and complex disability in nursing homes was developed through thematic analysis of the empirical knowledge of nurses. The findings provide new insights for developing specialized nursing interventions and practical nursing models in long-term care facilities. © 2017 Japan Academy of Nursing Science.
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Family planning in rural Kwazulu: transition from traditional to contemporary practices.
Kies, C W
1987-07-01
In South Africa, premarital vaginal penetration was not allowed in traditional Zulu society because illegitimate children disrupted the community. Young people could have external sexual intercourse between the thighs, however, only if 1st instructed in this practice by the leader of each peer group plus the girl's group leader had to approve of a meeting between the boy and girl. In addition, men could not marry before proving themselves in the battlefield, usually between 30-35 years old. Women could not marry until all the women of an older age group had married, therefore women were approximately 25 years old when married. In years past, the Zulu believed that a large enough quantity of semen must accumulate inside the wife's body before a baby would grow. Newlyweds therefore had intercourse day and night for the 1st few weeks until they believed that the wife was pregnant. Frequency of intercourse either decreased or ceased once a women was pregnant. A breast feeding mother could not have sexual intercourse because the fetus would poison the child who was still breast feeding. Children were breast fed for 3 years. Husbands could have sexual intercourse between the thighs with a mistress during the lactational period of his wife, however. Polygynists slept with each wife for only 1 period/month, often not during her most fertile days. They therefore had fewer children/wife than men in monogamous relationships. Today females do not practice abstinence after birth and breast feed their children for 3 years. Additionally, they become sexually active at an earlier age. Only 5% of the respondents of a survey were using modern contraceptives. Due to the nonuse of traditional practices and modern contraceptives, the present levels of fertility are higher than was the case in the past.
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Aarons, Gregory A; Cafri, Guy; Lugo, Lindsay; Sawitzky, Angelina
2012-09-01
Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.
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Charter for the ARM Atmospheric Modeling Advisory Group
DOE Office of Scientific and Technical Information (OSTI.GOV)
Advisory Group, ARM Atmospheric Modeling
The Atmospheric Modeling Advisory Group of the U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility is guided by the following: 1. The group will provide feedback on the overall project plan including input on how to address priorities and trade-offs in the modeling and analysis workflow, making sure the modeling follows general best practices, and reviewing the recommendations provided to ARM for the workflow implementation. 2. The group will consist of approximately 6 members plus the PI and co-PI of the Large-Eddy Simulation (LES) ARM Symbiotic Simulation and Observation (LASSO) pilot project. The ARM Technical Director,more » or his designee, serves as an ex-officio member. This size is chosen based on the ability to efficiently conduct teleconferences and to span the general needs for input to the LASSO pilot project.« less
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Child Passenger Safety Technician Consultation in the Pediatric Primary Care Setting.
Burstein, Dina; Zonfrillo, Mark R; Baird, Janette; Mello, Michael J
2017-09-01
Correct use of a child safety seat (CSS) can reduce the risk of fatal motor vehicle crash-related injury by up to 71%; however, misuse rates for CSS are as high as 70%. We recruited 189 caregivers at 2 large suburban pediatric office practices; 94 in the intervention group and 95 in the control group. All participants completed a baseline survey and received a CSS safety brochure. Intervention participants had their CSS installation checked at enrollment by a certified child passenger safety (CPS) technician. Follow-up was conducted 4 months post enrollment. Intervention group participants had a 21.3% reduction in critical misuse at follow-up, whereas control participants critical misuse rate at follow-up was identical to the intervention group at baseline. A consult with a certified CPS technician, at the time of a routine visit to the pediatrician, resulted in a reduction in CSS misuse rates.
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The impact of a general practice group intervention on prescribing costs and patterns.
Walker, Jane; Mathers, Nigel
2002-01-01
BACKGROUND: The formation of primary care groups (PCGs) and trusts (PCTs) has shifted the emphasis from individual practice initiatives to group-based efforts to control rising prescribing costs. However, there is a paucity of literature describing such group initiatives. We report the results of a multilevel group initiative, involving input from a pharmaceutical adviser, practice comparison feedback, and peer review meetings. AIM: To determine the impact of a prescribing initiative on the prescribing patterns of a group of general practices. DESIGN OF STUDY: A comparative study with non-matched controls. SETTING: Nine semi-rural/rural practices forming a commissioning group pilot, later a PCG, in Southern Derbyshire with nine practices as controls. METHOD: Practice data were collated for overall prescribing and for therapeutic categories, between the years 1997/1998 and 1998/1999 and analysed statistically. Prescribing expenditure trends were also collated. RESULTS: Although both groups came well within their prescribing budgets, in the study group this was for the first time in five years. Their rate of increase in expenditure slowed significantly following the initiative compared with that of the comparison group, which continued to rise (median practice net ingredient cost/patient unit (nic/PU) increase: Pound Sterling0.69 and Pound Sterling3.80 respectively; P = 0.03). The study group's nic/PU dropped below, and stayed below, that of the comparison group one month after the start of the initiative. For most therapeutic categories the study group had lower increases in costs and higher increases in percentage of generic items than the comparison group. Quality markers were unaffected. CONCLUSION: We suggest that practices with diverse prescribing patterns can work together effectively within a PCT locality to control prescribing costs. PMID:12030659
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Colla, Carrie. H.; Goodney, Philip P.; Lewis, Valerie A.; Nallamothu, Brahmajee K.; Gottlieb, Daniel J.; Meara, Ellen R.
2014-01-01
Background Accountable care organizations (ACOs) seek to reduce growth in healthcare spending while ensuring high-quality care. We hypothesized that ACO implementation would selectively limit utilization of discretionary cardiovascular care (defined as care occurring in the absence of indications such as myocardial infarction or stroke), while maintaining high-quality care such as non-discretionary cardiovascular imaging and procedures. Methods and Results The intervention group was composed of fee-for-service Medicare patients (n=819,779) from 10 groups participating in a Medicare pilot ACO, the Physician Group Practice Demonstration (PGPD). Matched controls were patients (n=934,621) from non-participating groups in the same regions. We compared utilization of cardiovascular care before (2002-2004) and after (2005-2009) PGPD implementation, studying both discretionary and non-discretionary carotid and coronary imaging and procedures. Our main outcome measure was the difference in the proportion of patients treated with imaging and procedures, among patients of PGPD practices compared to patients in control practices, before and after PGPD implementation (difference-in-difference). For discretionary imaging, the difference-in-difference between PGPD practices and controls was not statistically significant for discretionary carotid imaging (0.17%; 95% CI -0.51% to 0.85%, p=0.595) or discretionary coronary imaging (-0.19%; 95% CI -0.73% to 0.35%, p=0.468). Similarly, the difference-in-difference was also minimal for discretionary carotid revascularization (0.003%; 95% CI -0.008% to 0.002%, p=0.705) and coronary revascularization (-0.02%, 95% CI -0.11% to 0.07%, p=0.06). The difference-in-difference associated with PGPD implementation was also essentially zero for non-discretionary cardiovascular imaging or procedures. Conclusions Implementation of a pilot ACO did not limit the utilization of discretionary or non-discretionary cardiovascular care in ten large health systems. PMID:25421044
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Colla, Carrie H; Goodney, Philip P; Lewis, Valerie A; Nallamothu, Brahmajee K; Gottlieb, Daniel J; Meara, Ellen
2014-11-25
Accountable care organizations (ACOs) seek to reduce growth in healthcare spending while ensuring high-quality care. We hypothesized that accountable care organization implementation would selectively limit the use of discretionary cardiovascular care (defined as care occurring in the absence of indications such as myocardial infarction or stroke), while maintaining high-quality care, such as nondiscretionary cardiovascular imaging and procedures. The intervention group was composed of fee-for-service Medicare patients (n=819 779) from 10 groups participating in a Medicare pilot accountable care organization, the Physician Group Practice Demonstration (PGPD). Matched controls were patients (n=934 621) from nonparticipating groups in the same regions. We compared use of cardiovascular care before (2002-2004) and after (2005-2009) PGPD implementation, studying both discretionary and nondiscretionary carotid and coronary imaging and procedures. Our main outcome measure was the difference in the proportion of patients treated with imaging and procedures among patients of PGPD practices compared with patients in control practices, before and after PGPD implementation (difference-in-difference). For discretionary imaging, the difference-in-difference between PGPD practices and controls was not statistically significant for discretionary carotid imaging (0.17%; 95% confidence interval, -0.51% to 0.85%; P=0.595) or discretionary coronary imaging (-0.19%; 95% confidence interval, -0.73% to 0.35%; P=0.468). Similarly, the difference-in-difference was also minimal for discretionary carotid revascularization (0.003%; 95% confidence interval, -0.008% to 0.002%; P=0.705) and coronary revascularization (-0.02%; 95% confidence interval, -0.11% to 0.07%; P=0.06). The difference-in-difference associated with PGPD implementation was also essentially 0 for nondiscretionary cardiovascular imaging or procedures. Implementation of a pilot accountable care organization did not limit the use of discretionary or nondiscretionary cardiovascular care in 10 large health systems. © 2014 American Heart Association, Inc.
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Foster, Byron Alexander; Farragher, Jill; Parker, Paige; Hale, Daniel E
2015-06-01
Positive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices. In a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight. Interviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups. We found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.
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A campus-wide study of STEM courses: new perspectives on teaching practices and perceptions.
Smith, Michelle K; Vinson, Erin L; Smith, Jeremy A; Lewin, Justin D; Stetzer, MacKenzie R
2014-01-01
At the University of Maine, middle and high school science, technology, engineering, and mathematics (STEM) teachers observed 51 STEM courses across 13 different departments and collected information on the active-engagement nature of instruction. The results of these observations show that faculty members teaching STEM courses cannot simply be classified into two groups, traditional lecturers or instructors who teach in a highly interactive manner, but instead exhibit a continuum of instructional behaviors between these two classifications. In addition, the observation data reveal that student behavior differs greatly in classes with varied levels of lecture. Although faculty members who teach large-enrollment courses are more likely to lecture, we also identified instructors of several large courses using interactive teaching methods. Observed faculty members were also asked to complete a survey about how often they use specific teaching practices, and we find that faculty members are generally self-aware of their own practices. Taken together, these findings provide comprehensive information about the range of STEM teaching practices at a campus-wide level and how such information can be used to design targeted professional development for faculty. © 2014 M. K. Smith et al. CBE—Life Sciences Education © 2014 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).
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Skin care practice in German nursing homes: a German-wide cross-sectional study.
Kottner, Jan; Rahn, Yasmin; Blume-Peytavi, Ulrike; Lahmann, Nils
2013-04-01
Due to anatomical and physiological changes in the course of aging and due to increased vulnerability, there are special skin care needs in elderly and care-dependent persons. Little is known about skin care practice in German long-term care facilities. The aim of the study was to gather epidemiological data about skin care practice in German nursing homes. In spring 2012 a German-wide cross sectional study was conducted in 47 nursing homes. Based on standardized data collection sheets. demographics and variables about methods and frequencies of skin cleansing and application of skin care products for 3 552 nursing home residents were collected and analyzed. The variables age, gender and level of care dependency was representative for the group of all German nursing home residents. More than 90% of investigated nursing home residents required skin care assistance. Washing body parts or the whole body were conducted most frequently (89.1%, 95% CI 88.0- 90.1). Skin care leave-on products were used in 91.7% (95% CI 90.7-92.6), whereas there were large variations between individuals. In total, more than 100 brands were used. Skin care practice in multimorbid care dependent persons shows large variations. How skin care products meet the special requirements of aged skin and whether they enhance the skin barrier function and prevent cuteneous skin damage is unknown. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.
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Reforming primary healthcare: from public policy to organizational change.
Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne
2015-01-01
Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation using a longitudinal multi-level design.
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NASA Astrophysics Data System (ADS)
Sahingoz, Selcuk
One of the most important goals of science education is preparing effective science teachers which includes the development of a science pedagogical orientation. Helping in-service science teachers improve their orientations toward science teaching begins with identifying their current orientations. While there are many aspects of an effective science teaching orientation, this study specifically focuses on effective pedagogy. The interest of this study is to clarify pedagogical orientations of middle school science teachers in Turkey toward the teaching of science conceptual knowledge. It focuses on what instructional preferences Turkish middle school science teachers have in theory and practice. The purpose of this study is twofold: 1) to elucidate teacher pedagogical profiles toward direct and inquiry instructional approaches. For this purpose, quantitative profile data, using a Turkish version of the Pedagogy of Science Teaching Test (POSTT-TR) assessment instrument, was collected from 533 Turkish middle school science teachers; 2) to identify teaching orientations of middle school science teachers and to identify their reasons for preferring specific instructional practices. For this purpose, descriptive qualitative, interview data was collected from 23 teachers attending a middle school science teacher workshop in addition to quantitative data using the POSTT-TR. These teachers sat for interviews structured by items from the POSTT-TR. Thus, the research design is mixed-method. The design provides a background profile on teacher orientations along with insights on reasons for pedagogical choices. The findings indicate that instructional preference distributions for the large group and smaller group are similar; however, the smaller workshop group is more in favor of inquiry instructional approaches. The findings also indicate that Turkish middle school science teachers appear to have variety of teaching orientations and they have varied reasons. Moreover, the research found that several contextual factors contributed to teachers' instructional practices including internal and external issues such as school environment, limited resources, large class sizes, standardized test pressure, and limited accessibility to professional development. The findings provide insight on the readiness of middle school teachers to implement the Turkish Curriculum Framework, specifically, teacher readiness to put science inquiry instructional approaches into actual classroom practice. Given that new Turkish policy calls for greater inquiry instruction, this study can help inform teacher development efforts directed at promoting science inquiry instruction.
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Khanna, Dinesh; Pope, Janet; Khanna, Puja P.; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D
2011-01-01
Introduction Fatigue is a common symptom in RA and used as an outcome measure in RA clinical trials. We studied a large academic clinical practice to estimate the minimally important difference (MID) for a fatigue visual analog scale using patient-reported anchors (fatigue, pain and overall health). Methods RA patients (N=307) had clinic visits at 2 time points at a median of 5.9 months apart. They completed fatigue visual analog scale (VAS; 0–10) and retrospective anchor items, “How would you describe your overall fatigue/pain/overall health since the last visit?” Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/ overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. Results The mean (SD) age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) HAQ-DI score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at follow up was 4.3 (2.8) (mean change of −0.07 [2.5], p=NS). The fatigue change score (0–10 scale) for somewhat better and somewhat worsened for fatigue anchor averaged −1.12 and 1.26, respectively. Using pain anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.87 and 1.13 and using global anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.82 and 1.17, respectively. Effect size (ES) estimates using 3 anchors were small for somewhat better (range: 0.27 to 0.39) and somewhat worsened (range: 0.40 to 0.44) groups but larger than the no-change group (range: 0.03 to 0.08). Conclusions The MID for fatigue VAS is between −0.82 to −1.12 for improvement and 1.13 to 1.26 for worsening on 0–10 scale in a large RA clinical practice and similar to that seen in RA clinical trials. This information can aid in interpreting fatigue VAS in day-to-day care in clinical practice. PMID:19004044
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Pollard, Richard J; Hopkins, Thomas; Smith, C Tyler; May, Bryan V; Doyle, James; Chambers, C Labron; Clark, Reese; Buhrman, William
2018-05-21
Perianesthetic mortality (death occurring within 48 hours of an anesthetic) continues to vary widely depending on the study population examined. The authors study in a private practice physician group that covers multiple anesthetizing locations in the Southeastern United States. This group has in place a robust quality assurance (QA) database to follow all patients undergoing anesthesia. With this study, we estimate the incidence of anesthesia-related and perianesthetic mortality in this QA database. Following institutional review board approval, data from 2011 to 2016 were obtained from the QA database of a large, community-based anesthesiology group practice. The physician practice covers 233 anesthetizing locations across 20 facilities in 2 US states. All detected cases of perianesthetic death were extracted from the database and compared to the patients' electronic medical record. These cases were further examined by a committee of 3 anesthesiologists to determine whether the death was anesthesia related (a perioperative death solely attributable to either the anesthesia provider or anesthetic technique), anesthetic contributory (a perioperative death in which anesthesia role could not be entirely excluded), or not due to anesthesia. A total of 785,467 anesthesia procedures were examined from the study period. A total of 592 cases of perianesthetic deaths were detected, giving an overall death rate of 75.37 in 100,000 cases (95% CI, 69.5-81.7). Mortality judged to be anesthesia related was found in 4 cases, giving a mortality rate of 0.509 in 100,000 (95% CI, 0.198-1.31). Mortality judged to be anesthesia contributory were found in 18 cases, giving a mortality of 2.29 in 100,000 patients (95% CI, 1.45-3.7). A total of 570 cases were judged to be nonanesthesia related, giving an incidence of 72.6 per 100,000 anesthetics (95% CI, 69.3-75.7). In a large, comprehensive database representing the full range of anesthesia practices and locations in the Southeastern United States, the rate of perianesthestic death was 0.509 in 100,000 (95% CI, 0.198-1.31). Future in-depth analysis of the epidemiology of perianesthetic deaths will be reported in later studies.
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Managing Astronomy Research Data: Case Studies of Big and Small Research Projects
NASA Astrophysics Data System (ADS)
Sands, Ashley E.
2015-01-01
Astronomy data management refers to all actions taken upon data over the course of the entire research process. It includes activities involving the collection, organization, analysis, release, storage, archiving, preservation, and curation of research data. Astronomers have cultivated data management tools, infrastructures, and local practices to ensure the use and future reuse of their data. However, new sky surveys will soon amass petabytes of data requiring new data management strategies.The goal of this dissertation, to be completed in 2015, is to identify and understand data management practices and the infrastructure and expertise required to support best practices. This will benefit the astronomy community in efforts toward an integrated scholarly communication framework.This dissertation employs qualitative, social science research methods (including interviews, observations, and document analysis) to conduct case studies of data management practices, covering the entire data lifecycle, amongst three populations: Sloan Digital Sky Survey (SDSS) collaboration team members; Individual and small-group users of SDSS data; and Large Synoptic Survey Telescope (LSST) collaboration team members. I have been observing the collection, release, and archiving of data by the SDSS collaboration, the data practices of individuals and small groups using SDSS data in journal articles, and the LSST collaboration's planning and building of infrastructure to produce data.Preliminary results demonstrate that current data management practices in astronomy are complex, situational, and heterogeneous. Astronomers often have different management repertoires for working on sky surveys and for their own data collections, varying their data practices as they move between projects. The multitude of practices complicates coordinated efforts to maintain data.While astronomy expertise proves critical to managing astronomy data in the short, medium, and long term, the larger astronomy data workforce encompasses a greater breadth of educational backgrounds. Results show that teams of individuals with distinct expertise are key to ensuring the long-term preservation and usability of astronomy datasets.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Adams, R.D.; Queisser, J.A.; Yamamoto, J.H.
1996-10-30
This paper reports some interesting new transformations of thiirane, 2(R),3(S)-dimethylthiirane (cis-DMT), and 2(R),3(R)(2(S), 3(S))-dimethylthiirane (trans-DMT) by the W(CO){sub 5} group. The reaction of an excess of thiirane with W(CO){sub 5}-(NCMe) leads to the formation of the cyclic polydisulfides (CH{sub 2}-CH{sub 2}SS){sub n}, 1-4, n = 2-5 plus ethylene catalytically. The case of this new catalytic thiirane reaction indicates that it could be a practical route for the synthesis of large quantities of these and other cyclic polydisulfides. 17 refs., 1 fig.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Thwaites, D; Holloway, L; Bailey, M
2015-06-15
Purpose: Large amounts of routine radiotherapy (RT) data are available, which can potentially add clinical evidence to support better decisions. A developing collaborative Australian network, with a leading European partner, aims to validate, implement and extend European predictive models (PMs) for Australian practice and assess their impact on future patient decisions. Wider objectives include: developing multi-institutional rapid learning, using distributed learning approaches; and assessing and incorporating radiomics information into PMs. Methods: Two initial standalone pilots were conducted; one on NSCLC, the other on larynx, patient datasets in two different centres. Open-source rapid learning systems were installed, for data extraction andmore » mining to collect relevant clinical parameters from the centres’ databases. The European DSSs were learned (“training cohort”) and validated against local data sets (“clinical cohort”). Further NSCLC studies are underway in three more centres to pilot a wider distributed learning network. Initial radiomics work is underway. Results: For the NSCLC pilot, 159/419 patient datasets were identified meeting the PM criteria, and hence eligible for inclusion in the curative clinical cohort (for the larynx pilot, 109/125). Some missing data were imputed using Bayesian methods. For both, the European PMs successfully predicted prognosis groups, but with some differences in practice reflected. For example, the PM-predicted good prognosis NSCLC group was differentiated from a combined medium/poor prognosis group (2YOS 69% vs. 27%, p<0.001). Stage was less discriminatory in identifying prognostic groups. In the good prognosis group two-year overall survival was 65% in curatively and 18% in palliatively treated patients. Conclusion: The technical infrastructure and basic European PMs support prognosis prediction for these Australian patient groups, showing promise for supporting future personalized treatment decisions, improved treatment quality and potential practice changes. The early indications from the distributed learning and radiomics pilots strengthen this. Improved routine patient data quality should strengthen such rapid learning systems.« less
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Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee
2014-01-01
In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.
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Halley, Meghan C; Rendle, Katharine A; Gugerty, Brian; Lau, Denys T; Luft, Harold S; Gillespie, Katherine A
2017-11-01
Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate. Using standard protocols, three field representatives conducted NAMCS physician induction interviews (PIIs) while trained ethnographers observed and audio recorded the interviews. Transcripts and field notes were analyzed to identify recurrent issues in the data collection process. Results The majority of the NAMCS items appeared to have been easily answered by the physician respondents. Among the items that appeared to be difficult to answer, three themes emerged: (a) physician respondents demonstrated an inconsistent understanding of "location" in responding to questions; (b) lack of familiarity with administrative matters made certain questions difficult for physicians to answer; and (c) certain primary care‑oriented questions were not relevant to specialty care providers. Conclusions Some PII survey questions were challenging for physicians in a multispecialty practice setting. Improving the design and administration of NAMCS data collection is part of NCHS' continuous quality improvement process. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
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Molony, D; Beame, C; Behan, W; Crowley, J; Dennehy, T; Quinlan, M; Cullen, W
2016-11-01
While considerable changes are happening in primary care in Ireland and considerable potential exists in intelligence derived from practice-based data to inform these changes, relatively few large-scale general morbidity surveys have been published. To examine the most common reasons why people attend primary care, specifically 'reasons for encounter' (RFEs) among the general practice population and among specific demographic groups (i.e., young children and older adults). We retrospectively examined clinical encounters (which had a diagnostic code) over a 4-year time period. Descriptive analyses were conducted on anonymised data. 70,489 RFEs consultations were recorded (mean 13.53 recorded RFEs per person per annum) and consultations involving multiple RFEs were common. RFE categories for which codes were most commonly recorded were: 'general/unspecified' (31.6 %), 'respiratory' (15.4 %) and 'musculoskeletal' (12.6 %). Most commonly recorded codes were: 'medication renewal' (6.8 %), 'cough' (6.6 %), and 'health maintenance/prevention' (5.8 %). There was considerable variation in the number of RFEs recorded per age group. 6239 RFEs (8.9 %) were recorded by children under 6 years and 15,295 RFEs (21.7 %) were recorded by adults aged over 70. RFEs recorded per calendar month increased consistently through the study period and there was a marked seasonal and temporal variation in the number of RFEs recorded. Practice databases can generate intelligence on morbidity and health service utilisation in the community. Future research to optimise diagnostic coding at a practice level and to promote this activity in a more representative sample of practices is a priority.
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Reflective Practice in Group Co-Leadership
ERIC Educational Resources Information Center
Okech, Jane E. Atieno
2008-01-01
Group literature on co-leaders' experiences and perceptions while leading groups illuminate reflective practice as highly influential to co-leader relationships and performances. Using practical examples grounded by interdisciplinary literature on reflective practice, this article explores and expands dialogue on the complex interplay between…
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Hewson, Mariana G; Copeland, H Liesel; Mascha, Edward; Arrigain, Susana; Topol, Eric; Fox, Joan E B
2006-07-01
To meet the increasing patient interest in complementary and alternative medicine (CAM), conventional physicians need to understand CAM, be willing to talk with their patients about CAM, and be open to recommending selected patients to appropriate CAM modalities. We aimed to raise physicians' awareness of, and initiate attitudinal changes towards CAM in the context of integrative medical practice. We developed and implemented a professional development program involving experiential learning and conceptual change teaching approaches. A randomized controlled study with a pre-post design in a large academic medical center. The 8-hour intervention used experiential and conceptual change educational approaches. Forty-eight cardiologists were randomized to participant and control groups. A questionnaire measured physicians' conceptions of, and attitudes to CAM, the likelihood of changing practice patterns, and the factors most important in influencing such changes. The questionnaire included an embedded control question on a topic that was not the focus of this program. We administered the questionnaire before (pretest) and after (posttest) the intervention. We compared differences in pre- and post-intervention scores between the participant (N = 20) and control (N = 16) groups. We used both groups to identify factors that influenced their practice patterns. The study was NIH-funded and IRB-exempt. Both groups initially had little knowledge about, and negative attitudes to CAM. The participant group had significant positive changes in their conceptions about, and attitudes to CAM after the program, and significant improvements when compared with the control group. Participant physicians significantly increased in their willingness to integrate CAM in their practices. Physicians (combined groups) rated research evidence as the most important factor influencing their willingness to integrate CAM. They requested more research evidence for CAM efficacy, and more information on non-conventional pharmacology. Participants reflected enthusiasm for the experiential program. The participants were able to experience the positive effects of selected CAM modalities. It is possible to increase physician knowledge and change attitudes towards integrative medicine with an eight-hour intervention using experiential and conceptual change teaching approaches. Professional development on integrative medicine can be offered to medical practitioners using experiential learning and conceptual change teaching approaches, with the help of local CAM practitioners.
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Evidence for teaching practice: the impact of clickers in a large classroom environment.
Patterson, Barbara; Kilpatrick, Judith; Woebkenberg, Eric
2010-10-01
As the number of nursing students increases, the ability to actively engage all students in a large classroom is challenging and increasingly difficult. Clickers, or student response systems (SRS), are a relatively new technology in nursing education that use wireless technology and enable students to select individual responses to questions posed to them during class. The study design was a quasi-experimental comparison with one section of an adult medical-surgical course using the SRS and one receiving standard teaching. No significant differences between groups on any measure of performance were found. Focus groups were conducted to describe student perceptions of SRS. Three themes emerged: Being able to respond anonymously, validating an answer while providing immediate feedback, and providing an interactive and engaging environment. Although the clickers did not improve learning outcomes as measured by objective testing, perceptions shared by students indicated an increased degree of classroom engagement. Future research needs to examine other potential outcome variables. Copyright © 2009 Elsevier Ltd. All rights reserved.
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Improving Hepatitis C Identification: Technology Alone Is Not the Answer.
Nitsche, Bruce; Miller, Sara C; Giorgio, Margaret; Berry, Carolyn A; Muir, Andrew
2017-09-01
An estimated 3 to 5 million Americans are chronically infected with hepatitis C virus (HCV), and approximately 75% of those persons were born between 1945 and 1965 (the so-called baby boomer generation). Because of the largely asymptomatic nature of HCV, up to 50% of those infected are unaware of their disease. Risk-based testing has been largely ineffective. Based on prevalence data, the Centers for Disease Control and Prevention and other organizations recommend a onetime HCV antibody test for all baby boomers. However, uptake of this recommendation requires significant changes in clinical practice for already busy primary care clinicians. We studied the effectiveness of a quality improvement initiative based on continuous audit and feedback combined with education for improving testing in alignment with guidelines; the control group was a cohort of clinicians whose only reminder was an institution-wide electronic health record prompt. Our data show improved testing rates among all clinician groups, but more significant improvement occurred among providers who received continuous feedback about their clinical performance coupled with education.
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Improving Children’s Knowledge of Fraction Magnitudes
Fazio, Lisa K.; Kennedy, Casey A.; Siegler, Robert S.
2016-01-01
We examined whether playing a computerized fraction game, based on the integrated theory of numerical development and on the Common Core State Standards’ suggestions for teaching fractions, would improve children’s fraction magnitude understanding. Fourth and fifth-graders were given brief instruction about unit fractions and played Catch the Monster with Fractions, a game in which they estimated fraction locations on a number line and received feedback on the accuracy of their estimates. The intervention lasted less than 15 minutes. In our initial study, children showed large gains from pretest to posttest in their fraction number line estimates, magnitude comparisons, and recall accuracy. In a more rigorous second study, the experimental group showed similarly large improvements, whereas a control group showed no improvement from practicing fraction number line estimates without feedback. The results provide evidence for the effectiveness of interventions emphasizing fraction magnitudes and indicate how psychological theories and research can be used to evaluate specific recommendations of the Common Core State Standards. PMID:27768756
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Group functioning of a collaborative family research team.
Johnson, S K; Halm, M A; Titler, M G; Craft, M; Kleiber, C; Montgomery, L A; Nicholson, A; Buckwalter, K; Cram, E
1993-07-01
Collaborative research teams are an attractive means of conducting nursing research in the clinical setting because of the many opportunities that collaboration can supply. These opportunities include a chance to: (1) network with other nurses who have similar interests, (2) share knowledge and expertise for designing clinical studies that directly affect daily practice, (3) develop instruments, (4) write grant proposals, (5) collect and analyze data, and (6) prepare manuscripts for publication. The effectiveness of research teams, however, is strongly influenced by group functioning. This article describes the functioning of a collaborative family interventions research team of nursing faculty members and CNSs at a large Midwestern university setting. The formation of the group and membership characteristics are described, along with strategies used to identify the research focus and individual and group goals. Aspects related to the influence of the group on members and the internal operations of the group are also addressed. Future strategies to be explored will focus on the size of the group and joint authorship issues. The authors also set forth a number of recommendations for development of collaborative research groups.
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Baruch, Erez N; Benov, Avi; Shina, Avi; Berg, Amy L; Shlaifer, Amir; Glassberg, Elon; Aden, James K; Bader, Tarif; Kragh, John F; Yitzhak, Avraham
2016-12-01
Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel. Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed. The educational intervention was to allocate the participants into a monthly tourniquet practice program: either a single-application practice (SAP) group or a triple-application practice (TAP) group. Each group practiced according to its program. After 3 months, the participants' tourniquet use performance was reassessed. Assessments were conducted using the HapMed Leg Tourniquet Trainer (CHI Systems, Fort Washington, PA), a mannequin which measures time and pressure. A total of 151 participants dropped out, leaving 87 in the TAP group and 69 in the SAP group. On initial assessment, the TAP group and the SAP group performed similarly. Both groups improved their performance from the initial to the final assessment. The TAP group improved more than the SAP group in mean application time (faster by 18 vs 8 seconds, respectively; P = .023) and in reducing the proportion of participants who were unable to apply any pressure to the mannequin (less by 18% vs 8%, respectively; P = .009). Three applications per monthly practice session were superior to one. This is the first prospective validation of a tourniquet practice program based on objective measurements. Copyright © 2016 Elsevier Inc. All rights reserved.
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Using Baby Books to Increase New Mothers’ Safety Practices
Reich, Stephanie M.; Penner, Emily K.; Duncan, Greg J.
2010-01-01
Objective To determine if educational baby books are an effective method for increasing low-income, first-time mothers’ safety practices during their child’s first 18 months. Patients and Methods Primiparous women (n = 167) were randomly assigned to one of three groups: an educational book group, a non-educational book group, or a no-book group. Home visits and interviews measured safety practices when women were in their third trimester of pregnancy (baseline) and when their child was 2, 4, 6, 9, 12, and 18 months of age. Results Women in the educational book group had fewer risks in their homes and exercised more safety practices than the no-book group (effect size = −0.30; 20% risk reduction). When the safety practices involved little time or expense (e.g., putting away sharp objects), the educational book group was significantly more likely to engage in these behaviors than the no-book (40% higher practices; effect size = 0.19) or non-educational book groups (27% higher practices; effect size = 0.13). However, no differences were found between groups for behaviors that required high effort in time, money or hassle (e.g., installing latches on cabinets). Discussion Educational baby books appear to be an easy and low cost way to increase the safety practices of new mothers, especially if the practices involve little to no time, money, and hassle. PMID:21272822
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Rognstad, Sture; Brekke, Mette; Gjelstad, Svein; Straand, Jørund; Fetveit, Arne
2018-05-12
Potentially Inappropriate Prescriptions (PIP) is drug treatment, which in general, at the group level for a median/mean patient, can be considered unfavorable meaning that the risks commonly may outweigh the benefits. This MiniReview reports and discusses the main findings in a large cluster-randomized educational intervention in Norwegian general practice, aimed at reducing the prevalence of PIPs to patients ≥ 70 years (The Rx-PAD study). Targets for the intervention were general practitioners (GPs) in continuing medical education (CME) groups receiving educational outreach visits (i.e., peer academic detailing). A Delphi consensus process, with a panel of medical experts was undertaken to elaborate a list of explicit criteria defining PIPs for patients ≥ 70 years in general practice. Agreement was achieved for 36 explicit PIP criteria, the so-called Norwegian General Practice (NorGeP) criteria. Using a selection (n = 24) of these criteria during a one-year baseline period on the prescribing practice of 454 GPs (i.e., those enrolled to participate in the intervention trial), we found a prevalence rate of 24.7 PIPs per 100 patients ≥70 years per year. In the Rx-PAD study, 449 GPs completed an educational intervention (96.6% of the included GPs), 250 in the intervention group and 199 in the control arm. Following the intervention, PIPs were reduced by 13% (95% CI 8.6 - 17.3), and the number of patients who were no longer exposed to one or more PIPs was reduced by 1173 (8.1%). The GPs who responded most strongly to the educational intervention were the oldest GPs (57-68 years) and these were the GPs with the highest prevalence of PIPs at baseline before the intervention. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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NASA Astrophysics Data System (ADS)
Connell, Shelley Sha'ron
2007-12-01
This study was an investigation of the relationship between teacher beliefs and teaching practices. The relationship was explored to address reported inconsistencies among teacher beliefs, teaching practices and reform goals reported over the past 30 years. A self-study methodology was employed to collect data in a fourth-grade (n = 12) and a fifth-grade (n = 7) class at a private elementary school. Data were collected using a reflective journal and the Traditional Versus Inquiry-Based Classroom Behaviors instrument. Self-data were triangulated with critical judgment data from focus groups and interviews with students, parents, and a peer teacher observer. Data were collected and analyzed in four segments: (a) teacher beliefs, (b) teaching practices, (c) congruency between teacher beliefs and teaching practices, and (d) factors that influence congruency. Teacher beliefs were listed at the start of the school year and analyzed in narrative format. Teaching practices were recorded in the journal and analyzed through coding. The relationship between beliefs and practices was explored on two levels, following Haney & McArthur's (2002) modified theory of planned behavior. First, congruency between beliefs and practices was determined, yielding beliefs that were either central (congruent with practices) or peripheral (incongruent with practices) to the author's belief system. Second, congruency between central beliefs and two categories of teaching principles was determined, yielding three subdivisions: constructivist core (congruent with constructivist principles), emerging core (congruent with general principles) and conflict core (incongruent with constructivist principles) beliefs. Data analysis showed 16 central beliefs (those congruent with practice) in operation. The study finding was that teacher beliefs and practices were largely congruent for this one teacher. This contrasted most published reports. Coupling application of the TPB and modified TPB, congruence appeared to be largely influenced by teacher reflection on classroom experiences and student outcomes, as well as three belief factors about teaching by constructivist principles: (a) beliefs about positive or negative outcomes (b) beliefs about social pressure and (c) beliefs about external factors that impact one's ability. Implications for future professional development include categorizing beliefs, pairing with mentors identified as having constructivist core beliefs and the use of reflective practice during field experiences.
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Cuellar, Alison; Krist, Alex H; Nichols, Len M; Kuzel, Anton J
2018-04-01
Physicians have joined larger groups and hospital systems in the face of multiple environmental challenges. We examine whether there are differences across practice ownership in self-reported work environment, a practice culture of learning, psychological safety, and burnout. Using cross-sectional data from staff surveys of small and medium-size practices that participated in EvidenceNOW in Virginia, we tested for differences in work environment, culture of learning, psychological safety, and burnout by practice type. We conducted weighted multivariate linear regression of outcomes on ownership, controlling for practice size, specialty mix, payer mix, and whether the practice was located in a medically underserved area. We further analyzed clinician and staff responses separately. Participating were 104 hospital-owned and 61 independent practices and 24 federally qualified health centers (FQHCs). We analyzed 2,005 responses from practice clinicians and staff, a response rate of 49%. Working in a hospital-owned practice was associated with favorable ratings of work environment, psychological safety, and burnout compared with independent practices. When we examined separately the responses of clinicians vs staff, however, the association appears to be largely driven by staff. Hospital ownership was associated with positive perceptions of practice work environment and lower burnout for staff relative to independent ownership, whereas clinicians in FQHCs perceive a more negative, less joyful work environment and burnout. Our findings are suggestive that clinician and nonclinician staff perceive practice adaptive reserve differently, which may have implications for creating the energy for ongoing quality improvement work. © 2018 Annals of Family Medicine, Inc.
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Hinton, Daniel P; Higson, Helen
2017-01-01
The present research aims to more fully explore the issues of performance differences in higher education assessment, particularly in the context of a common measure taken to address them. The rationale for the study is that, while performance differences in written examinations are relatively well researched, few studies have examined the efficacy of anonymous marking in reducing these performance differences, particularly in modern student populations. By examining a large archive (N = 30674) of assessment data spanning a twelve-year period, the relationship between assessment marks and factors such as ethnic group, gender and socio-environmental background was investigated. In particular, analysis focused on the impact that the implementation of anonymous marking for assessment of written examinations and coursework has had on the magnitude of mean score differences between demographic groups of students. While group differences were found to be pervasive in higher education assessment, these differences were observed to be relatively small in practical terms. Further, it appears that the introduction of anonymous marking has had a negligible effect in reducing them. The implications of these results are discussed, focusing on two issues, firstly a defence of examinations as a fair and legitimate form of assessment in Higher Education, and, secondly, a call for the re-examination of the efficacy of anonymous marking in reducing group performance differences.
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Higson, Helen
2017-01-01
The present research aims to more fully explore the issues of performance differences in higher education assessment, particularly in the context of a common measure taken to address them. The rationale for the study is that, while performance differences in written examinations are relatively well researched, few studies have examined the efficacy of anonymous marking in reducing these performance differences, particularly in modern student populations. By examining a large archive (N = 30674) of assessment data spanning a twelve-year period, the relationship between assessment marks and factors such as ethnic group, gender and socio-environmental background was investigated. In particular, analysis focused on the impact that the implementation of anonymous marking for assessment of written examinations and coursework has had on the magnitude of mean score differences between demographic groups of students. While group differences were found to be pervasive in higher education assessment, these differences were observed to be relatively small in practical terms. Further, it appears that the introduction of anonymous marking has had a negligible effect in reducing them. The implications of these results are discussed, focusing on two issues, firstly a defence of examinations as a fair and legitimate form of assessment in Higher Education, and, secondly, a call for the re-examination of the efficacy of anonymous marking in reducing group performance differences. PMID:28813457
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Hill, Micah J.; Cooper, Janelle C.; Levy, Gary; Alford, Connie; Richter, Kevin S.; DeCherney, Alan H.; Katz, Charles; Levens, Eric D.; Wolff, Erin F.
2013-01-01
Objective It is unclear whether the stimulated state of the ovaries as part of ART results in an increased vulnerability to the effects of methotrexate. The objective of this study was to assess ovarian reserve following methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after ART. Design Retrospective cohort study. Setting Large ART practice. Patients Methotrexate or surgery following ART. Interventions None. Main Outcome Measures Follicle stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield were compared between subjects treated with methotrexate and surgery. Secondary outcomes were clinical pregnancy and live birth. Results There were 153 patients in the methotrexate group and 36 patients in the surgery group. Neither group demonstrated differences in ovarian reserve or oocyte yield comparing before and after treatment values. The change in ovarian reserve and oocyte yield after treatment were similar between the two groups. The number of doses of methotrexate was not correlated with changes in ovarian reserve, indicating no dose-dependent effect. Time between treatment and repeat ART was not correlated with outcomes. Live birth in subsequent cycles was similar in the two groups. Conclusions Ovarian reserve and subsequent ART cycle outcomes were reassuring following methotrexate and surgical management of ectopic pregnancy. An adverse impact of methotrexate was not detected in this large fertility cohort as has been previously described. PMID:24269042
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Manifesto: towards a clinically-oriented psychometrics.
Vickers, Andrew J; Chen, Ling Y
2017-04-26
New technologies to collect patient - reported outcomes have substantially solved the challenge of integrating a questionnaire in a busy clinical practice. At Memorial Sloan Kettering, we have been collecting patient reported outcomes electronically for many years. Our experience confirms the predicted benefits of obtaining patient reported outcomes but has also raised serious concerns about whether instruments developed for the research setting are appropriate for routine clinical use. We summarize four principles for a clinically - relevant psychometrics. First, minimize patient burden: the use of a large number of items for a single domain may be of interest for research but additional items have little clinical utility. Secondly, use simplified language: patients who do not have good language skills are typically excluded from research studies but will nonetheless present in clinical practice. Third, avoid dumb questions: many questionnaire items are inappropriate when applied to a more general population. Fourth, what works for the group may not work for the individual: group level statistics used to validate survey instruments can obscure problems when applied to a subgroup of patients. There is a need for a clinically-oriented psychometrics to help design, test, and evaluate questionnaires that would be used in routine practice. Developing statistical methods to optimize questionnaires will be highly challenging but needed to bring the potential of patient reported outcomes into widespread clinical use.
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Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L
2010-04-01
Test a model of family physician job satisfaction and commitment. Data were collected from 1,482 family physicians in a Midwest state during 2000-2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure.
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Quality of work life of independent vs employed family physicians in Wisconsin: a WReN study.
Beasley, John W; Karsh, Ben-Tzion; Hagenauer, Mary Ellen; Marchand, Lucille; Sainfort, Francois
2005-01-01
Family physicians in Wisconsin who are mainly employed by large health care organizations have voiced concerns regarding the quality of their work lives. We explored the quality of work life and its relationship to employment by health care organizations. We conducted a cross-sectional survey of the 1,482 active members of the Wisconsin Academy of Family Physicians in 2000. A 47% overall response rate was obtained, and 584 respondents could be identified as independent or employed by a health care organization. There were no differences in age or sex between the 2 groups. The independent physicians worked longer hours, were in smaller work groups, and had been in practice longer and in their current practice longer than the employed physicians. Independent physicians reported better working relationships, more satisfaction with family time, more influence over management decisions, better satisfaction with being a physician, better perceived quality of the care they provided, greater ability to achieve professional goals, and lesser intention to leave the practice. Independent physicians have significantly more positive ratings of several aspects of the quality of their work life compared with physicians employed by health care organizations. Health care organizations need to address these issues if they are to have a satisfied and stable workforce.
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Kim, Sujeong; Park, Chang; O'Rourke, Jennifer
2017-04-01
Best practice standards of simulation recommend standardized simulation training for nursing faculty. Online training may offer an effective and more widely available alternative to in-person training. Using the Theory of Planned Behavior, this study evaluated the effectiveness of an online simulation training program, examining faculty's foundational knowledge of simulation as well as perceptions and intention to adopt. One-group pretest-posttest design. A large school of nursing with a main campus and five regional campuses in the Midwestern United States. Convenience sample of 52 faculty participants. Knowledge of foundational simulation principles was measured by pre/post-training module quizzes. Perceptions and the intention to adopt simulation were measured using the Faculty Attitudes and Intent to Use Related to the Human Patient Simulator questionnaire. There was a significant improvement in faculty knowledge after training and observable improvements in attitudes. Attitudes significantly influenced the intention to adopt simulation (B=2.54, p<0.001). Online simulation training provides an effective alternative for training large numbers of nursing faculty who seek to implement best practice of standards within their institutions. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Coetsee, Carla; Terblanche, Elmarie
2017-01-01
Older adults are encouraged to participate in regular physical activity to counter the age-related declines in physical and cognitive health. Literature on the effect of different exercise training modalities (aerobic vs resistance) on these health-related outcomes is not only sparse, but results are inconsistent. In general, it is believed that exercise has a positive effect on executive cognitive function, possibly because of the physiological adaptations through increases in fitness. Indications are that high-intensity interval training is a potent stimulus to improve cardiovascular fitness, even in older adults; however, its effect on cognitive function has not been studied before. Therefore, the purpose of this study was to compare the effects of resistance training, high-intensity aerobic interval training and moderate continuous aerobic training on the cognitive and physical functioning of healthy older adults. Sixty-seven inactive individuals (55 to 75 years) were randomly assigned to a resistance training (RT) group ( n = 22), high-intensity aerobic interval training (HIIT) group ( n = 13), moderate continuous aerobic training (MCT) group ( n = 13) and a control (CON) group ( n = 19) for a period of 16 weeks. Cognitive function was assessed with a Stroop task and physical function with the Timed-Up-and-Go (TUG) and submaximal Bruce treadmill tests. No significant GROUP x TIME interaction was found for Stroop reaction time ( P > .05). The HIIT group showed the greatest practical significant improvement in reaction time on the information processing task, i.e. Stroop Neutral (ES = 1.11). MCT group participants had very large practical significant improvements in reaction time on the executive cognitive tasks, i.e. Stroop Incongruent and Interference (ES = 1.28 and 1.31, respectively). The HIIT group showed the largest practically significant increase in measures of physical function, i.e. walking endurance (ES = 0.91) and functional mobility (ES = 0.36). MCT and RT proved to be superior to HIIT for the enhancement of older individuals' executive cognitive function; whereas HIIT were most beneficial for improvement in information processing speed. HIIT also induced the largest gains in physical function.
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Al-Mallah, Mouaz H; Pascual, Thomas N B; Mercuri, Mathew; Vitola, João V; Karthikeyan, Ganesan; Better, Nathan; Dondi, Maurizio; Paez, Diana; Einstein, Andrew J
2018-05-15
There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort. Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportion of patients with ED ≤ 9 mSv, a target level specified in guidelines. Among 7911 patients undergoing MPI in 308 laboratories in 65 countries, mean ED was 10.0 ± 4.5 mSv with slightly higher exposure among younger age groups (trend p value < 0.001). There was no difference in the proportion of patients with ED ≤ 9 mSv across age groups, or in adherence to best practices based on the median age of patients in a laboratory. In contemporary nuclear cardiology practice, the age of the patient appears not to impact protocol selection and radiation dose, contrary to professional society guidelines. Copyright © 2018. Published by Elsevier B.V.
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Wiltink, Jörg; Ruckes, Christian; Hoyer, Jürgen; Leichsenring, Falk; Joraschky, Peter; Leweke, Frank; Pöhlmann, Karin; Beutel, Manfred E
2017-03-14
Despite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD. The manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D). Remission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = -0.605 to d = -2.937. Benefits of mSTPP were limited to single outcomes. Findings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity of personality disorders and a long treatment history may need longer treatments. German Clinical Trials Register (DRKS) DRKS00000570 , registered 03. March 2011.
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Mojola, Sanyu A
2014-01-01
This paper draws on ethnographic and interview based fieldwork to explore accounts of intimate relationships between widowed women and poor young men that emerged in the wake of economic crisis and a devastating HIV epidemic among the Luo ethnic group in Western Kenya. I show how the cooptation of widow inheritance practices in the wake of an overwhelming number of widows as well as economic crisis resulted in widows becoming providing women and poor young men becoming kept men. I illustrate how widows in this setting, by performing a set of practices central to what it meant to be a man in this society – pursuing and providing for their partners - were effectively doing masculinity. I will also show how young men, rather than being feminized by being kept, deployed other sets of practices to prove their masculinity and live in a manner congruent with cultural ideals. I argue that ultimately, women’s practice of masculinity in large part seemed to serve patriarchal ends. It not only facilitated the fulfillment of patriarchal expectations of femininity – to being inherited – but also served, in the end, to provide a material base for young men’s deployment of legitimizing and culturally valued sets of masculine practice. PMID:25489121
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McCabe, Marita P; Waqa, Gade; Dev, Anjileena; Cama, Tilema; Swinburn, Boyd A
2013-05-01
This study investigated cultural values related to body image and eating practices in Western and non-Western societies. In total, 628 Fijian, 463 Indo-Fijian, 598 Tongan, and 534 Australian adolescents completed measures of cultural values and religious influences in relation to the ideal body and eating practices. Fijian and Tongan adolescents were more likely to value a large body. Religious influences were most strongly associated with eating practices for Fijians, Indo-Fijians, and Tongans. The findings support the role of religion in transmitting cultural values regarding eating practices in Pacific Island communities. What is already known on this subject? Previous research has demonstrated that sociocultural factors shape body image and eating behaviours. Most of this research has been conducted in Western countries. What does this study add? The current study identifies the role of cultural values and religious influences on body image and eating behaviours in a number of different cultural groups. This is the first study to use the same methodology to explore these relationships across Western and Pacific Island communities. © 2012 The British Psychological Society.
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NASA Astrophysics Data System (ADS)
Sund, Per
2016-09-01
Science teachers regard practical work as important and many claim that it helps students to learn science. Besides theoretical knowledge, such as concepts and formulas, practical work is considered to be an integral and basic part of science education. As practical work is perceived and understood in different ways, comparing the results between classes and schools is difficult. One way of making the results comparable is to develop systematic inquiries to be assessed in national large-scale tests. However, introducing similar testing conditions in a laboratory environment is not always possible. Although the instructions and assessment guides for such tests are detailed, many obstacles need to be overcome if equality in the overall test situation is to be achieved. This empirical case study investigates two secondary school science teachers' assessments of 15-16 years old students in three separate groups in the practical part of a Swedish national test in chemistry. Data are gathered using two video cameras and three pairs of spy camera glasses. The results show that individual and independent assessments are difficult due to the social interactions that take place and the physical sources of errors that occur in this type of setting.
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Liu, Li-Zhi; Wu, Fang-Xiang; Zhang, Wen-Jun
2014-01-01
As an abstract mapping of the gene regulations in the cell, gene regulatory network is important to both biological research study and practical applications. The reverse engineering of gene regulatory networks from microarray gene expression data is a challenging research problem in systems biology. With the development of biological technologies, multiple time-course gene expression datasets might be collected for a specific gene network under different circumstances. The inference of a gene regulatory network can be improved by integrating these multiple datasets. It is also known that gene expression data may be contaminated with large errors or outliers, which may affect the inference results. A novel method, Huber group LASSO, is proposed to infer the same underlying network topology from multiple time-course gene expression datasets as well as to take the robustness to large error or outliers into account. To solve the optimization problem involved in the proposed method, an efficient algorithm which combines the ideas of auxiliary function minimization and block descent is developed. A stability selection method is adapted to our method to find a network topology consisting of edges with scores. The proposed method is applied to both simulation datasets and real experimental datasets. It shows that Huber group LASSO outperforms the group LASSO in terms of both areas under receiver operating characteristic curves and areas under the precision-recall curves. The convergence analysis of the algorithm theoretically shows that the sequence generated from the algorithm converges to the optimal solution of the problem. The simulation and real data examples demonstrate the effectiveness of the Huber group LASSO in integrating multiple time-course gene expression datasets and improving the resistance to large errors or outliers.
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42 CFR 495.306 - Establishing patient volume.
Code of Federal Regulations, 2010 CFR
2010-10-01
... calculate patient volume at the group practice/clinic level, but only in accordance with all of the following limitations: (1) The clinic or group practice's patient volume is appropriate as a patient volume... practice's patient volume determination. (3) All EPs in the group practice or clinic must use the same...
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Fan, Tianyong; Xian, Peng; Yang, Lu; Liu, Yong; Wei, Qiang; Li, Hong
2009-11-01
To summarize our experience and evaluate the learning curve of retroperitoneal laparoscopic ureterolithotomy of the upper ureter. Between May 2004 and May 2007, 40 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. We divided the first and last 20 patients into group I and group II. There was no statistical difference in stone size between groups. Operative time and complications were measured as a basis for the assessment of the learning curve. In group I, the complication rate was 15% (3/20), including two patients whose procedure was converted to open surgery because of intraoperative bleeding, and one patient who experienced urine leakage because of a displaced Double-J ureteral stent. In group II, no postoperative complications occurred, while the mean operative time was significantly shorter compared with the earlier operations (65 vs 120 min). Retroperitoneal laparoscopic ureterolithotomy is safe and effective for large or impacted stones of the upper ureter. It is associated with a short learning curve in the setting of an active laparoscopic practice for selected patients.
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Metaphors as contextual evidence for engaging Haitian clients in practice: a case study.
Rahill, Guitele; Jean-Gilles, Michele; Thomlison, Barbara; Pinto-Lopez, Elsa
2011-01-01
Haitian immigrants remain underserved in the United States (U.S.), despite their large presence and their visibility, which increased after the January 12, 2010 earthquake. Employing cultural-specific practice strategies to engage Haitians in the U.S. who experienced loss in their social networks, requires understanding the context of their ecological culture and consideration of relevant linguistic and cultural elements. Through a case example, we describe the use of metaphors in cultural language as part of a strategy used to engage a Haitian immigrant with symptoms of posttraumatic stress disorder. Outcomes indicate that the use of storytelling and metaphors facilitate disclosure of clients' worldviews, experiences, feelings and hopes in a safe environment while providing them with tools to determine progress. We identify four practice guidelines for intervention strategies with ethnic minority groups who share similar cultural contexts. Metaphors, which are a viable approach to practice, focus on cultural strengths and resiliencies over traditional models of deficit and can enhance access to needed effective services for underserved populations, such as Haitians in the United States.
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Lhermitte's sign: Review with special emphasis in oncology practice.
Gemici, Cengiz
2010-05-01
Lhermitte's sign (LS) is characterized by electric shock like sensation, spreading along the spine in a cervico-caudal direction and also into both arms and legs, which is felt upon forward flexion of the neck. It is a myelopathy resulting from damage to sensory axons at the dorsal columns of the cervical or thoracic spinal cord and a well-known clinical sign in neurology practice. Patients with cancer may present with LS due to various causes either related to the tumor itself or to its treatment. Spinal cord tumors, radiotherapy and chemotherapy are possible causes of LS observed in oncology practice. While LS is observed with a frequency of 3.6-13% in large patient groups receiving radiotherapy for head and neck and thoracic malignancies, the true incidence of chemotherapy and spinal cord tumor induced LS is unknown with only few reported cases in the literature. In the present article, various pathologies causing Lhermitte's sign are reviewed with special emphasis on the implications of this sign in oncology practice. 2009 Elsevier Ireland Ltd. All rights reserved.
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Sexual behavior of medical students: A single institutional survey.
Daniyam, C A; Agaba, P A; Agaba, E I
2010-06-01
We investigated the sexual practices of medical students as they are positioned to serve as peer educators in the fight against HIV/AIDS. This was a cross sectional study, where self- administered questionnaires were distributed to consenting 4(th) to 6(th) year medical students in Jos, Nigeria with a view of elucidating information regarding sexual practices and condom utilization. Safe sex practice was defined as the use of condoms and being in a monogamous relationship. Of a total of 400 questionnaires distributed, 365 respondents (249 males and 116 females) had adequate data for analysis. A large proportion (62%) of our students have never had sex before and less than 30% of them are sexually active. Only 6.1% had multiple sexual partners and homosexuality was uncommon (1.9%). Condom utilization amongst the sexually active was high (65%) and similar among male and female students (71.3% vs. 51.9% respectively, p = 0.08). There exists safe sexual practice among medical students in our setting. This group could be recruited as peer educators in the war against HIV/AIDS.
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Health responsibility and workplace health promotion among women: early detection of cancer.
Kushnir, T; Rabinowitz, S; Melamed, S; Weisberg, E; Ribak, J
1995-01-01
The importance of health responsibility as one aspect of a health-promoting lifestyle has been emphasized repeatedly. Yet there are only a few empirical studies of its role in preventive behavior. We examined the relationship between health responsibility and early-detection practices for breast and cervical cancer. A group of 253 women employees of a large industrial company participated in a cancer screening program subsidized by the employer. They completed questionnaires assessing health responsibility and reported early-detection practices: frequency of breast self-examination and physician breast examinations, frequency of Pap tests, and time lapsed since last Pap test and breast examinations. Health responsibility was a significant independent predictor of breast examination indicators but not of Pap tests. Education level was an important predictor for Pap tests, and age predicted most early-detection practices. The findings lend some support to the role of health responsibility in initiating breast examinations. Better prediction of early-detection practices could be achieved by adding cognitive and emotional components to the existing responsibility scale and by distinguishing between retrospective and prospective responsibility.
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Community detection using preference networks
NASA Astrophysics Data System (ADS)
Tasgin, Mursel; Bingol, Haluk O.
2018-04-01
Community detection is the task of identifying clusters or groups of nodes in a network where nodes within the same group are more connected with each other than with nodes in different groups. It has practical uses in identifying similar functions or roles of nodes in many biological, social and computer networks. With the availability of very large networks in recent years, performance and scalability of community detection algorithms become crucial, i.e. if time complexity of an algorithm is high, it cannot run on large networks. In this paper, we propose a new community detection algorithm, which has a local approach and is able to run on large networks. It has a simple and effective method; given a network, algorithm constructs a preference network of nodes where each node has a single outgoing edge showing its preferred node to be in the same community with. In such a preference network, each connected component is a community. Selection of the preferred node is performed using similarity based metrics of nodes. We use two alternatives for this purpose which can be calculated in 1-neighborhood of nodes, i.e. number of common neighbors of selector node and its neighbors and, the spread capability of neighbors around the selector node which is calculated by the gossip algorithm of Lind et.al. Our algorithm is tested on both computer generated LFR networks and real-life networks with ground-truth community structure. It can identify communities accurately in a fast way. It is local, scalable and suitable for distributed execution on large networks.
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Plantar pressure with and without custom insoles in patients with common foot complaints.
Stolwijk, Niki M; Louwerens, Jan Willem K; Nienhuis, Bart; Duysens, Jacques; Keijsers, Noël L W
2011-01-01
Although many patients with foot complaints receive customized insoles, the choice for an insole design can vary largely among foot experts. To investigate the variety of insole designs used in daily practice, the insole design and its effect on plantar pressure distribution were investigated in a large group of patients. Mean, peak, and pressure-time-integral per sensor for 204 subjects with common foot complaints for walking with and without insoles was measured with the footscan® insole system (RSscan International). Each insole was scanned twice (precision3D), after which the insole height along the longitudinal and transversal cross section was calculated. Subjects were assigned to subgroups based on complaint and medial arch height. Data were analyzed for the total group and for the separate subgroups (forefoot or heel pain group and flat, normal or high medial arch group). The mean pressure significantly decreased under the metatarsal heads II-V and the calcaneus and significantly increased under the metatarsal bones and the lateral foot (p<0.0045) due to the insoles. However, similar redistribution patterns were found for the different foot complaints and arch heights. There was a slight difference in insole design between the subgroups; the heel cup was significantly higher and the midfoot support lower for the heel pain group compared to the forefoot pain group. The midfoot support was lowest in the flat arch group compared to the high and normal arch group (p<0.05). Although the insole shape was specific for the kind of foot complaint and arch height, the differences in shape were very small and the plantar pressure redistribution was similar for all groups. This study indicates that it might be sufficient to create basic insoles for particular patient groups.
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Turck, Charles J; Frazee, Erin; Kram, Bridgette; Daley, Mitchell J; Day, Sarah A; Horner, Deanna; Lesch, Christine; Mercer, Jessica M; Plewa, Angela M; Herout, Peter
2014-01-01
Recent impactful additions to the professional literature on the role of pharmacotherapy in treating the critically ill are summarized. An unusually large number of updated practice guidelines and other publications with broad critical care pharmacotherapy ramifications appeared in the primary biomedical literature during the designated review period (February 2012-February 2013). Hundreds of relevant articles were evaluated by the Critical Care Pharmacotherapy Literature Update group (CCPLU), a national group of pharmacists who routinely monitor 25 peer-reviewed journals for emerging evidence that pertains to rational medication use in the intensive care unit (ICU) setting. From among those articles, 64 were summarized for dissemination to CCPLU members; the 8 publications deemed to have the greatest utility for critical care practitioners, as determined by CCPLU through a voting process, were selected for inclusion in this review, with preference given to evidence meeting high standards of methodological quality. The summaries presented here include (1) important new recommendations on management of pain, agitation, and delirium in critically ill patients, (2) a comprehensive update of a practice guideline issued in 2008 by the Surviving Sepsis Campaign, (3) novel strategies for the prevention and/or treatment of hyperglycemia in critical care, and (4) reports on clinical trials of promising alternative methods of sedation for use in weaning patients from mechanical ventilation. This review provides synopses of practice guidelines and other recent additions to the professional literature pertaining to rational medication use in the ICU practice setting.
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NASA Astrophysics Data System (ADS)
Roberts, Brenden; Vidick, Thomas; Motrunich, Olexei I.
2017-12-01
The success of polynomial-time tensor network methods for computing ground states of certain quantum local Hamiltonians has recently been given a sound theoretical basis by Arad et al. [Math. Phys. 356, 65 (2017), 10.1007/s00220-017-2973-z]. The convergence proof, however, relies on "rigorous renormalization group" (RRG) techniques which differ fundamentally from existing algorithms. We introduce a practical adaptation of the RRG procedure which, while no longer theoretically guaranteed to converge, finds matrix product state ansatz approximations to the ground spaces and low-lying excited spectra of local Hamiltonians in realistic situations. In contrast to other schemes, RRG does not utilize variational methods on tensor networks. Rather, it operates on subsets of the system Hilbert space by constructing approximations to the global ground space in a treelike manner. We evaluate the algorithm numerically, finding similar performance to density matrix renormalization group (DMRG) in the case of a gapped nondegenerate Hamiltonian. Even in challenging situations of criticality, large ground-state degeneracy, or long-range entanglement, RRG remains able to identify candidate states having large overlap with ground and low-energy eigenstates, outperforming DMRG in some cases.
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Combined Orbital Fractures: Surgical Strategy of Sequential Repair
Hur, Su Won; Kim, Sung Eun; Chung, Kyu Jin; Lee, Jun Ho; Kim, Tae Gon
2015-01-01
Background Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. Methods We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant. Results In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed. Conclusions We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon. PMID:26217562
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Effectiveness of PETTLEP imager on performance of passing skill in volleyball.
Afrouzeh, M; Sohrabi, E; Haghkhan, A; Rowshani, F; Goharrokhi, S
2015-01-01
This study was conducted to compare the effectiveness of PETTLEP-based imagery, and traditional imagery interventions, on performance of passing skill in volleyball. 36 beginners male volleyball players (Mage =13.5 years, SD=0.55 years) with 5-6 months practice experience were randomly assigned to one of three groups: physical practice + PETTLEP imagery (PP+PI) (N.=15), physical practice + traditional imagery (N.=15), and physical practice only (PP; N.=15). Subjects in the PP+PI group applied the seven components of PETTLEP imagery training; whereas subjects in the PP+TI engaged in a relaxation session before imagery and used response laden motor imagery scripts. The two groups completed 15 minutes of imagery training followed immediately by 13 minutes of "passing" practice three times per week. The PP group completed only 13 minutes of "passing" practice three times per week. Each group performed its respective tasks for 7 weeks. A pre-test took place during the first practice session in which "passing" was assessed. After the 7-week practice program, a post-test took place followed by a retention test, one "no-practice" week later. All groups improved significantly (P<0.05) from pre- to post-test and retention test. However, as hypothesised the PP+PI group improved more (P<0.05) than the PP+TI and PP groups. The findings, therefore, support the effectiveness of PETTLEP imagery in enhancing performance of passing skill in volleyball when combined with physical practice.
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2013-11-01
A short-cut review was carried out to establish whether the size of chest drain inserted is important in haemothoraces. Forty-nine papers were found of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 4. The clinical bottom line is that while the available evidence suggests that small bore drains may be as effective as large bore drains in resolving traumatic haemothoraces without additional complications, there is insufficient evidence currently available to recommend a change to standard practice (ie, large bore drains).
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Ethnic differences in prevalence and determinants of mother-child bed-sharing in early childhood.
Luijk, Maartje P C M; Mileva-Seitz, Viara R; Jansen, Pauline W; van IJzendoorn, Marinus H; Jaddoe, Vincent W V; Raat, Hein; Hofman, Albert; Verhulst, Frank C; Tiemeier, Henning
2013-11-01
To date few studies have examined how multiple layers of influences shape the emergence of bed-sharing practices in the first 2 years postpartum. In our report, we examined bed-sharing in a large multiethnic sample, exploring the influences of three broad classes of influence on bed-sharing at single time points and across time: (1) sociodemographic and (2) contextual factors such as breastfeeding, maternal mental health and stress, and (3) child temperament and sleep habits. Frequencies of bed-sharing were assessed at two time points, 2 and 24 months, in a population-based multiethnic (Dutch, Turkish or Moroccan, and Caribbean) sample of 6309 children born in the Netherlands. In Dutch mothers, the majority of mothers did not share their beds with their child, and bed-sharing rates decreased from 2 to 24 months. Other ethnic groups showed higher bed-sharing rates, typified by both increases in bed-sharing (the Turkish and Moroccan group) and persistence of bed-sharing over time (the Caribbean group). There were few family and child characteristics associated with bed-sharing in the non-Dutch ethnic groups. In contrast, bed-sharing in Dutch mothers was associated with child temperament and sleeping problems, maternal depression, and sociodemographic variables like crowding and maternal education. Our results suggest that mothers with a Turkish and Moroccan or Caribbean background were more influenced by cultural values, whereas bed-sharing practices were more reactive in the Dutch group. Copyright © 2013 Elsevier B.V. All rights reserved.
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Fryer, Caroline; Mackintosh, Shylie; Stanley, Mandy; Crichton, Jonathan
2012-01-01
This paper is a report of a methodological review of language appropriate practice in qualitative research, when language groups were not determined prior to participant recruitment. When older people from multiple language groups participate in research using in-depth interviews, additional challenges are posed for the trustworthiness of findings. This raises the question of how such challenges are addressed. The Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, Ageline, PsycINFO, Sociological abstracts, Google Scholar and Allied and Complementary Medicine databases were systematically searched for the period 1840 to September 2009. The combined search terms of 'ethnic', 'cultural', 'aged', 'health' and 'qualitative' were used. In this methodological review, studies were independently appraised by two authors using a quality appraisal tool developed for the review, based on a protocol from the McMaster University Occupational Therapy Evidence-Based Practice Research Group. Nine studies were included. Consideration of language diversity within research process was poor for all studies. The role of language assistants was largely absent from study methods. Only one study reported using participants' preferred languages for informed consent. More examples are needed of how to conduct rigorous in-depth interviews with older people from multiple language groups, when languages are not determined before recruitment. This will require both researchers and funding bodies to recognize the importance to contemporary healthcare of including linguistically diverse people in participant samples. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.
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Vickery, Charlotte E.; Dorjee, Dusana
2016-01-01
Studies investigating the feasibility and impact of mindfulness programs on emotional well-being when delivered by school teachers in pre-adolescence are scarce. This study reports the findings of a controlled feasibility pilot which assessed acceptability and emotional well-being outcomes of an 8-week mindfulness program (Paws b) for children aged 7–9 years. The program was delivered by school teachers within a regular school curriculum. Emotional well-being was measured using self-report questionnaires at baseline, post-training and 3 months follow-up, and informant reports were collected at baseline and follow-up. Seventy one participants aged 7–9 years were recruited from three primary schools in the UK (training group n = 33; control group n = 38). Acceptability of the program was high with 76% of children in the training group reporting ‘liking’ practicing mindfulness at school, with a strong link to wanting to continue practicing mindfulness at school (p < 0.001). Self-report comparisons revealed that relative to controls, the training group showed significant decreases in negative affect at follow-up, with a large effect size (p = 0.010, d = 0.84). Teacher reports (but not parental ratings) of meta-cognition also showed significant improvements at follow-up with a large effect size (p = 0.002, d = 1.08). Additionally, significant negative correlations were found between changes in mindfulness and emotion regulation scores from baseline to post-training (p = 0.038) and baseline to follow-up (p = 0.033). Findings from this study provide initial evidence that the Paws b program in children aged 7–9 years (a) can be feasibly delivered by primary school teachers as part of the regular curriculum, (b) is acceptable to the majority of children, and (c) may significantly decrease negative affect and improve meta-cognition. PMID:26793145
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Binswanger, Ingrid A; Koester, Stephen; Mueller, Shane R; Gardner, Edward M; Goddard, Kristin; Glanz, Jason M
2015-12-01
The rate of fatal unintentional pharmaceutical opioid poisonings has increased substantially since the late 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in the event of an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription. Our aim was to investigate the knowledge, attitudes and beliefs about overdose education and naloxone prescription among clinical staff in primary care. This was a qualitative study using focus groups to elucidate both clinic-level and provider-level barriers and facilitators. Ten primary care internal medicine, family medicine and infectious disease/HIV practices in three large Colorado health systems. A focus group guide was developed based on behavioral theory. Focus group transcripts were coded for manifest and latent meaning, and analyzed for themes using a recursive approach that included inductive and deductive analysis. Themes emerged in four content areas related to overdose education and naloxone prescription: knowledge, barriers, benefits and facilitators. Clinical staff (N = 56) demonstrated substantial knowledge gaps about naloxone and its use in outpatient settings. They expressed uncertainty about who to prescribe naloxone to, and identified a range of logistical barriers to its use in practice. Staff also described fears about offending patients and concerns about increased risk behaviors in patients prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors. Findings from these qualitative focus groups may not be generalizable to other settings. In addition to evidence gaps, logistical and attitudinal barriers will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain.
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ERIC Educational Resources Information Center
Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul
2010-01-01
Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…
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Bardach, Naomi S; Wang, Jason J; De Leon, Samantha F; Shih, Sarah C; Boscardin, W John; Goldman, L Elizabeth; Dudley, R Adams
2013-09-11
Most evaluations of pay-for-performance (P4P) incentives have focused on large-group practices. Thus, the effect of P4P in small practices, where many US residents receive care, is largely unknown. Furthermore, whether electronic health records (EHRs) with chronic disease management capabilities support small-practice response to P4P has not been studied. To assess the effect of P4P incentives on quality in EHR-enabled small practices in the context of an established quality improvement initiative. A cluster-randomized trial of small (<10 clinicians) primary care clinics in New York City from April 2009 through March 2010. A city program provided all participating clinics with the same EHR software with decision support and patient registry functionalities and quality improvement specialists offering technical assistance. Incentivized clinics were paid for each patient whose care met the performance criteria, but they received higher payments for patients with comorbidities, who had Medicaid insurance, or who were uninsured (maximum payments: $200/patient; $100,000/clinic). Quality reports were given quarterly to both the intervention and control groups. Comparison of differences in performance improvement, from the beginning to the end of the study, between control and intervention clinics for aspirin or antithrombotic prescription, blood pressure control, cholesterol control, and smoking cessation interventions. Mixed-effects logistic regression was used to account for clustering of patients within clinics, with a treatment by time interaction term assessing the statistical significance of the effect of the intervention. Participating clinics (n = 42 for each group) had similar baseline characteristics, with a mean of 4592 (median, 2500) patients at the intervention group clinics and 3042 (median, 2000) at the control group clinics. Intervention clinics had greater adjusted absolute improvement in rates of appropriate antithrombotic prescription (12.0% vs 6.1%, difference: 6.0% [95% CI, 2.2% to 9.7%], P = .001 for interaction term), blood pressure control (no comorbidities: 9.7% vs 4.3%, difference: 5.5% [95% CI, 1.6% to 9.3%], P = .01 for interaction term; with diabetes mellitus: 9.0% vs 1.2%, difference: 7.8% [95% CI, 3.2% to 12.4%], P = .007 for interaction term; with diabetes mellitus or ischemic vascular disease: 9.5% vs 1.7%, difference: 7.8% [95% CI, 3.0% to 12.6%], P = .01 for interaction term), and in smoking cessation interventions (12.4% vs 7.7%, difference: 4.7% [95% CI, -0.3% to 9.6%], P = .02 for interaction term). Intervention clinics performed better on all measures for Medicaid and uninsured patients except cholesterol control, but no differences were statistically significant. Among small EHR-enabled clinics, a P4P incentive program compared with usual care resulted in modest improvements in cardiovascular care processes and outcomes. Because most proposed P4P programs are intended to remain in place more than a year, further research is needed to determine whether this effect increases or decreases over time. clinicaltrials.gov Identifier: NCT00884013.
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Huijsman, Robbert; de Kuyper, Ruben Dennis Maurice; Fabbricotti, Isabelle Natalina
2016-01-01
Background: The impact of integrated working on professionals’ objective burden and job satisfaction was examined. An evidence-based intervention targeting frail elderly patients was implemented in the Walcheren region of the Netherlands in 2010. The intervention involved the primary care practice as a single entry point, and included proactive frailty screening, a comprehensive assessment of patient needs, case management, multidisciplinary teams, care plans and protocols, task delegation and task specialisation, a shared information system, a geriatric care network and integrated funding. Methods: A quasi-experimental design with a control group was used. Data regarding objective burden involved the professionals’ time investments over a 12-month period that were collected from patient medical records (n = 377) time registrations, transcripts of meetings and patient questionnaires. Data regarding job satisfaction were collected using questionnaires that were distributed to primary care and home-care professionals (n = 180) after the intervention’s implementation. Within- and between-groups comparisons and regression analyses were performed. Results: Non-patient related time was significantly higher in the experimental group than in the control group, whereas patient-related time did not differ. Job satisfaction remained unaffected by the intervention. Conclusion and Discussion: Integrated working is likely to increase objective burden as it requires professionals to perform additional activities that are largely unrelated to actual patient care. Implications for research and practice are discussed. [Current Controlled Trials ISRCTN05748494]. PMID:28413364
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Dual expression of MYC and BCL2 proteins predicts worse outcomes in diffuse large B-cell lymphoma.
Clark Schneider, Kelli M; Banks, Peter M; Collie, Angela M B; Lanigan, Christopher P; Manilich, Elena; Durkin, Lisa M; Hill, Brian T; Hsi, Eric D
2016-07-01
Recent studies suggested that MYC and BCL2 protein co-expression is an independent indicator of poor prognosis in diffuse large B-cell lymphoma. However, the immunohistochemistry protocols for dual-expression staining and the scoring cut-offs vary by study. Sixty-nine cases of diffuse large B-cell lymphoma were evaluated for MYC and BCL2 protein expression using various cut-offs that have been recommended in prior studies. Independent of the International Prognostic Index risk group, cases with dual protein expression of BCL2 and MYC using ≥50%/40% cut-offs and ≥70%/40% had significantly shorter overall survival than cases without. It was verified in this patient population that the use of BCL2 and MYC immunohistochemistry, performed with available in vitro diagnostic-cleared antibodies, provides rapid prognostic information in patients with de novo diffuse large B-cell lymphoma. This study has practical implications for diagnostic laboratories and serves as a guide for implementation in the setting of future clinical trials.
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Novel characterization of landscape-level variability in historical vegetation structure.
Collins, Brandon M; Lydersen, Jamie M; Everett, Richard G; Fry, Danny L; Stephens, Scott L
2015-07-01
We analyzed historical timber inventory data collected systematically across a large mixed-conifer-dominated landscape to gain insight into the interaction between disturbances and vegetation structure and composition prior to 20th century land management practices. Using records from over 20 000 trees, we quantified historical vegetation structure and composition for nine distinct vegetation groups. Our findings highlight some key aspects of forest structure under an intact disturbance regime: (1) forests were low density, with mean live basal area and tree density ranging from 8-30 m2 /ha and 25-79 trees/ha, respectively; (2) understory and overstory structure and composition varied considerably across the landscape; and (3) elevational gradients largely explained variability in forest structure over the landscape. Furthermore, the presence of large trees across most of the surveyed area suggests that extensive stand-replacing disturbances were rare in these forests. The vegetation structure and composition characteristics we quantified, along with evidence of largely elevational control on these characteristics, can provide guidance for restoration efforts in similar forests.
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Klein-Jöbstl, Daniela; Arnholdt, Tim; Sturmlechner, Franz; Iwersen, Michael; Drillich, Marc
2015-08-19
Calf disease may result in great economic losses. To implement prevention strategies it is important to gain information on management and to point out risk factors. The objective of this internet based survey was to describe calf management practices on registered dairy breeding farms in Austria and to estimate differences in calf disease incidences depending on farm structure and management practices. A total of 1287 questionnaires were finally analysed (response rate 12.2 %). Herd characteristics and regional distribution of farms indicated that this survey gives a good overview on calf management practices on registered dairy farms in Austria. The median number of cows per farm was 20 (interquartile range 13-30). Significant differences regarding farm characteristics and calf management between small and large farms (≤20 vs >20 cows) were present. Only 2.8 % of farmers tested first colostrum quality by use of a hydrometer. Storing frozen colostrum was more prevalent on large farms (80.8 vs 64.2 %). On 85.1 % of the farms, whole milk, including waste milk, was fed to the calves. Milk replacer and waste milk were more often used on large farms. In accordance with similar studies from other countries, calf diarrhoea was indicated as the most prevalent disease. Multivariable logistic regression analysis revealed that herd size was associated with calf diarrhoea and calf respiratory tract disease, with higher risk of disease on large farms. Furthermore, feeding waste milk to the calves was associated with increasing calf diarrhoea incidence on farm. In the final model with calf respiratory tract disease as outcome, respondents from organic farms reported less often a respiratory tract disease incidence of over 10 % compared with conventional farms [odds ratio (OR) 0.40, 95 % confidence interval (CI) 0.21-0.75] and farmers that housed calves individually or in groups after birth significantly reported more often to have an incidence of respiratory tract disease >10 % compared with farms where all calves were housed individually (OR 2.28, 95 % CI 1.16-4.48). The results obtained in this study provide an overview on calf management on dairy breeding farms in Austria and may help to further point out areas to be improved on farm.
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Dresden, Graham M.; Baldwin, Laura-Mae; Andrilla, C. Holly A.; Skillman, Susan M.; Benedetti, Thomas J.
2008-01-01
PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline—the impact of obstetrics on physician lifestyle. METHODS In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices. RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice. CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics. PMID:18195307
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Theoretical Issues in Clinical Social Group Work.
ERIC Educational Resources Information Center
Randall, Elizabeth; Wodarski, John S.
1989-01-01
Reviews relevant issues in clinical social group practice including group versus individual treatment, group work advantages, approach rationale, group conditions for change, worker role in group, group composition, group practice technique and method, time as group work dimension, pretherapy training, group therapy precautions, and group work…
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Molony, Julia T; Monda, Keri L; Li, Suying; Beaubrun, Anne C; Gilbertson, David T; Bradbury, Brian D; Collins, Allan J
2016-08-01
Little is known about epoetin alfa (EPO) dosing at dialysis centers after implementation of the US Medicare prospective payment system and revision of the EPO label in 2011. Retrospective cohort study. Approximately 412,000 adult hemodialysis patients with Medicare Parts A and B as primary payer in 2009 to 2012 to describe EPO dosing and hemoglobin patterns; of these, about 70,000 patients clustered in about 1,300 dialysis facilities to evaluate facility-level EPO titration practices and patient-level outcomes in 2012. Facility EPO titration practices when hemoglobin levels were <10 and >11g/dL (grouped treatment variable) determined from monthly EPO dosing and hemoglobin level patterns. Patient mean hemoglobin levels, red blood cell transfusion rates, and all-cause and cause-specific hospitalization rates using a facility-based analysis. Monthly EPO dose and hemoglobin level, red blood cell transfusion rates, and all-cause and cause-specific hospitalization rates. Monthly EPO doses declined across all hemoglobin levels, with the greatest decline in patients with hemoglobin levels < 10g/dL (July-October 2011). In 2012, nine distinct facility titration practices were identified. Across groups, mean hemoglobin levels differed slightly (10.5-10.8g/dL) but within-patient hemoglobin standard deviations were similar (∼0.68g/dL). Patients at facilities implementing greater dose reductions and smaller dose escalations had lower hemoglobin levels and higher transfusion rates. In contrast, patients at facilities that implemented greater dose escalations (and large or small dose reductions) had higher hemoglobin levels and lower transfusion rates. There were no clinically meaningful differences in all-cause or cause-specific hospitalization events across groups. Possibly incomplete claims data; excluded small facilities and those without consistent titration patterns; hemoglobin levels reported monthly; inferred facility practice from observed dosing. Following prospective payment system implementation and labeling revisions, EPO doses declined significantly. Under the new label, facility EPO titration practices were associated with mean hemoglobin levels (but not standard deviations) and transfusion use, but not hospitalization rates. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Abera, Hiwot; Mengistu, Daniel; Bedaso, Asres
2017-01-01
The prevalence of cancer is growing rapidly in all parts of the word and Ethiopia is no exception. Secondary prevention, as simple as monthly breast self-examination, is the best option to tackle the rising of this epidemic. Health awareness programs on screening and early detection are the corner stones to reduce the morbidity and mortality resulting from breast cancer. The aim of the study is to assess the effectiveness of planned teaching program on knowledge and practice of breast self-examination among first year female midwifery students in Hawassa health Sciences College. A pre-experimental one group pre-posttest design was used among 61 students who were selected by systematic random sampling technique. Data was collected using structured questionnaire and adapted and approved checklist. Data was entered using Epi-Info and analyzed using SPSS version 20. Pre-and post-intervention results were calculated using paired t-test. The mean age of the study participants was 20.13(±2.27) and 77% of the study participants were single. Before the intervention 14(23%) of respondents had information and practiced breast self-examination, only 8(13.1%) performed breast self -examination on a regular monthly basis. The number and percentage of the knowledgeable respondents pre-post intervention is 23(37.7%) and 35(57.4%), respectively. The mean knowledge difference for the pre-post intervention is 0.18±0.695 (P < 0.05). The respondents' pre- post interventions score of satisfactory practical competency were 10(16.4%) and 43(70.5%), respectively as well. The mean net gain for the pre-post breast self-examination intervention is 0.51± 0.62 (P < 0.001). Both the knowledge and practical competency scores showed highly significant increment after the intervention, showing that the research hypothesis was accepted. Planned teaching intervention on knowledge and Breast self-examination of students has resulted in an increment of both knowledge and the practice of breast self-examination. Teaching breast self-examination with demonstration to all at risk groups as a secondary prevention for breast cancer and large scale studies on heterogeneous groups is important.
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42 CFR 411.352 - Group practice.
Code of Federal Regulations, 2011 CFR
2011-10-01
... effective control over the group's assets and liabilities (including, but not limited to, budgets... 42 Public Health 2 2011-10-01 2011-10-01 false Group practice. 411.352 Section 411.352 Public... Entities Furnishing Designated Health Services § 411.352 Group practice. For purposes of this subpart, a...
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Influence of mental practice on development of voluntary control of a novel motor acquisition task.
Creelman, Jim
2003-08-01
The purpose of this investigation was to assess whether mental practice facilitates the development of voluntary control over the recruitment of the abductor hallucis muscle to produce isolated big toe abduction. A sample of convenience of 15 women and 20 men with a mean age of 28.8 yr. (SD=5.7) and healthy feet, who were unable voluntarily to abduct the big toe, were randomly assigned to one of three groups, a mental practice group, a physical practice group, and a group who performed a control movement during practice. Each subject received neuromuscular electrical stimulation to introduce the desired movement prior to each of five practice bouts over a single session lasting 2 hr. Big toe abduction active range of motion and surface electromyographic (EMG) output of the abductor hallucis and extensor digitorum brevis muscles were measured prior to the first practice bout and following each practice bout, yielding seven acquisition trials. Acquisition is defined as an improvement in both active range of motion and in the difference between the integrated EMG of the abductor hallucis and extensor digitorum brevis muscles during successive acquisition trials. Seven members of both the mental and physical practice groups and one member of the control group met the acquisition criteria. Chi-square analysis indicated the group difference was statistically significant, suggesting mental practice was effective for this task.
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Contextual Interference in Complex Bimanual Skill Learning Leads to Better Skill Persistence
Pauwels, Lisa; Swinnen, Stephan P.; Beets, Iseult A. M.
2014-01-01
The contextual interference (CI) effect is a robust phenomenon in the (motor) skill learning literature. However, CI has yielded mixed results in complex task learning. The current study addressed whether the CI effect is generalizable to bimanual skill learning, with a focus on the temporal evolution of memory processes. In contrast to previous studies, an extensive training schedule, distributed across multiple days of practice, was provided. Participants practiced three frequency ratios across three practice days following either a blocked or random practice schedule. During the acquisition phase, better overall performance for the blocked practice group was observed, but this difference diminished as practice progressed. At immediate and delayed retention, the random practice group outperformed the blocked practice group, except for the most difficult frequency ratio. Our main finding is that the random practice group showed superior performance persistence over a one week time interval in all three frequency ratios compared to the blocked practice group. This study contributes to our understanding of learning, consolidation and memory of complex motor skills, which helps optimizing training protocols in future studies and rehabilitation settings. PMID:24960171
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Random Versus Blocked Practice to Enhance Mental Representation in Golf Putting.
Fazeli, Davoud; Taheri, HamidReza; Saberi Kakhki, Alireza
2017-06-01
The purpose of this study was to investigate changes in mental representation from either random or blocked practice when engaged in golf putting. Thirty participants were randomly assigned to random practice, blocked practice, and no-practice groups. First, we measured novice golfers' initial mental representation levels and required them to perform 18 putting trials as a pre-test. We then asked random and blocked groups to practice in accordance with their group assignment for six consecutive days (10 blocks each day, 18 trials each). A week after the last practice session, we re-measured all participants' final mental representation levels and required them to perform 18 putting trials to evaluate learning retention through practice. While those engaged in the random practice method putted more poorly during acquisition (i.e., practice) than those in blocked practice, the random practice group experienced more accurate retention during the final putting trials, and they showed a more structured mental representation than those in blocked practice, one that was more similar to that of skilled golfers. These results support the acquisition of a rich mental representation through random versus blocked practice.
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Adib-Hajbaghery, Mohsen; Faraji, Mona
2016-01-01
This study aimed to compare the effects between group discussion and educational booklet on nursing students' attitude and practice toward patient privacy in Iran. A two-group, pre-test and post-test design study was conducted in 2015. The study was conducted on 60 nursing students in Kashan, Iran who were randomly allocated into two groups to be trained on patient privacy either through group discussion or by an educational booklet. The students' attitude and practice was assessed before and after the education using a questionnaire and a checklist. Data analysis was performed through paired t-test, Wilcoxon signed ranks test, and independent samples t-tests. Before the intervention, no significant difference was found between the group designated to group discussion and that designated to the educational booklet in the mean overall score of attitude (P=0.303) and practice (P=0.493) toward patient privacy. After the intervention, the mean attitude score significantly increased in the two groups (P=0.001). Moreover, the students' practice score increased in the discussion group while it did not significantly change in the booklet group (P=0.001). Both methods were effective on the students' attitude; however, the educational booklet did not affect their practice toward patient privacy. Group discussion can effectively improve the students' attitude and practice toward patient privacy.
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77 FR 7169 - Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2012-02-10
... physicians in group practices, and in 2006, to permit certain physicians to treat up to 100 patients. To..., telephone and fax numbers; email address; name and address of group practice; group practice employer identification number; names and DEA registration numbers of group practitioners; purpose of notification new...
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Vameghi, R; Mohammad, K; Karimloo, M; Soleimani, F; Sajedi, F
2010-01-01
The aim of the study was to compare the effects of 'face-to-face education' and 'educational movies' on 'knowledge' and 'practice' of women of child-bearing-age, in terms of health-care during pregnancy and during infancy in a suburban region near Tehran City, Iran. In this quasi-experimental study, the sample included 873 married women. Questionnaires for knowledge and practice assessment were designed. The women were assigned to three groups: control (group I), face-to-face education (group II), and educational movie (group III). Knowledge questionnaires were completed before and immediately after intervention. Practice questionnaires were completed before and three months after intervention. Both questionnaires consisted of two types of questions: type A (concerning infant care issues) and type B (concerning prenatal health care). There was a significant difference in post-test knowledge between groups I and II and between groups I and III, but not between groups II and III. In terms of post-test practice, the changes were determined for every individual question, and significantly, better results were seen in group II, especially concerning type B questions. Face to face education lead to better practice than educational movies. In addition, significantly better practice occurred regarding child health care issues rather than prenatal issues in both groups. Realistic and tangible issues, those easy to practice, and with little or no economical burden imposed on the family, progressed from the knowledge state to the practice state more successfully in both groups.
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Contributing to Meaning Making: Facilitating Discourse in the High School Physics Classroom
NASA Astrophysics Data System (ADS)
Hovan, Scot Alan
The Next Generation Science Standards (NGSS) identify eight practices as essential to science and engineering, and these practices include asking students to construct explanations, to engage in argumentation, and to communicate scientific information. However, few teacher-training programs instruct teachers how to facilitate such discourse in the classroom. Modeling Instruction is one movement in physics education that organizes high school physics content around a small number of student-derived scientific models, and it relies on student discourse for the design, development, and deployment of these models. This research is a self-study of one high school physics teacher's experience facilitating large group discourse in the high school modeling physics classroom. Whiteboard meetings and graded discussions were examined by applying the analytical framework created by Mortimer and Scott (2003) to characterize the classroom talk and the discourse facilitation moves that I employed. In addition, elements of discourse analysis were used to examine some of the tensions that I experienced in the facilitation of this discourse. The findings suggest that deliberate identification of the teaching purposes for the discussion can help determine the scaffolding needed for students to enter the Discourse (Gee, 2011) of being a participant in these large group conversations. In addition, connecting the dialogic dimension of exploring student ideas with the authoritative dimension of introducing the scientific view and supporting the internalization of that view is necessary to contribute to meaning making in the science classroom.
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Fraser, Robin C.; Clayton, David G.
1981-01-01
This paper presents the results of a point prevalent evaluation of the comparative reliability and validity of age-sex registers, practice medical records and family practitioner committee (FPC) registers from five teaching practices. They all exhibited similar levels of acceptable accuracy for patient names, sex and age, but the distribution of wrong addresses varied greatly: practice medical records 3·9 per cent, age-sex registers 8·2 per cent and FPC registers 17·1 per cent. The presence of a patient entry in all three registers was associated with a high degree of probability (95·3 per cent) that this individual would be a bona fide practice patient. The register population inflation rates were FPC records 5·5 per cent, practice records 9·8 per cent and age-sex registers 10·6 per cent, but there were large variations between individual practices. A statistically significant contribution to inflation rates came from the age groups 0 to 1 and 21 to 40 (p<0·0005). The register population deflation rates were minimal. The significance of these findings is discussed and the need for practices to determine the accuracy of their individual age-sex registers is stressed. A convenient and economic method for so doing is suggested. We also suggest ways of making it easier to construct and use age-sex registers, since they can be a most versatile and useful aid to research in general practice. ImagesFigure 1. PMID:7320986
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Portraiture in the Large Lecture: Storying One Chemistry Professor's Practical Knowledge
NASA Astrophysics Data System (ADS)
Eddleton, Jeannine E.
Practical knowledge, as defined by Freema Elbaz (1983), is a complex, practically oriented set of understandings which teachers use to actively shape and direct their work. The goal of this study is the construction of a social science portrait that illuminates the practical knowledge of a large lecture professor of general chemistry at a public research university in the southeast. This study continues Elbaz's (1981) work on practical knowledge with the incorporation of a qualitative and intentionally interventionist methodology which "blurs the boundaries of aesthetics and empiricism in an effort to capture the complexity, dynamics, and subtlety of human experience and organizational life," (Lawrence-Lightfoot & Davis, 1997). This collection of interviews, observations, writings, and reflections is designed for an eclectic audience with the intent of initiating conversation on the topic of the large lecture and is a purposeful attempt to link research and practice. Social science portraiture is uniquely suited to this intersection of researcher and researched, the perfect combination of methodology and analysis for a project that is both product and praxis. The following research questions guide the study. • Are aspects of Elbaz's practical knowledge identifiable in the research conversations conducted with a large lecture college professor? • Is practical knowledge identifiable during observations of Patricia's large lecture? Freema Elbaz conducted research conversations with Sarah, a high school classroom and writing resource teacher who conducted much of her teaching work one on one with students. Patricia's practice differs significantly from Sarah's with respect to subject matter and to scale.
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Neck keloids: evaluation of risk factors and recommendation for keloid staging system.
Tirgan, Michael H
2016-01-01
Importance : Health care providers have long struggled with recurrent and hard to treat keloids. Advancing our understanding of natural history and risk factors for development of large, very large and massive neck keloids can lead to improved treatment outcomes. Clinical staging system for the categorization of keloid lesions, as well as grouping of keloid patients according to the extent of skin involvement is both fundamental for design and delivery of proper plan of care and an absolute necessity for methodical trial design and interpretation of the results thereof. Objective : To review clinical presentation and natural history of neck keloids; to explore risk factors for development of large, very large and massive neck keloids; and to propose a clinical staging system that allows for categorization of keloid lesions by their size and grouping of keloid patients by the extent of their skin involvement. Setting: This is a retrospective analysis of 82 consecutive patients with neck keloids who were seen by the author in his keloid specialty medical practice. Intervention : Non-surgical treatment was offered to all patients. Results : Neck-area keloids were found to have several unique characteristics. All 65 African Americans in this study had keloidal lesions elsewhere on their skin. Very large and massive neck keloids appear to be race-specific and almost exclusively seen among African Americans. Submandibular and submental skin was the most commonly involved area of the neck. Keloid removal surgery was found to be the main risk factor for development of very large and massive neck keloids. Conclusions and relevance : Surgical removal of neck keloids results in wounding of the skin and triggering a pathological wound-healing response that often leads to formation of a much larger keloid. Given the potential for greater harm from surgery, the author proposes non-surgical approach for treatment of all primary neck keloids. Author's attempts to properly categorize keloid lesions and to group the study subjects was hampered by the lack of a previously defined methodology. A clinical staging system is proposed to address the deficiency in grouping of keloid patients according to the size and extent of skin involvement with keloid lesions.
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Crutches, confetti or useful tools? Professionals' views on and use of health education leaflets.
Murphy, S; Smith, C
1993-06-01
This paper examines the views on and use of health education leaflets by a number of professional groups: health visitors, midwives, occupational health workers, pharmacists and school health education co-ordinators. Eighty nine percent currently obtain leaflets from health promotion units, with the exception of health visitors, professionals are largely satisfied with the units' service. Seventy six percent use commercial or sponsored leaflets primarily because of the large numbers and topics that are available. The numbers and type of leaflets used were found to vary across the professions. All professionals see an increasingly important role for leaflets in their work. A number of them, pharmacists and occupational health workers in particular, saw the numbers they use rising. These views were accompanied by lower levels of belief in a leaflets ability to increase knowledge and behaviour as well as lower levels of satisfaction with current leaflet use and a concern over the public's reception of leaflets. Methods of leaflet distribution to the public largely reflect the professionals' work contexts. Most popular were handing out leaflets with advice, leaving them in a public place and using them as a back-up to a meeting. A number of contradictions emerge between distribution practices and perceived effectiveness. Few professionals thought leaving leaflets in a public place was effective, and few health visitors and midwives believed giving leaflets to the family of a client was effective despite large numbers doing so. The implications of these findings for health promotion policy and practice are discussed.
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Attitudes and barriers to evidence-based practice in optometry educators.
Suttle, Catherine M; Challinor, Kirsten L; Thompson, Rachel E; Pesudovs, Konrad; Togher, Leanne; Chiavaroli, Neville; Lee, Adrian; Junghans, Barbara; Stapleton, Fiona; Watt, Kathleen; Jalbert, Isabelle
2015-04-01
Evidence-based practice (EBP) is an essential component of good quality, patient-centered health care. This requires practitioners to acquire EBP skills and knowledge during undergraduate and continuing education. Evidence-based practice education exists in a range of health care disciplines, including optometry. Evidence-based practice education, however, depends on relevant skills and knowledge in educators. Courses and workshops exist for the development of EBP teaching skills in some areas of health care but not in optometry. Here, we describe a pilot workshop designed to enhance the teaching of EBP and to investigate the perspectives of optometric educators on EBP including their attitudes and perceived barriers to EBP and its teaching. Twenty-seven optometric educators including 8 facilitators participated. Of these, 14 were academics (including the 8 facilitators) and 13 were practitioners. Evidence-based practice attitudes were assessed using the Evidence-Based Practice Attitude Scale-50 with appropriate modifications for optometry. Workshop design incorporated strategies to trigger discussion among participants. A nominal group technique was used to identify, prioritize, and reach consensus on barriers to EBP. Although some participants expressed reservations about EBP, a common understanding of the contemporary definition of EBP emerged in educators. Thirty-five barriers to EBP were identified; "time" was selected in the top five barriers by most participants and attracted the highest total score, well above any other barrier (negative attitude to EBP, volume of evidence, integration with clinical practice, and lack of lifelong learning mind-set). Attitudes toward EBP were generally positive and negatively correlated with age and time since graduation, respectively. A group of optometrists and academics new to implementing education in EBP displayed positive attitudes to EBP but considered that its application and teaching could be significantly hindered by a lack of time to access and appraise the large volume of available research evidence in the field of eye care.
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Menon, Purnima; Nguyen, Phuong Hong; Saha, Kuntal Kumar; Tran, Lan Mai; Sanghvi, Tina; Hajeebhoy, Nemat; Afsana, Kaosar; Haque, Raisul; Frongillo, Edward A.; Ruel, Marie T.; Rawat, Rahul
2016-01-01
Background Despite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009–2014) and aimed to improve breastfeeding practices through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) intervention components delivered at scale in the context of policy advocacy (PA) in Bangladesh and Viet Nam. In Bangladesh, IPC was delivered through a large non-governmental health program; in Viet Nam, it was integrated into government health facilities. This study evaluated the population-level impact of intensified IPC, MM, CM, and PA (intensive) compared to standard nutrition counseling and less intensive MM, CM, and PA (non-intensive) on breastfeeding practices in these two countries. Methods and Findings A cluster-randomized evaluation design was employed in each country. For the evaluation sample, 20 sub-districts in Bangladesh and 40 communes in Viet Nam were randomized to either the intensive or the non-intensive group. Cross-sectional surveys (n ~ 500 children 0–5.9 mo old per group per country) were implemented at baseline (June 7–August 29, 2010, in Viet Nam; April 28–June 26, 2010, in Bangladesh) and endline (June 16–August 30, 2014, in Viet Nam; April 20–June 23, 2014, in Bangladesh). Difference-in-differences estimates (DDEs) of impact were calculated, adjusting for clustering. In Bangladesh, improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h (DDE 36.2 percentage points [pp], 95% CI 21.0–51.5, p < 0.001; prevalence in intensive group rose from 48.5% to 87.6%) and engaging in early initiation of breastfeeding (EIBF) (16.7 pp, 95% CI 2.8–30.6, p = 0.021; 63.7% to 94.2%). In Viet Nam, EBF increases were greater in the intensive group (27.9 pp, 95% CI 17.7–38.1, p < 0.001; 18.9% to 57.8%); EIBF declined (60.0% to 53.2%) in the intensive group, but less than in the non-intensive group (57.4% to 40.6%; DDE 10.0 pp, 95% CI −1.3 to 21.4, p = 0.072). Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a “pure control” area with no MM or national/provincial PA. Conclusions At-scale interventions combining intensive IPC with MM, CM, and PA had greater positive impacts on breastfeeding practices in Bangladesh and Viet Nam than standard counseling with less intensive MM, CM, and PA. To our knowledge, this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation designs. Strategies to design and deliver similar programs could improve breastfeeding practices in other contexts. Trial registration ClinicalTrials.gov NCT01678716 (Bangladesh) and NCT01676623 (Viet Nam) PMID:27780198
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Menon, Purnima; Nguyen, Phuong Hong; Saha, Kuntal Kumar; Khaled, Adiba; Kennedy, Andrew; Tran, Lan Mai; Sanghvi, Tina; Hajeebhoy, Nemat; Baker, Jean; Alayon, Silvia; Afsana, Kaosar; Haque, Raisul; Frongillo, Edward A; Ruel, Marie T; Rawat, Rahul
2016-10-01
Despite recommendations supporting optimal breastfeeding, the number of women practicing exclusive breastfeeding (EBF) remains low, and few interventions have demonstrated implementation and impact at scale. Alive & Thrive was implemented over a period of 6 y (2009-2014) and aimed to improve breastfeeding practices through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) intervention components delivered at scale in the context of policy advocacy (PA) in Bangladesh and Viet Nam. In Bangladesh, IPC was delivered through a large non-governmental health program; in Viet Nam, it was integrated into government health facilities. This study evaluated the population-level impact of intensified IPC, MM, CM, and PA (intensive) compared to standard nutrition counseling and less intensive MM, CM, and PA (non-intensive) on breastfeeding practices in these two countries. A cluster-randomized evaluation design was employed in each country. For the evaluation sample, 20 sub-districts in Bangladesh and 40 communes in Viet Nam were randomized to either the intensive or the non-intensive group. Cross-sectional surveys (n ~ 500 children 0-5.9 mo old per group per country) were implemented at baseline (June 7-August 29, 2010, in Viet Nam; April 28-June 26, 2010, in Bangladesh) and endline (June 16-August 30, 2014, in Viet Nam; April 20-June 23, 2014, in Bangladesh). Difference-in-differences estimates (DDEs) of impact were calculated, adjusting for clustering. In Bangladesh, improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h (DDE 36.2 percentage points [pp], 95% CI 21.0-51.5, p < 0.001; prevalence in intensive group rose from 48.5% to 87.6%) and engaging in early initiation of breastfeeding (EIBF) (16.7 pp, 95% CI 2.8-30.6, p = 0.021; 63.7% to 94.2%). In Viet Nam, EBF increases were greater in the intensive group (27.9 pp, 95% CI 17.7-38.1, p < 0.001; 18.9% to 57.8%); EIBF declined (60.0% to 53.2%) in the intensive group, but less than in the non-intensive group (57.4% to 40.6%; DDE 10.0 pp, 95% CI -1.3 to 21.4, p = 0.072). Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a "pure control" area with no MM or national/provincial PA. At-scale interventions combining intensive IPC with MM, CM, and PA had greater positive impacts on breastfeeding practices in Bangladesh and Viet Nam than standard counseling with less intensive MM, CM, and PA. To our knowledge, this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation designs. Strategies to design and deliver similar programs could improve breastfeeding practices in other contexts. ClinicalTrials.gov NCT01678716 (Bangladesh) and NCT01676623 (Viet Nam).
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Less fog on the Tyne? Programme budgeting in Newcastle and North Tyneside.
Miller, P; Parkin, D; Craig, N; Lewis, D; Gerard, K
1997-06-01
Programme Budgeting (PB) has been widely promoted as a model for the better conduct of the work of Health Authorities in the National Health Service in the United Kingdom. This paper reports on a project which looked at the development of PB in Newcastle and North Tyneside Health Authority (NNTHA), concentrating on the construction of a computerised tool for the compilation and analysis of programme budgets. The main activities carried out were a survey of user requirements for PB, a survey of data availability, the collection of data to construct programme budgets, and development of a relational database for storing and manipulating PB information. The main source of data was the Contract Minimum Data Set, which was supplemented by data from a number of other sources to give comprehensive information on spending in NNTHA. Costed activity data were produced, which could be aggregated in a large number of ways, such as by care setting (inpatient, outpatient, community, general practice, etc.), disease group (ICD9 chapter headings), case mix (Healthcare Resource Groups) and socio-demographic variables (age/sex, locality of GPs practice).
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Practices and perceptions on water resource sustainability in ecovillages
NASA Astrophysics Data System (ADS)
de Moura Leite, Flavia Brunale Vilela; Bertolo, Lídia Sanches; Santos, Rozely Ferreira
2016-08-01
In many areas of the world, groups of people have attempted to create urban landscapes that follow the principles of environmental sustainability. To this end, groups have devised alternative models, such as ecovillages, where low-impact handling is used and a way of life different from that of large population centers is adopted. Although these villages exist, their efficiency in the conservation of natural resources has not been effectively evaluated. This study evaluated the practices used by two Brazilian ecovillages to conserve water resources to assess whether this new concept of living is indeed successful in meeting sustainability goals. We selected 25 indicators of water sustainability, and using the compromise programming method, we quantified the distance between those landscapes self-referenced as sustainable and an ideal hypothetical scenario. We also interpreted the communities perceptions using the distance between the current situations and the envisioned scenario. We concluded that both ecovillage are far from technically ideal scenario, but the communities have a strong sense of their limitations in implementing water resources conservation. The communities attributed this fact primarily to deficiencies in the shared management.
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Aarons, Gregory A; Wells, Rebecca S; Zagursky, Karen; Fettes, Danielle L; Palinkas, Lawrence A
2009-11-01
We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Implementation of EBP is a complex process. Cross-system-level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.
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Sherrard, Heather; Duchesne, Lloyd; Wells, George; Kearns, Sharon Ann; Struthers, Christine
2015-01-01
There is evidence from large clinical trials that compliance with standardized best practice guidelines (BPGs) improves survival of acute coronary syndrome (ACS) patients. However, their application is often suboptimal. In this study, the researchers evaluated whether the use of an interactive voice response (IVR) follow-up system improved ACS BPG compliance. This was a single-centre randomized control trial (RCT) of 1,608 patients (IVR=803; usual care=805). The IVR group received five automated calls in 12 months. The primary composite outcome was increased medication compliance and decreased adverse events. A significant improvement of 60% in the IVR group for the primary composite outcome was found (RR 1.60, 95% CI: 1.29 to 2.00, p <0.001). There was significant improvement in medication compliance (p <0.001) and decrease in unplanned medical visits (p = 0.023). At one year, the majority of patients ( 85%) responded positively to using the system again. Follow-up by IVR produced positive outcomes in ACS patients.
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42 CFR 411.352 - Group practice.
Code of Federal Regulations, 2012 CFR
2012-10-01
... practices under common ownership or control through a physician practice management company, hospital... of whether the member's time in the HPSA is spent in a group practice, clinic, or office setting. (5...
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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.
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The mediating effect of context variation in mixed practice for transfer of basic science.
Kulasegaram, Kulamakan; Min, Cynthia; Howey, Elizabeth; Neville, Alan; Woods, Nicole; Dore, Kelly; Norman, Geoffrey
2015-10-01
Applying a previously learned concept to a novel problem is an important but difficult process called transfer. Practicing multiple concepts together (mixed practice mode) has been shown superior to practicing concepts separately (blocked practice mode) for transfer. This study examined the effect of single and multiple practice contexts for both mixed and blocked practice modalities on transfer performance. We looked at performance on near transfer (familiar contexts) cases and far transfer (unfamiliar contexts) cases. First year psychology students (n = 42) learned three physiological concepts in a 2 × 2 factorial study (one or two practice contexts and blocked or mixed practice). Each concept was practiced with two clinical cases; practice context was defined as the number of organ systems used (one system per concept vs. two systems). In blocked practice, two practice cases followed each concept; in mixed practice, students learned all concepts before seeing six practice cases. Transfer testing consisted of correctly classifying and explaining 15 clinical cases involving near and far transfer. The outcome was ratings of quality of explanations on a 0-3 scale. The repeated measures analysis showed a significant near versus far by organ system interaction [F(1,38) = 3.4, p < 0.002] with practice with a single context showing lower far transfer scores than near transfer [0.58 (0.37)-0.83 (0.37)] compared to the two contexts which had similar far and near transfer scores [1.19 (0.50)-1.01 (0.38)]. Practicing with two organ contexts had a significant benefit for far transfer regardless of mixed or blocked practice; the single context mixed practice group had the lowest far transfer performance; this was a large effect size (Cohen's d = 0.81). Using only one practice context during practice significantly lowers performance even with the usually superior mixed practice mode. Novices should be exposed to multiple contexts and mixed practice to facilitate transfer.
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2013-01-01
Background Achieving target levels of laboratory parameters of bone and mineral metabolism in chronic kidney disease (CKD) patients is important but also difficult in those living with end-stage kidney disease. This study aimed to determine if there are age-related differences in chronic kidney disease-mineral and bone disorder (CKD-MBD) characteristics, including treatment practice in Hungarian dialysis patients. Methods Data were collected retrospectively from a large cohort of dialysis patients in Hungary. Patients on hemodialysis and peritoneal dialysis were also included. The enrolled patients were allocated into two groups based on their age (<65 years and ≥65 years). Characteristics of the age groups and differences in disease-related (epidemiology, laboratory, and treatment practice) parameters between the groups were analyzed. Results A total of 5008 patients were included in the analysis and the mean age was 63.4±14.2 years. A total of 47.2% of patients were women, 32.8% had diabetes, and 11.4% were on peritoneal dialysis. Diabetes (37.9% vs 27.3%), bone disease (42.9% vs 34.1%), and soft tissue calcification (56.3% vs 44.7%) were more prevalent in the older group than the younger group (p<0.001 for all). We found an inverse relationship between age and parathyroid hormone (PTH) levels (p<0.001). Serum PTH levels were lower in patients with diabetes compared with those without diabetes below 80 years (p<0.001). Diabetes and age were independently associated with serum PTH levels (interaction: diabetes × age groups, p=0.138). Older patients were more likely than younger patients to achieve laboratory target ranges for each parameter (Ca: 66.9% vs 62.1%, p<0.001; PO4: 52.6% vs 49.2%, p<0.05; and PTH: 50.6% vs 46.6%, p<0.01), and for combined parameters (19.8% vs 15.8%, p<0.001). Older patients were less likely to receive related medication than younger patients (66.9% vs 79.7%, p<0.001). Conclusions The achievement of laboratory target ranges for bone and mineral metabolism and clinical practice in CKD depends on the age of the patients. A greater proportion of older patients met target criteria and received less medication compared with younger patients. PMID:23865464
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Gallegos, Carlos Andres; Waters, William F; Kuhlmann, Anne Sebert
2017-03-01
Traditional beliefs, knowledge and practices are formally integrated into the Ecuadorian health system. We sought to understand whether they are integrated in practice. Qualitative data were collected in two rural parishes in the central highlands of Ecuador through four focus group discussions (30 participants), eight key informant interviews, three participatory exercises (24 participants), structured observations of health facilities and analysis of official documents. We found different levels of integration, coexistence, tolerance, and intolerance of traditional health beliefs and practices in health facilities. One parish has undergone dramatic social and cultural transformation, and the role of traditional birth attendants is limited. In the other parish, traditional indigenous norms and values persist, and traditional birth attendants are sought during pregnancy and childbirth. The degree to which traditional birth attendants, indigenous women and their families are included or excluded from public health services depends largely on decisions taken by local health professionals. Formal policies in Ecuador stipulate that health care should be intercultural, but the role of traditional birth attendants is not necessarily incorporated in practice. The integration of culturally-informed beliefs and practices is critical for providing appropriate health services to members of vulnerable populations. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Chen, Fei-Fei; Yang, Zi-Yue; Zhu, Ying-Jie; Xiong, Zhi-Chao; Dong, Li-Ying; Lu, Bing-Qiang; Wu, Jin; Yang, Ri-Long
2018-01-09
To date, the scaled-up production and large-area applications of superhydrophobic coatings are limited because of complicated procedures, environmentally harmful fluorinated compounds, restrictive substrates, expensive equipment, and raw materials usually involved in the fabrication process. Herein, the facile, low-cost, and green production of superhydrophobic coatings based on hydroxyapatite nanowire bundles (HNBs) is reported. Hydrophobic HNBs are synthesised by using a one-step solvothermal method with oleic acid as the structure-directing and hydrophobic agent. During the reaction process, highly hydrophobic C-H groups of oleic acid molecules can be attached in situ to the surface of HNBs through the chelate interaction between Ca 2+ ions and carboxylic groups. This facile synthetic method allows the scaled-up production of HNBs up to about 8 L, which is the largest production scale of superhydrophobic paint based on HNBs ever reported. In addition, the design of the 100 L reaction system is also shown. The HNBs can be coated on any substrate with an arbitrary shape by the spray-coating technique. The self-cleaning ability in air and oil, high-temperature stability, and excellent mechanical durability of the as-prepared superhydrophobic coatings are demonstrated. More importantly, the HNBs are coated on large-sized practical objects to form large-area superhydrophobic coatings. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.
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Evans, Steven W; Randy Koch, J; Brady, Christine; Meszaros, Peggy; Sadler, Joanna
2013-07-01
Youth with learning and behavioral problems are at elevated risk for substance use during adolescence. Although evidence-based substance use prevention and screening practices are described in the literature, the extent with which these are provided to these youth is unclear. Mental health professionals in schools and community mental health centers are in an ideal position to conduct substance use screening and prevention practices since they have frequent contact with this high risk group. In order to determine whether these mental health professionals were using evidence based substance use screening and prevention programs with these youth, we analyzed 345 completed surveys from mental health professionals in schools and community clinics throughout a mid-Atlantic state. Results indicated that a large portion of the respondents were unfamiliar with evidence based practices and they were infrequently used. Implications for the division of labor at schools and community mental health centers are discussed in relation to time allotment and priority for these procedures.
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Blaney, Cerissa L; Redding, Colleen A; Paiva, Andrea L; Rossi, Joseph S; Prochaska, James O; Blissmer, Bryan; Burditt, Caitlin T; Nash, Justin M; Bayley, Keri Dotson
2018-03-01
Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals' (BHPs') readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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The Relevance of Cultural Activities in Ethnic Identity Among California Native American Youth
Schweigman, Kurt; Soto, Claradina; Wright, Serena; Unger, Jennifer
2013-01-01
This study analyzed data from a large statewide sample of Native American adolescents throughout California to determine whether participation in cultural practices was associated with stronger ethnic identity. The Multigroup Ethnic Identity Measure (MEIM) scale was used to measure the ethnic identity of 945 Native American adolescents (416 male, 529 female) aged 13 – 19 across California. Respondents who participated in cultural activities including pow-wows, sweat lodge, drum group and roundhouse dance reported significantly higher Native American ethnic identity than their counterparts who did not take part in cultural activities. The association between cultural activities and ethnic identity was only significant among urban youth and not among reservation youth. Higher grades in school were associated with ethnic identity among females but not among males. Findings from this study show a strong association between cultural activities and traditional practices with tribal enculturation among Native American youth in California. Cultural-based practices to enhance Native identity could be useful to improve mental and behavioral health among Native American youth. PMID:22400467
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Solid-loaded flows: applications in technology
DOE Office of Scientific and Technical Information (OSTI.GOV)
Molerus, O.
1983-01-01
The evaluation of experiments and the representation of the resulting data by nondimensional groups defined ad hoc largely governs the treatment of problems arising with solid-loaded flows in practice. Without doubt, this is a result of the very complex nature of solid-loaded flows and, consequently, empiricism tends to prevail, more or less. To overcome this situation, two sets of nondimensional groups, which take into consideration the translatory, as well as the rotary, motion of particles suspended in a fluid, are derived from the equations of motion of a solid body. The intuitive meaning of these nondimensional groups arises from theirmore » derivation. With respect to applications in engineering, the influence of the rotary motion of a particle on the motion of its center of gravity can thus be taken into account. As such, a common basis for the representation of the different phenomena observed with solid-loaded flows is established. The application of the above concepts to fluidization and hydraulic and pneumatic conveying proves their usefulness. New insights into well-known facts as well as new results demonstrate that taking the real nature of solid particles (i.e., those of finite dimensions) into consideration will provide a common and profound basis for the representation of different phenomena observed with solid-loaded flows in practice.« less
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Guidelines to group practice. Fédération Dentaire Internationale. Technical Report No. 22.
1985-09-01
This report reviews the types of group practice, the essential financial arrangements and the management procedures involved. The advantages and disadvantages of group practice to the dentist and the patient are reviewed.
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On the Influence of Grouping Practices on Classroom Teaching
ERIC Educational Resources Information Center
Aydin, Emin; Tugal, Ilker
2005-01-01
The article starts with a historical overview, discusses the arguments for and against ability grouping. It surveys the literature on different practices of grouping that exist in the American and British literature. The study mainly focuses on instructional grouping practices based on ability and on cooperation. It discusses arguments for and…