PubMed · 15739925
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Laurence A Savett, Vivian Good. 2004. Continuing education for nurses: a problem-oriented system.. https://pubmed.ncbi.nlm.nih.gov/15739925/
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OBJECTIVE: To assess the potential effect of educational intervention on episiotomy practice. STUDY DESIGN: A survey of the attitude of obstetrical caregivers toward episiotomy was conducted among obstetricians and midwives in the three public hospitals in Haifa. Data regarding episiotomy rates was collected for the years 2001-2003. At the beginning of 2002, lectures on the risks and benefits of episiotomy were given in two hospitals. Episiotomy rates before and after the lecture were compared. RESULTS: A significant and lasting reduction in episiotomy rates was observed in the two hospitals where lectures were given. There were no clinically significant and consistent changes in the episiotomy practices in the third hospital. CONCLUSION: Education may play an important role in changing common medical practices, as in episiotomy. It was clearly shown that our beliefs are not always up to date. We call for periodic reassessment of all medical procedures, as common and accepted as they are.
OBJECTIVE: To assess, from the perspective of UK hospital doctors, the content validity and operational validity of a set of 14 previously developed explicit indicators of the appropriateness of long-term prescribing started during a hospital admission. METHOD: A combination of data extraction from medical records and qualitative interviews with a maximum variability sample of hospital doctors. PARTICIPANTS: The indicators were applied to 132 new prescriptions, intended for long-term use, prescribed for 61 patients; 36 doctors, of various grades, were purposively selected for interview. RESULTS: Appropriate prescribing was viewed as prescribing that was indicated, necessary, evidence based (using a broad meaning of 'evidence') and of acceptable cost and risk-benefit ratio. These concepts applied to individual drugs for individual patients, rather than at a more general, public health level. Where drugs had failed an indicator, rationales were explored. Often, it was missing data in the medical notes that had resulted in the drug failing the indicator. CONCLUSIONS: The 14 indicators were considered to have content validity, reflecting all aspects of appropriate prescribing discussed by the doctors. Their operational validity was less clear-cut, due to the lack of necessary data in the medical notes. This has implications for the use of explicit indicators for assessing prescribing appropriateness, as these hospital doctors did not consider that the data required for objective, systematic assessment of prescribing would ever be recorded in hospital medical notes.
OBJECTIVES: The purpose of this study was threefold. First, we gathered and synthesized the historic literature regarding electronic health record (EHR) adoption rates among physicians in small practices (ten or fewer members). Next, we constructed models to project estimated future EHR adoption trends and timelines. We then determined the likelihood of achieving universal EHR adoption in the near future and articulate how barriers can be overcome in the small and solo practice medical environment. DESIGN: This study used EHR adoption data from six previous surveys of small practices to estimate historic market penetration rates. Applying technology diffusion theory, three future adoption scenarios, optimistic, best estimate, and conservative, are empirically derived. MEASUREMENT: EHR adoption parameters, external and internal coefficients of influence, are estimated using Bass diffusion models. RESULTS: All three EHR scenarios display the characteristic diffusion S curve that is indicative that the technology is likely to achieve significant market penetration, given enough time. Under current conditions, EHR adoption will reach its maximum market share in 2024 in the small practice setting. CONCLUSION: The promise of improved care quality and cost control has prompted a call for universal EHR adoption by 2014. The EHR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers.