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PubMed1984

Application of gas adsorption kinetics--II. A theoretical model for respirator cartridge service life and its practical applications.

A previously introduced theoretical model addressing respirator cartridge contaminant breakthrough was further developed in this study. This development involved the introduction of a new theoretical parameter, a, to complement the parameters k' and tau employed in the initial theoretical approach. The extension of the theory permits the theoretical investigation of the following: (1) the effect of contaminant concentration on breakthrough time; (2) the effect of flow rate on breakthrough time; (3) the influence of contaminant concentration on percentage of breakthrough; and (4) the effect of contaminant concentration on the weight of adsorbed contaminant at a given time. We also compared new theoretical expressions with previously published empirical equations. Utilizing the parameter a, we derived a set of equations of significant practical value. These equations relate the ratio of two contaminant concentrations (one experimental reference concentration and any other concentration of interest) to either the ratio of the corresponding breakthrough times or the corresponding weights of adsorbed contaminant. Three practical examples are provided demonstrating that the new theoretical model reduces experimental work required to predict respirator cartridge service life.

Adsorption↗
PubMed1986

Surgical practice and perceived training needs of selected Ohio family physicians.

This study was performed to determine, relative to Ohio, what percentage of family physicians are actively involved in providing surgical care, what types of surgical care are provided, and what variations exist in opinions and practices regarding surgery related to previous training and practice location. Data were collected from active members of the Ohio Academy of Family Physicians; usable returns were secured from 76 percent of the members. Several conclusions were made. Overwhelming percentages of family physicians in Ohio are actively involved in providing surgical care. A considerably greater percentage of family physicians are actively involved in performing minor surgery compared with major surgery, although they perform a wide range of minor and major surgical procedures at relatively high frequencies. Over the years, however, there has been a decrease in performance of major surgery on the part of family physicians in Ohio. Issues related to surgery in family practice are more positively influenced by being in a rural practice rather than an urban or suburban practice, having had more surgical training, and having had family practice residency training. Family physicians in Ohio definitely think that surgical training should be included in family practice training programs, and they think that the surgical training should be balanced between a curriculum standardized for all residents and one individualized to the anticipated future practices of the residents.

Attitude of Health Personnel↗
PubMed1998

Algorithm for the diagnosis and management of asthma: a practice parameter update: Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

This algorithm on the diagnosis and treatment of asthma is intended to complement and update the previously published Practice Parameters for the Diagnosis and Treatment of Asthma. Both documents were developed by the Joint Task Force on Practice Parameters, representing the AAAAI, ACAAI, and the JCAAI. The authors of this asthma algorithm have attempted to include all the elements essential for the diagnosis and care of patients with asthma. Every effort was made to keep the algorithm clear and concise, yet thorough and complete (Fig 1). Each component of the algorithm is elaborated further in a brief annotation. For further discussion, the reader is referred to the more extensive Practice Parameters for the Diagnosis and Treatment of Asthma.

Acute Disease↗
PubMed1999

Creating a living document: developing the National Association of School Nurses Mission Statement for the new millennium.

The second in a series of three articles devoted to the development, maintenance, and implementation of the National Association of School Nurses 1998-2001 Strategic Plan and how it relates to the practice of school nurses. Information about the development of a mission/vision statement for the organization is given along with strategies for developing a local school district school health program strategic plan. A previous Nursing Practice Management section article discussed the development of the Association's strategic plan considering the changing health care climate, the shifting needs of school children, and the economic climate for school funding. A future Nursing Practice Management section article will discuss the implementation of the seven goal areas in the National Association of School Nurses 1998-2001 Strategic Plan.

Forecasting↗
PubMed2002

The identification and description of critical thinking behaviors in the practice of clinical laboratory science, Part 1: Design, implementation, evaluation, and results of a national survey.

The ability to think critically has been identified as a pivotal attribute of health care professionals. The purpose of this study was to identify and describe critical thinking (CT) behaviors and observable events resulting from CT, important in the practice of clinical laboratory science. Medical, educational, and psychological literature related to the many behaviors characterized under the CT rubric has been focused by an operationalized definition positing CT to be a metaprocess that facilitates learning by interlinking the more basic processes associated with different learning orientations: behaviorist, cognitivist, humanist, and situated/contextual learning. A total of 65 CT behaviors were identified through a process including discovery (expert interviews, a focus group with practitioners) and refinement (literature comparisons, expert rankings/reviews, pilot survey). CT behaviors were characterized further through a national survey of practitioners (n = 1,571, > 50% of time in bench work). Using a 6-point scale, practitioners ranked the importance of the CT behaviors. Important CT behaviors were characterized as being not only cognitive in nature, but also behavioral, affective, and situated/contextual. These findings suggest a stronger relationship between CT behaviors and all aspects of practice than previously reported. Given that these behaviors span all learning domains, findings support the metaprocess view of CT. Implications are that CT behaviors cannot be learned or taught, apart from a discipline-related practice setting. This study contributes to learning theory related to transfer and how learning occurs and to literature describing survey methodology. It also provides a basis for measurement of CT in practice settings.

Data Collection↗
PubMed2003

Randomised controlled trial of a theoretically grounded tailored intervention to diffuse evidence-based public health practice [ISRCTN23257060].

BACKGROUND: Previous studies have shown that Norwegian public health physicians do not systematically and explicitly use scientific evidence in their practice. They work in an environment that does not encourage the integration of this information in decision-making. In this study we investigate whether a theoretically grounded tailored intervention to diffuse evidence-based public health practice increases the physicians' use of research information. METHODS: 148 self-selected public health physicians were randomised to an intervention group (n = 73) and a control group (n = 75). The intervention group received a multifaceted intervention while the control group received a letter declaring that they had access to library services. Baseline assessments before the intervention and post-testing immediately at the end of a 1.5-year intervention period were conducted. The intervention was theoretically based and consisted of a workshop in evidence-based public health, a newsletter, access to a specially designed information service, to relevant databases, and to an electronic discussion list. The main outcome measure was behaviour as measured by the use of research in different documents. RESULTS: The intervention did not demonstrate any evidence of effects on the objective behaviour outcomes. We found, however, a statistical significant difference between the two groups for both knowledge scores: Mean difference of 0.4 (95% CI: 0.2-0.6) in the score for knowledge about EBM-resources and mean difference of 0.2 (95% CI: 0.0-0.3) in the score for conceptual knowledge of importance for critical appraisal. There were no statistical significant differences in attitude-, self-efficacy-, decision-to-adopt- or job-satisfaction scales. There were no significant differences in Cochrane library searching after controlling for baseline values and characteristics. CONCLUSION: Though demonstrating effect on knowledge the study failed to provide support for the hypothesis that a theory-based multifaceted intervention targeted at identified barriers will change professional behaviour.

Evidence-Based Medicine↗
PubMed2000

GPs' employment of locum doctors and satisfaction with their service.

BACKGROUND: Locum doctors provide cover during normal working hours for GPs absent due to holidays, sickness, maternity leave or for educational purposes. However, there is little information on the extent of the use of locums or of GPs' perception of their services. OBJECTIVES: To examine the level of use of locum doctors by GPs, the ease of recruitment and satisfaction with their services. METHODS: A postal survey of all general practices in one of the six health regions in England was carried out. Logistic regression analysis was used to examine the independent effects on locum use of practice size and type of area, source of recruitment and GPs' satisfaction with their services. RESULTS: A total of 935 (80.6%) general practices responded. Locum GPs were employed by 81.7% of practices in the previous 12 months. Two-thirds of practices reported problems obtaining locum cover, especially at short notice and for holiday periods. One-fifth of practices employing a locum in the previous 12 months were dissatisfied with the locum. CONCLUSIONS: There are high demands for, but a considerable shortage of, locum doctors in general practice. Educational and other initiatives for GPs may contribute to increased demands for locum cover. Difficulties in recruitment may be reduced by measures to improve the conditions of employment for doctors working as locums on a longer term basis. New codes of practice for employing locums may increase satisfaction with locum services.

Attitude of Health Personnel↗
PubMed1999

ACOG practice bulletin. Vaginal birth after previous cesarean delivery. Number 2, October 1998. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists.

A trial of labor after previous cesarean delivery has been accepted as a way to lower the overall cesarean delivery rate. In 1995, 27.5% of women who had a previous cesarean delivery attempted vaginal birth; some clinicians believe that an even higher percentage is possible. Although there is a strong consensus that trial of labor is appropriate for most women who have had a previous low-transverse cesarean delivery, increased experience with vaginal birth after cesarean delivery (VBAC) indicates there are several potential problems. This document will review the current risks and benefits of VBAC in various situations and provide practical management guidelines.

Algorithms↗
PubMed2004

Tectonic arrangement of BaCO3 nanocrystals into helices induced by a racemic block copolymer.

Morphosynthesis strategies inspired by biomineralization processes gives access to a wide range of fascinating and useful crystalline mesostructures. Biomimetic synthesis of inorganic materials with complex shapes can now be used to control the nucleation, tensorial growth, and alignment of inorganic crystals in a way previously not practicable. Double hydrophilic block copolymers (DHBCs) consisting of a hydrophilic block strongly interacting with inorganic minerals, and a non-interacting hydrophilic block, were recently introduced for the control of mineralization reactions. DHBCs are 'improved versions' of the previously used polyelectrolytes or amphiphiles and are extraordinarily effective in crystallization control. Here, we report on the formation of helices of achiral BaCO(3) nanocrystals in the presence of a racemic DHBC suggesting that a helical alignment can be induced by racemic polymers through selective adsorption on the (110) face of nanocrystals. This mechanism is the key for a better understanding of the self-assembly of chiral organic-inorganic superstructures that don't follow a direct template route.

Barium Compounds↗
PubMed1985

The shadow of life: psychosocial explanations for placenta rituals.

Culturally determined patterns of behavior associated with placenta disposal are characteristic of many modern and ancient societies. This paper defines this type of placenta disposal as a ritual event that delimits a "portion of reality"; explanations are provided leading to the conclusion that placenta rituals operate as anxiety releasing mechanisms that provide a means of control over the future health and welfare of mother, child, and community. The question of why the placenta figures so prominently in folk beliefs and practices has previously been attributed to its morphological and physiological properties; this paper argues that attributes associated with it from a psychosocial model are equally important. The data for this study were drawn from a compilation of ethnographic reports of post-partum practices in African, Asian, European, and Latin American societies. Additional information on placenta disposal was derived from interviews with 1,859 Peruvian informants. Analysis of the data obtained from the Peruvian studies show a significant difference between rural and semi-urban patterns of placenta disposal.

Ceremonial Behavior↗
PubMed1997

The indications for polysomnography and related procedures.

This paper is a review of the literature on the use of polysomnography in the diagnosis of sleep disorders in the adult. It is based on a search of MEDLINE from January 1966 through April 1996. It has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association and provides the background for the accompanying ASDA Standards of Practice Committee's Parameters for the Practice of Sleep Medicine in North America. The diagnostic categories reviewed are: sleep-related breathing disorders; other respiratory disorders; narcolepsy; parasomnias and sleep-related epilepsy; restless legs syndrome and periodic limb movement disorders: insomnia; and circadian rhythm sleep disorders. Where appropriate, previously published practice parameters papers are cited and discussed. The relevant published peer-reviewed literature used as the basis for critical decisions was compiled into accompanying evidence tables and is analyzed in the text. In the section on the assessment of sleep apnea syndrome, options for estimating pretest probability to select high risk patients are also reviewed. Sleep-testing procedures other than standard polysomnography are also addressed (daytime polysomnography, split-night studies, oximetry, limited full respiratory recordings, and less-than-full respiratory recording) and treatment-related follow-up studies are discussed.

Adult↗
PubMed1991

Demographic characteristics and knowledge of BSE of women electing to attend a BSE training program in Victoria, Australia.

Participants in the Mammacheck breast self-examination (BSE) training program were surveyed to assess the characteristics of women choosing to attend BSE training sessions, as well as to assess the factors that related to their BSE practice prior to attending the session. In all, 5,673 women completed questionnaires. In comparison with the general population, women who attended Mammacheck tended to be younger, married, and more highly educated, but did not differ in relation to prior experience of breast problems. Previous BSE practice related predominantly to the amount of knowledge about BSE the women reported that they had acquired before attending a training session. The findings highlight the importance of education and raised the important question of how to teach women with lower education levels and little or no knowledge about BSE. Recommendations are made.

Adult↗
PubMed2001

Factors influencing contraceptive use in Tehran.

BACKGROUND: Despite reluctance to conceive, approximately 30% of couples do not use any method of contraception. Health concerns, side effects, failure of the method and some demographic issues such as education, age, residential region and number of living children have a major effect on contraceptive use. OBJECTIVE: The aim of the present study was to determine those factors which influence contraceptive use in Tehran. METHODS: Data from the project "The Study of the Effectiveness of Postpartum Consultation about Family Planning on Contraceptive Practice during 2 years after Parturition in University Hospitals of Tehran in 1996" were applied for the analysis of those factors which influence contraceptive use by Iranian couples. A total of 4177 women of reproductive age who gave birth in one of the 12 hospitals in Tehran during the 24 hours following the interview of the initial study and had at least one living child were enrolled in the present study. The questionnaire used included some questions about socio-demographic status, fertility history, knowledge of contraceptives and the source of this knowledge, and previous contraception practice and its effectiveness. RESULTS: Using a logistic regression model, it was found that age, women's level of education, their husbands' level of education and previous familiarity with contraceptive methods were the most significant factors influencing contraceptive use. CONCLUSIONS: It is suggested that health policy makers strengthen the family planning services through providing appropriate counselling in family planning clinics.

Adult↗
PubMed1993

Clinical value of microbiological investigations in general practice.

The clinical value of many laboratory tests has frequently been queried. A short questionnaire was attached to individual microbiology reports issued to general practitioners in Bradford for an eight week period. Of the 2386 questionnaires sent out 1847 (77%) were returned. The general practitioners indicated that 34% of reports gave unexpected findings, 28% resulted in a change of therapy and most of the investigations (83%) were seen as beneficial to the patients. The majority of the specimens (56%) were mid-stream urine samples of which 77% gave negative findings. This study indicates that conventional microbiology test results are more valuable in general practice than previous hospital based surveys might suggest. Alternative strategies for investigation to reduce the number of tests of low value are discussed.

Bacteriological Techniques↗
PubMed1993

[Patients of private practice physicians--selected results of a survey in general practice offices].

The structural changes in outpatient medical care in the new Federal Laender were characterised by the fact that doctors now established their own medical practice whereas previously they had been part of a state-controlled and state-organised system of medical centres for outpatient treatment. The aim of the present study consisted in analysing the opinions of patients on these changes in ambulatory medical care from state control to a physician in own medical practice. The standardised questionnaire used in this study contained questions on the conditions of organisation within the practice, e.g. waiting period, consultation period, home visit and accessibility of the doctor. Furthermore the patients were asked for important criteria of medical care by a family doctor. Selected results of this inquiry of patients are compared to a study realised in 1988/89 under conditions of the former public health system of the GDR. Comparison of both studies results in significant differences. In a practice of a consulting-room practitioner the waiting period is shorter, the accessibility of the doctor is better and the time of consultations is positively changed compared to the former public health system. In 1992 about 94% of patients considered the general practitioner in his own practice as their family doctor, in 1988/89 under the conditions of the public health system only 66% of patients did so. These differences are due to the higher degree of realisation of the criteria of medical care by a family doctor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗