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At least 235 records · Page 13Linked to original sources
PubMed2003

Value gaps in dental practice: understanding how differences in core values can adversely affect the practice.

BACKGROUND: The authors explore the importance of human values in dental practice, an area often overlooked as we struggle to deal with the everyday demands of treating patients and managing staff members. Such values are, however, fundamental to the success of any practice; therefore, it is important to understand their significance. CONCLUSIONS: Problems arise in dental practices when gaps develop between the values held by the various players involved (that is, between the entire dental team and patients, the dentist/owner's personal values and business goals, the dentist/owner and staff members, and the dental practice and any third-party funding organizations). PRACTICE IMPLICATIONS: By understanding the potentially damaging consequences of value gaps for practice viability, dental practice owners and managers can take steps to create a more harmonious workplace in which all parties strive to reach common goals.

Attitude of Health Personnel↗
PubMed2000

A comparative study on the service profiles and practice facilities among urban general practices in east and west Malaysia.

1171 urban general practices in East and West Malaysia were compared regarding their service profiles and practice facilities. In general, practices in both parts put important emphasis on preventive health care. More practices in East Malaysia were providing hormone replacement therapy and sexually transmitted diseases services but less were providing intrapartum care, counselling services including sexual and marital counselling and problems associated with social deviance such as alcohol and drug abuse. Although most practices in East Malaysia were solo practices, they were more comprehensive in terms of the provision of practice facilities when compared to those in West Malaysia. A greater number of them had ultrasound facilities, peak flow meters, ECG machines, computers and blood biochemistry facilities.

Family Practice↗
PubMed2001

Complete practice operating systems: the long-term solution to practice management.

A carefully structured, well thought-out CPOS based on a successful prototype(s) that has proven itself over time is probably the fastest and most reliable way to get your practice on the road to profitability that can be sustained and built upon over the life of the practice. If you rely on "bits and pieces" of practice management ideas and extraneous methods that of themselves may be effective, they may, when integrated into your existing operating structure or system, actually have a negative impact. When addressing something as important as your practice operations, and hence, your livelihood, carefully determine if the changes advocated will be effective, and how these changes will interface with your existing systems. If your existing systems are faulty, building on them may be futile. Look closely and carefully examine the knowledge, credibility, and expertise of anyone who is suggesting and implementing change in your practice. Further, and equally important, ask these two questions: (1) Is the operating system you are considering designed and built from a successful prototype? (2) Can the system's success be documented in terms of sustained increase in production, collections, and net income over time? If the answer is "no" to either or both of the above, tread lightly. You may actually be making things worse. Look for an operating system that has made other dental practices successful, and you can have the great practice you've always wanted!

Appointments and Schedules↗
PubMed1992

Cost effectiveness of minor surgery in general practice: a prospective comparison with hospital practice.

The cost effectiveness of general practitioners undertaking minor surgery in their practices was determined in a prospective comparison of patients having minor surgery undertaken in five general practices over a 12 week period in 1989, and in the departments of dermatology and general surgery in Rotherham District General Hospital over a contemporaneous eight week period. There were no differences between the settings in the reported rates of wound infection or other complications and only one general practice patient was subsequently referred to hospital for specialist treatment. General practitioners sent a smaller proportion of specimens to a histopathology laboratory than hospital doctors (61% versus 90%, P less than 0.001); incorrectly diagnosed a larger proportion of malignant conditions as benign (10% versus 1%, P less than 0.05) and inadequately excised 5% of lesions where this never happened in hospital (difference not significant). General practice patients had shorter waiting times between referral and treatment, spent less time and money attending for treatment and more of them were satisfied with their treatment. The cost of a procedure undertaken in general practice was less than in hospital--pounds 33.53 versus pounds 45.54 for the excision of a lesion and pounds 3.00 versus pounds 3.22 for cryotherapy of a wart (1989-90 prices). Performing minor surgery in general practice would seem cost effective compared with a hospital setting. However, the risk of general practitioners inadequately excising a malignancy and not sending it to a histopathology laboratory must be addressed and the conclusion regarding cost effectiveness only applies where general practice is a substitute for the hospital setting and not an additional activity.

Case-Control Studies↗
PubMed1991

How well do family practitioner committee and general practice records agree? Experience in a semi-rural practice.

General practice notes may be inaccurate for various reasons. A study was carried out in one semi-rural practice to investigate the agreement between records held by the family practitioner committee and those kept in the practice. Details on the practice notes and the family practitioner committee list were compared for 800 patients. The details examined included name, sex, date of birth, address and National Health Service number. While 58% of records agreed, discrepancies occurred in 339 records (42%). The most common discrepancies concerned the patient's address (30.6%), date of birth (9.4%) and NHS number (8.0%). Nearly 5% of the practice notes appeared to be for patients who were no longer on the practice list or dependent on its care. These findings have implications under the new general practitioner contract where screening programmes, target related payments, and increased capitation fees require accurate practice records.

Documentation↗
PubMed1978

Quantitative assessment of the quality of medical care provided in five family practices before and after attachment of a family practice nurse.

The standards of patient care were maintained in five urban medical practices after the introduction of family practice nurses. Evaluations were achieved before and after their appointment by the indicator condition method. Minimal explicit criteria for the management of patients with 12 indicator conditions and by the use of 14 drugs were approved by an ad hoc peer group of community physicians. These cirteria were applied to the five practices by the use of a single-blind design and the abstraction of unaltered medical records. A standardized score for each practic e permitted comparison of scores for the management of indicator conditions and for the clinical use of drugs before and after attachment of the family practice nurses. For each of the indicator conditions and the drugs assessed in the five practices similar levels of adequacy were observed in the two study periods. These explicit (objective) audit resutls agreed with the implicit (subjective) assessments of the family practice nurses by their physician colleagues.

Drug Therapy↗
PubMed1994

Incongruence of existing practice management curricula content and actual medical practice need.

BACKGROUND AND OBJECTIVES: Practice management is an important, but often overlooked, element of medical training, especially for physicians in primary care. The objective of this study was to evaluate our program's practice management curriculum to determine if it meets the needs of its graduates. METHODS: A questionnaire, developed and sent to 1986-1991 graduates of the residency program (n = 76), determined their perceptions of how well the practice management curriculum prepared them to operate a practice. Fifty (65.8%) usable surveys were returned. RESULTS: The respondents perceived deficits in areas of preparing for office management, starting and building a practice, using professional services (especially in the areas of financial decisions and use of professionals), and reimbursement procedures. CONCLUSIONS: Physicians need an understanding of business fundamentals such as economics, organization management, contract evaluation, negotiation and mediation skills, methods of allocation of limited resources, information science, and consumerism. This article offers a process through which other family practice residency programs can begin evaluating and restructuring their practice management curricula to meet these needs.

Curriculum↗
PubMed1998

The use and overlap of AED and general practice services by patients registered at two inner London general practices.

BACKGROUND: The improvement of general practitioner (GP) availability has been suggested as a factor influencing the rise in attendance rates at accident and emergency departments (AEDs) in the United Kingdom, particularly in innercity areas. However, previous studies suggest that only 3-6% of patients attempt to contact their GP before attending the AED, and measures of the availability of appointments in the surgery are not associated with AED self-referral rates. AIM: To examine the overlap of services between general practice and AEDs, and the characteristics of patients who attend at both sites. METHOD: A prospective observational study, set in east London, of all AED attendances from two group practices located within two kilometers of the Royal London Hospital, over a seven month period in 1994. RESULTS: Of 1785 attendances analysed, 80% were self referrals. Rates of hospital admission (18.1%) and outpatient referral (9.5%) reflect national figures. There was a significantly higher proportion of attendance from those of white ethnicity among children under 16. Using the Sheffield process-based classification, 43% of adult attendances were categorized as primary care attendances. Within this category the rate of attendance declined with age. Twenty-five point eight per cent of primary care attendances occurred between 10.00 pm and 8.00 am. Among self-referrals to the AED, 16% were seen by their GP in the previous two weeks for a similar problem. Frequent attendance at the AED was associated with a significantly higher consultation rate at the GP surgery (F = 19.6, df = 5, P < 0.0001). Less than 2% of attendances were recalled to the AED for follow-up. A minority (14%) of attendances resulted in a communication with the GP. The seven-month AED attendance rates for the two practices were significantly different (72 per 1000 (95% CI 67-78) and 111 per 1000 (95% CI 105-116), despite similar practice organization and markers of social deprivation. CONCLUSIONS: AED attendance rates were below the national average. GP referral and admission rates to AEDs from inner urban practices mirror national rates. High rates of primary care attendance occurred in younger age groups, with more than expected occurring out of hours. The reduction in case follow-up within the AED must be supported by improvements in communication with GPs, and an expansion of practice-based nursing. Practices that are geographically close, and with similar sociodemographic features, may have different AED attendance rates. This has important implications for resource allocation in primary care.

Adolescent↗
PubMed1997

Group practice vs. solo practice--a dentist's view.

The percentage of dentists joining group practices has increased sharply in the past fifteen years. Many advantages to practicing in a group setting including social, clinical, and financial aspects have contributed to this change. Solo practice has become increasingly difficult for new dentists. Market forces as well as insurance changes have accelerated the transition to group practice. Multispecialty groups have particular features that have allowed them to become much more popular. The advent of dental practice management companies has fueled the growth of multispecialty groups and has created new business opportunities for dental practice owners.

Dentists↗
PubMed1975

Patterns of dental practice in the United States: solo vs group practice.

This overview of selected characteristics of group and solo practices provides baseline information on the dimensions and structures of two general practice types in the United States. It appears that although a dentist spends no more hours or sees no more patients on the average in a group practice, the structure in terms of use of auxiliaries, appointment flexibility, and structured programs provides the dentist in a group practice more opportunity to participate in other professional activities and generate a higher income. Further analysis on the interrelation of these variables will provide a more conclusive comparison of group and solo practices. Also, more conclusive research on variations among different types of group arrangements is needed to appreciate differences in partnerships, groups, and incorporations.

Allied Health Personnel↗
PubMed2002

Integrating science and practice: Reclaiming the science in practice.

This article is intended to be somewhat provocative, stimulating discussion in our efforts to better integrate science and practice. Three major areas of divisiveness between science and practice are posited-understanding of practitioners' approach to practice, definition of scholarship, and the role of theory and diagnosis in practice. Some general principles are offered that may further our thinking about integration of the applications of science in the practice of psychology and the participation of practitioners in science: (a) all practitioners do evidence-based practice; (b) scholarship has many forms, each of which provides an important piece of the puzzle of advancing knowledge; and (c) "eclectic" is a theoretically and practically meaningful term.

Evidence-Based Medicine↗
PubMed2000

[Putting it into practice is difficult. A qualitative study on the theory-practice transfer in the case of kinesthetics].

The theory-practice-gap in nursing is a well-known phenomenon. However, to date there is only very little well-founded evidence in nursing research available on this topic, especially in the context of the FRG. Therefore, a qualitative nursing research project, oriented by the methods of Grounded Theory, on theory transfer into practice using the example of a continuing in-service education program on kinesthetics in nursing was carried out that aimed at examining factors that influence the implementation of kinesthetics into nursing practice. After the program, the researcher conducted mainly semi-structured interviews with the participants about their experiences with using what they had learned in their daily work on the ward. As part of the results, the impact of the category "attributes of kinesthetics" on the theory-practice-transfer of the participants in the continuing education program on the topic will be shown. That is to say something about whether the fact that kinesthetics is perceived as practical, strange and exotic, connected with closeness, or as difficult or risky, has an influence on the use of newly learned knowledge in practice. Finally, the relation of this category to the key-category "working in knowledge and new things" will be shown. The findings of this study suggest that putting emphasis on transfer of knowledge alone is not sufficient to account for the complex structure of the process of theory-practice-transfer.

Diffusion of Innovation↗
PubMed1999

Structural Organization of Practice: Effects of Practicing Under Different Informational Constraints on the Acquisition of One-Handed Catching Skill.

The question addressed in this study was the effects of the manipulation of the informational constraints of practice conditions on the acquisition of one-handed catching skill. Three groups of poor catchers (8 participants per group) practiced in either a normal-light, ball-only, or interspersed ball-only and normal-light condition (N = 450 trials). All groups exhibited a significant improvement in the number of catches and catching score and a reduction in the number of misses by the end of practice. The structural organization of the practice conditions had a significant effect on catching performance. Practicing in the interspersed condition had a positive residual effect on subjects' performance in normal light. Similarly, there was a positive residual effect of practicing in the ball-only and the interspersed conditions on subjects' normal-light, posttest performance. The findings are interpreted as support for the argument that practicing under varying informational constraints can benefit skill acquisition by directing the subjects' search toward relevant sources of information.

Journal Article↗
PubMed1999

The advanced practice nurse. Changing the practice law: what did we learn?

The nurse practice statute was changed in Connecticut during the 1999 Legislative session in an effort to more accurately reflect the current practice of advanced practice nurses. The effort to make changes began in 1990, when the psychiatric clinical nurse specialists organized and incorporated to improve the practice status of this nurse specialty group and to improve patient accessibility to their services. This article describes the changes that were made in the practice statute and the lessons that were learned along the way. It elaborates on the need for strong organizational identification, coalition building, choosing legal and lobbying support carefully, negotiating with the opposition, and grassroots lobbying. Compromise was reached and statutory changes were made so that advanced practice nurses moved from being under the direction of physicians to a mutually agreed-on collaborative relationship with physicians. The article provides insights and learning experiences that may help others moving along the road to more independent practice laws.

Connecticut↗
PubMed2004

Introducing the Learning Practice--II. Becoming a Learning Practice.

RATIONALE, AIMS AND OBJECTIVES: This paper is the second of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. METHODS: Based on a theoretical and empirical review of available evidence, here we introduce the process by which a Practice can start to become a Learning Practice (LP). RESULTS AND CONCLUSIONS: Steps taken to enhance both individual and organizational learning begin the process of moving towards a learning culture. Attention is given to the routines that can be established within the practice to make learning systematically an integral part of what the practice does. This involves focusing on all three of single-, double- and triple-loop learning. Within the paper, a distinction is made between individual, collective and organizational learning. We argue that individual and collective learning may be easier to achieve than organizational learning as processes and systems already exist within the Health Service to facilitate personal learning and development with some opportunities for collective and integrated learning and working. However, although organizational learning needs to spread beyond the LP to the wider Health Service to inform future training courses, policy and decision-making, there currently seem to be few processes by which this might be achieved. This paper contributes to the wider quality improvement debate in three main ways. First, by reviewing existing theoretical and empirical material on LOs in health care settings it provides both an informed vision and a set of practical guidelines on the ways in which a Practice could start to effect its own regime of learning, innovation and change. Second, it highlights the paucity of opportunities individual general practitioner practices have to share their learning more widely. Thirdly, it adds to the evidence base on how to apply LO theory and activate learning cultures in health care settings.

Guidelines as Topic↗
PubMed2000

Measurement and psychotherapy. Evidence-based practice and practice-based evidence.

BACKGROUND: Measurement is the foundation of evidence-based practice. Advances in measurement procedures should extend to psychotherapy practice. AIMS: To review the developments in measurement relevant to psychotherapy. METHOD: Domains reviewed are: (a) interventions; (b) case formulation; (c) treatment integrity; (d) performance (including adherence, competence and skillfulness); (e) treatment definitions; (f) therapeutic alliance; and (g) routine outcome measurement. RESULTS: Modern methods of measurement can support 'evidence-based practice' for psychological treatments. They also support 'practice-based evidence', a complementary paradigm to improve clinical effectiveness in routine practice via the infrastructure of Practice Research Networks (PRNs). CONCLUSIONS: Advances in measurement derived from psychotherapy research support a model of professional self-management (practice-based evidence) which is widely applicable in psychiatry and medicine.

Clinical Competence↗
PubMed2006

The excimer laser-assisted nonocclusive anastomosis practice model: development and application of a tool for practicing microvascular anastomosis techniques.

OBJECTIVE: To practice microsurgical skills, several experimental models are available that diminish the need for experimental animals. We defined criteria with which such models should comply, and we tested whether the models described in literature, as well as our own practice model, comply with these criteria. METHODS: We defined the criteria to which these models should comply, and we performed a literature search on microvascular practice models. During the development of the Excimer laser-assisted nonocclusive anastomosis technique, we designed our own Excimer laser-assisted nonocclusive anastomosis Practice Model (EPM) according to those criteria, and we compared that model with the models described in the literature. RESULTS: All practice models could be categorized into three groups: beginner, moderate, and advanced. Our EPM complies with almost all criteria defined in the beginner and moderate groups and has much in common with the models that are categorized in the advanced group. CONCLUSION: In consideration of the methods to learn microvascular surgical techniques, the EPM can be used for a very long time before the need for living animals arises. This last aspect remains an inescapable condition for practicing microsurgical skills. However, with use of the EPM or another practice model, the amount of experimental animals can be drastically reduced.

Anastomosis, Surgical↗
PubMed2006

Academic--practice partnerships in practice research: A cultural shift for health social workers.

Academic practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data -driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as 'research focused practitioners'.

Aged↗