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PubMedDate not supplied

The influence of practice type, region, and age on treatment recommendations for primary teeth.

The purpose of this study was to investigate dentists' treatment recommendations for interproximal surfaces of primary molars based on the type of practitioner (general dentist or pediatric dentist), geographic location, and age of practitioner. Simulated cases, which included histories and pictures of bite-wing radiographs, were mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Dentists were asked to select their treatment recommendations for eight cases involving the interproximal surface of a specified primary molar. The return rate was 42% (1245) overall, with 36% (723) from general dentists and 52% (522) from pediatric dentists. An amalgam restoration was recommended most often for these eight cases. Dentists in the age 60+ category and pediatric dentists were more likely to recommend treatment for smaller interproximal lesions. Composite resins were recommended infrequently; however, dentists in the 60+ age category and dentists in the Northeast and Southwest were somewhat more likely to recommend composite resin than younger dentists, or dentists in other geographic locations. Dentists in the 40-49 age range, pediatric dentists, and dentists in the Southwest were the most likely to recommend stainless steel crowns. These simulated cases demonstrate differences and similarities in the treatment recommendations for interproximal lesions on primary molars based on age, practice type, and region.

Adult↗
PubMed2005

[Infant and toddler nutrition: WHO recommendations and information encountered by Czech parents].

BACKGROUND: During the last 15 years much effort with remarkable success has been devoted to the promotion and support of breast-feeding. Much less attention has been paid, until recently, to child nutrition during the period of transition from exclusively milk feeding to the family diet. The aim of presented study is to provide a qualitative review of information on feeding of children 6 - 24 months old available to parents from various sources and to compare it with the WHO recommendations based on the Global Strategy for Infant and Young Child Feeding. METHODS AND RESULTS: Within the frame of field practice, students of the Charles University, 1st Medical Faculty conducted interviews with 273 mothers of children under 5 years old, focused interview with 19 paediatric general practitioners, gathered 42 promotion materials, identified and evaluated 16 relevant publications and 14 web sites. All practitioners interviewed provided information on the nutrition, recommend exclusive breast-feeding up to the age of 6 months and the appropriate introduction of complementary food but they probably did not promote sufficiently breast-feeding beyond six months. Review of various information sources revealed, as expected, certain variations in feeding recommendations, which is partially a consequence of their changes during the last decade. Most publications emphasise breast-feeding as the ideal nutrition for up to 6 months. Recommendations for breast-feeding beyond 6 months are inadequate. Complementary feeding recommendations are, with exceptions, common for breast-fed and non-breastfed children as well as for those who need to start complementary feeding before 6 months of age. Except for sporadic notes, publications do not deal with the safe food preparation and feeding during and after a common disease. CONCLUSIONS: Consideration to all 10 areas of WHO guiding principles should be given. Also the clear formulation of breastfeeding recommendations, differentiation of information according to the target population, and recommendations based on the conditions of a thriving infant exclusively breast-fed for 6 months would contribute to the harmonization of information on the older infant and toddler nutrition with WHO recommendations.

Breast Feeding↗
PubMedDate not supplied

Risk factors and recommendations for 230 adult primary care patients, based on U.S. Preventive Services Task Force guidelines.

We used a computer program based on the U.S. Preventive Services Task Force guidelines to identify recommendations for 230 adult patients who presented to an ambulatory family practice residency clinic. We entered risk factors into the computer program from sex-specific questionnaires that patients completed. On average, patients had 15.4 risk factors and 24.5 recommendations for preventive services (13.0 recommendations for screening, 10.5 for counseling, and 1.1 for immunizations). We noted a significant increase in the number of risk factors and recommendations with increasing age, except for counseling recommendations. The average patient incurs a large number of recommendations, which depend on many different risk factors, making the task of complete clinician compliance with the U.S. Preventive Services Task Force guidelines difficult. Many of these recommendations include counseling, which may take more time and require skills that clinicians may think they lack. Complete adherence may require several visits for the physician to address all recommendations. Measures to increase patient responsibility for health maintenance and innovations using comprehensive, interactive, and educational computer programs may help solve these problems.

Adult↗
PubMed1990

Comprehensive geriatric assessment recommendations: adherence of family practice residents.

A study was performed to determine whether family practice residents followed recommendations made by a comprehensive geriatric assessment clinic. Of 109 consecutive consultations, 27 patients had follow-up visits with family practice residents who participated in the assessment and who subsequently served as their primary care physicians. Adherence of residents to 437 clinic recommendations was monitored for 90 days by medical record review. Although recommendations to begin or increase a medication were followed 85.4% of the time, residents followed recommendations to stop or decrease medications less than 65% of the time. Recommendations to order a specific laboratory test or x-ray examination were acted on 70.3% of the time. Preventive recommendations were followed only 54.3% of the time. Residents' adherence to team-based care plans varied widely by type of recommendation. Special efforts are needed to increase compliance with comprehensive geriatric assessment clinic recommendations, particularly those for preventive services.

Aged↗
PubMed1994

Effect of institutional prestige on reviewers' recommendations and editorial decisions.

OBJECTIVE: To determine whether manuscripts from institutions with greater prestige are more likely to be recommended for publication by reviewers and to be accepted for publication. DESIGN: Retrospective study of reviewers' recommendations and editorial decisions for manuscripts from the United States received at the Journal of Pediatrics between January 1 and July 31, 1992. Manuscripts were classified as major papers or as brief reports. Institutions were ranked in quintiles according to the monetary value of grants funded by the National Institutes of Health. Reviewers' recommendations were classified as reject, reconsider, or accept, and editorial decisions as accept or reject, without regard to qualifying recommendations. RESULTS: For the 147 brief reports, lower institutional rank was associated with lower rates of recommendation for acceptance and of selection for publication. For the 258 major papers, however, there was no significant relationship between institutional rank and either the reviewers' recommendations or the acceptance rate. Similar results were found when the manuscripts were divided into five numerically equal groups according to institutional rank. CONCLUSIONS: Major manuscripts from institutions with greater prestige were no more likely to be recommended or accepted for publication than those from institutions with lesser prestige. In contrast, the likelihood of recommendation for acceptance and of selection for publication of brief reports appeared to correlate with the prestige of the institution.

Manuscripts as Topic↗
PubMed1993

Recall of recommendations and adherence to advice among patients with chronic medical conditions.

BACKGROUND: Patient adherence to treatment regimens may be a critical mediator between physician recommendations and patient outcomes, but levels of adherence have not been compared across disease groups, and patient self-reports have not been well validated. METHODS: To determine recall of and adherence to physicians' recommendations among patients with chronic medical conditions and to measure the correspondence between self-reported adherence and disease activity, we analyzed data from the Medical Outcomes Study. A total of 1751 patients with diabetes mellitus, hypertension, and heart disease were identified among 20,223 patients visiting family physicians, general internists, cardiologists, and endocrinologists in 1986. Main outcome measures included recall of 15 disease-specific recommendations, self-reported general and specific adherence, and correlations between adherence and clinical measures of disease activity and control. RESULTS: Among patients in all three disease groups, the proportion recalling recommendations to take prescribed medications (> or = 90%) exceeded the fraction recalling recommendations to follow a restricted diet, exercise regularly, and perform various self-care activities (22% to 84%). Adherence to recalled recommendations was similar across conditions but varied markedly according to the nature of the recommendations; for example, 91% of diabetics took prescribed medications but 69% followed a diabetics diet and 19% engaged in regular exercise. Adherence to recommendations was correlated with reduced serum glucose (r = -.33) and glycohemoglobin (r = -.25) levels among insulin-dependent diabetics and with reduced diastolic blood pressure among patients with hypertension (r = -.15). CONCLUSIONS: The majority of chronically ill patients failed to recall elements of potentially important medical advice and did not always adhere to advice that was recalled. Self-reported adherence was correlated with clinical measures of disease activity and control. Additional research is needed not only to improve adherence to medical advice in patients with chronic illnesses but also to determine which life-style changes are truly beneficial for these patients.

Adult↗
PubMed1993

Preventive practice among primary care physicians in British Columbia: relation to recommendations of the Canadian Task Force on the Periodic Health Examination.

OBJECTIVES: To compare the current practice of preventive medicine in British Columbia with the recommendations of the Canadian Task Force on the Periodic Health Examination. Four common, preventable forms of cancer (cervical, breast, lung and colorectal) were used as sentinel conditions. DESIGN: Random sample mailed survey. SETTING: Private primary care practices in British Columbia. PARTICIPANTS: A sample of 300 primary care physicians in 1991; of 285 eligible physicians 185 (65%) responded. OUTCOME MEASURE: Compliance with preventive practices recommended by the task force. RESULTS: Preventive practice complied with the task force's recommendations for breast examinations, mammography, cervical smears and initial counselling against smoking; over 90% of the physicians performed these manoeuvres in all or most cases. However, less than half performed two recommended manoeuvres for all or most patients who smoke: advice to follow a diet high in beta-carotene (reported by 10%) and scheduling of follow-up visits to reinforce antismoking counselling (by 46%). Most of the physicians stated that they perform preventive manoeuvres in the context of an annual general physical examination rather than integrating them into routine patient care. CONCLUSIONS: The task force's carefully constructed recommendations are incompletely followed. Overall, there appears to be a high level of compliance with traditional and recommended manoeuvres but also widespread persistence in performing traditional manoeuvres no longer recommended and failure to adopt new recommendations.

Breast Neoplasms↗
PubMed1996

Update: vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

This report provides updated information concerning the potential adverse events associated with vaccination for hepatitis B, poliomyelitis, measles, mumps, diphtheria, tetanus, and pertussis. This information incorporates findings from a series of recent literature reviews, conducted by an expert committee at the Institute of Medicine (IOM), of all evidence regarding the possible adverse consequences of vaccines administered to children. This report contains modifications to the previously published recommendations of the Advisory committee on Immunization Practices (ACIP) and is based on an ACIP review of the IOM findings and new research on vaccine safety. In addition, this report incorporates information contained in the "Recommendations of the Advisory Committee on Immunization Practices: Use of Vaccines and Immune Globulins in Persons with Altered Immunocompetence" (MMWR 1993;42[No. 44-4]) and the "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" (MMWR 1994;43[No. RR-1]). Major changes to the previous recommendations are highlighted within the text, and specific information concerning the following vaccines and the possible adverse events associated with their administration are included: hepatitis B vaccine and anaphylaxis, measles vaccine and a) thrombocytopenia and b) possible risk for death resulting from anaphylaxis or disseminated disease in immunocompromised persons; diphtheria and tetanus toxoids and pertussis vaccine (DTP) and chronic encephalopathy; and tetanus-toxoid-containing vaccines and a) Guillain-Barre syndrome, b) brachial neuritis, and c) possible risk for death resulting from anaphylaxis. These modifications will be incorporated into more comprehensive ACIP recommendations for each vaccine when such statements are revised. Also included in this report are interim recommendations concerning the use of measles and mumps vaccines in a) persons who are infected with human immunodeficiency virus and b) persons who are allergic to eggs; ACIP is still evaluating these recommendations.

Bacterial Proteins↗
PubMed1997

Current recommendations and practice regarding soft lens replacement and disinfection.

PURPOSE: We evaluate contact lens wearers' compliance with practitioner recommendations through the analysis of survey data. Trends in practitioner recommendations on discarding intervals and frequency of disinfection for soft contact lenses are analyzed and compared to actual wearer usage. METHODS: The results of two primary surveys are used. One survey measures fit and wear recommendations for contact lens patients by eyecare providers during 1994 and 1995. The second survey was conducted at the end of 1995 to ascertain contact lens wearers' practices in contact lens wear and care. RESULTS: The general trend in practitioner recommendations is towards either disposable or frequent programmed replacement intervals coupled with daily disinfection. Approximately 15% of the brands marketed for disposable use were recommended for replacement at intervals longer than two weeks--the longest interval associated with disposable lenses. We observe a discrepancy between practitioner recommendations and the lens care provided by patients, noting a tendency to replace lenses at intervals longer than recommended. CONCLUSIONS: Trends in practitioner recommendations are consistent with expectations of providers. However, the observation that patients tend to increase their discarding intervals implies that practitioners could do better in educating their patients as to discarding intervals and in prescribing products that best match patient needs for both convenience and cost. These data should alert contact lens fitters to the importance of giving clear instructions to patients on how they should wear and care for contact lenses.

Contact Lens Solutions↗
PubMed1998

Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA.

OBJECTIVE: To provide recommendations for the treatment of acquired immunodeficiency syndrome-related cytomegalovirus (CMV) end-organ diseases, including retinitis, colitis, pneumonitis, and neurologic diseases. PARTICIPANTS: A 17-member panel of physicians with expertise in clinical and virological research and inpatient care in the field of CMV diseases. EVIDENCE: Available clinical and virological study results. Recommendations are rated according to the quality and strength of available evidence. Recommendations were limited to the treatment of CMV diseases; prophylaxis recommendations are not included. PROCESS: The panel was convened in February 1997 and met regularly through November 1997. Subgroups of the panel summarized and presented available information on specific topics to the full panel; recommendations and ratings were determined by group consensus. CONCLUSIONS: Although the epidemiological features of CMV diseases are changing in the setting of potent, combination antiretroviral therapy, continued attention must be paid to CMV diseases in patients infected with the human immunodeficiency virus to prevent irreversible endorgan dysfunction. The initial and maintenance treatment of CMV retinitis must be individualized based on the characteristics of the lesions, including location and extent, specific patient factors, and characteristics of available therapies among others. Management of relapse or refractory retinitis must be likewise individualized. Ophthalmologic screening for patients at high risk for retinitis or who have a prior diagnosis of extraretinal disease is recommended. Recommendations for gastrointestinal, pulmonary, and neurologic manifestations are included.

AIDS-Related Opportunistic Infections↗
PubMed1990

Current recommendations for breast-feeding in cystic fibrosis centers.

In recent years, breast-feeding has been strongly recommended, and the decision to breast-feed is made by a large percentage of women before pregnancy. We performed a survey to determine the current recommendations given to mothers in cystic fibrosis (CF) centers. For mothers of infants with CF, 77% of centers recommend breast-feeding alone or with pancreatic enzyme supplements and/or hydrolyzed formula. For mothers with CF, the following responses were given: 11% recommend breast-feeding, 8% do not recommend it, 42% make the recommendation according to the health status of the mother, and 32% make the recommendation according to the personal wishes of the mother. The duration of breast-feeding for mothers of infants with CF was reported to be from 3 to 6 months by 43% of centers, whereas for mothers with CF, 41% of centers reported the duration to be less than 3 months. Several centers reported that their experiences were not always positive, thus indicating a need to establish criteria to predict and ensure a successful outcome.

Breast Feeding↗
PubMed2000

Antiretroviral drug resistance testing in adult HIV-1 infection: recommendations of an International AIDS Society-USA Panel.

OBJECTIVE: Assays for drug resistance testing in human immunodeficiency virus type 1 (HIV-1) infection are now available and clinical studies suggest that viral drug resistance is correlated with poor virologic response to new therapy. The International AIDS Society-USA sought to update prior recommendations to provide guidance for clinicians regarding indications for HIV-1 resistance testing. PARTICIPANTS: An International AIDS Society-USA 13-member physician panel with expertise in basic science, clinical research, and patient care involving HIV resistance to antiretroviral drugs was reconvened to provide recommendations for the clinical use of drug resistance testing. EVIDENCE AND CONSENSUS PROCESS: The full panel met regularly between January and October 1999. Resistance and resistance testing data appearing in the last decade through April 2000 and presentations at national and international research conferences were reviewed. Recommendations and considerations were developed by 100% group consensus, acknowledging that definitive data to support final recommendations are not yet available. CONCLUSIONS: Emerging data indicate that despite limitations, resistance testing should be incorporated into patient management in some settings. Resistance testing is recommended to help guide the choice of new regimens after treatment failure and for guiding therapy for pregnant women. It should be considered in treatment-naive patients with established infection, but cannot be firmly recommended in this setting. Testing also should be considered prior to initiating therapy in patients with acute HIV infection, although therapy should not be delayed pending the results. Expert interpretation is recommended given the complexity of results and assay limitations.

Adult↗
PubMed2001

Impact of recommendations to suspend the birth dose of hepatitis B virus vaccine.

CONTEXT: In July 1999, due to concerns about thimerosal content, the American Academy of Pediatrics (AAP) and the Public Health Service (PHS) recommended suspending hepatitis B virus (HBV) vaccination at birth except for mothers who had positive or unknown hepatitis B surface antigen (HBsAg) status. In September 1999, the Centers for Disease Control and Prevention recommended that hospitals resume HBV vaccination at birth with a new thimerosal-free vaccine. Whether the 2 changes in recommendations within 3 months led to less-than-optimal compliance in hospital nurseries is unknown. OBJECTIVE: To determine hospital HBV vaccination policy before the recommendation for delay of HBV vaccination and 1 year later. DESIGN, SETTING, AND PARTICIPANTS: Survey of all 46 hospitals with obstetric services and neonatal nurseries in Cook County, Illinois. MAIN OUTCOME MEASURES: Hepatitis B virus immunization practices before July 1999 and in August 2000; hospital factors associated with routine HBV immunization and compliance with AAP and PHS recommendations. RESULTS: Before July 1999, 74% of surveyed hospital nurseries offered HBV vaccine to all neonates; only 39% did so in August 2000. Being located in the Chicago city limits (88% vs 57%; P =.02) and having an academic affiliation (93% vs 66%; P =.05) were positively associated with routine neonatal immunization before July 1999. Both academic affiliation and city location were associated with routine immunization in August 2000 (71% vs 25% [P =.003] and 60% vs 14% [P =.002], respectively) and with compliance with recommendations for suspension (57% vs 25% [P =.03] and 56% vs 10% [P =.001]). CONCLUSIONS: We documented a 35% decrease in hospital nurseries that routinely offered HBV immunization 1 year after the AAP and PHS recommendations were made. Special efforts may be required to make at-birth administration of HBV vaccination universal.

Guideline Adherence↗
PubMed1999

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997.

OBJECTIVE: To assemble expert clinical experience and judgment regarding the treatment of anxiety disorders in a systematic, quantitative manner, particularly with respect to changes during the preceding five years. METHOD: A panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997. This report focuses on the experts' responses to questions about therapeutic options relevant to seven vignettes describing typical cases of different anxiety disorders. RESULTS: The preferred initial treatment strategy in 1992 was a combination of medication with a psychological therapy for all vignettes except simple phobia, where a psychological procedure alone was favored. There was little change in 1997, primarily some decrease in the choice of psychological therapy and some increase in the choice of medication for social phobia. Experts recommending a medication in 1992 most often chose as first-line treatment a benzodiazepine anxiolytic (BZ) for panic disorder (PD), generalized anxiety disorder (GAD), simple phobia, and adjustment disorder. They recommended a beta-blocker most often for social phobia and a tricyclic anti-depressant (TCA) for agoraphobia and obsessive-compulsive disorder (OCD). Nearly a fourth chose a combination of medications, usually a TCA plus a BZ. In 1997, the expert panel's most frequent recommendation for agoraphobia, PD, and OCD changed to a specific serotonin reuptake inhibitor (SSRI); and they also recommended these compounds more often for GAD, social phobia, and simple phobia. Fewer experts chose BZs or TCAs. However, in 1997 many again chose a combination of medications, often a BZ plus a SSRI, so that, overall, there was only a small decline in recommendations for BZs. As second-line medications (1997 only), the experts recommended SSRIs most often for most vignettes, but a TCA for PD and GAD. Recommendations for a combination of medications rose substantially for most vignettes, usually a BZ plus an antidepressant. CONCLUSIONS: Combined cognitive-behavioral therapy plus medication was highly favored by the experts as the initial treatment strategy for anxiety disorders. During the preceding five years, SSRIs displaced older antidepressants as the experts' first-line choices for the pharmacotherapy of anxiety disorders. In case of an unsatisfactory response, the experts' second-line choices more often were an older antidepressant or a combination of an antidepressant plus a BZ. According to the experts' judgements, the BZs, especially combined with an antidepressant, remain mainstays of pharmacotherapy for anxiety disorders.

Anti-Anxiety Agents↗
PubMed1996

[Historical development of dietary recommendations].

The discovery of the preventive action of lemon juice against scorbut led to a first recommendation on dietary intake in 1753. During the tight economic situation of the following century and in face of the economic crisis after the World War I, several concepts of dietary recommendations developed, all of which primarily served to relieve starvation and hunger and to maintain the ability to work of males. Increasing knowledge of human requirements for essential nutrients led to a clear distinction between dietary standards and health policy recommendations. With their first set of Recommended Dietary Allowances in 1941, especially the American Food and Nutrition Board directed concepts towards the improvement and maintenance of health of all people. National and international work on dietary recommendations took place to an increased extent in the 1970s. In face of currently expanding demands on dietary recommendations at present new directives for the revision of the American Recommended Dietary Allowances are discussed.

Dietetics↗
PubMed2006

[Persons requiring long-term care: Recommendation and utilization of rehabilitative therapies].

In Germany all members of the statutory health insurance are also compulsory members of the nursing care insurance which financially supports nursing care at home and in nursing homes. Benefits are provided dependent on a standardized medical examination performed at the home of the applicants by trained physicians or nurses of the health insurances' medical service (MDK). The benefits are granted to those persons who are limited in the performance of activities of daily living due to physical, cognitive or mental disorders. In the German Code of Social Law regulating the long-term care system, one important entitlement is "rehabilitation before long-term care". It aims at maintaining life of disabled persons in their familiar surroundings as long as possible. Up to now in the nursing care insurance this aim has been implemented insufficiently. The objective of this study was therefore to investigate the frequency of suggested ambulatory rehabilitation, which is recommended by the MDK at the examinations, and the following prescription of ambulatory rehabilitation, issued by an office-based physician. The database included the medical examinations of the years 2001 to 2002 linked to a random sample of persons insured in a statutory sickness fund in the German federal state of Hesse. Nursing care-related information including recommended rehabilitation therapy was derived from the medical examinations. Insurance data provided information on prescriptions. Data of 7,840 persons could be analyzed. Rehabilitative therapy was recommended in 15% of the nursing care applicants, mostly physiotherapy (ca. 90%). Persons receiving the recommendation were mainly male, they were younger, were more disabled, had less often a diagnosis of the ICD-10 chapter "symptoms and abnormal clinical and laboratory findings" or "mental and behavioral disorders", live less often alone and were more restricted in their motion compared to persons without recommendation for rehabilitative therapy. Only 55.3% of the persons with a recommendation for physiotherapy and only one-third with a recommendation for occupational therapy or logopedics received a prescription for the respective therapy in the following three months after examination. The age younger than 80 years, professional care, no home care, and-as the strongest item-preceding therapy were positively related to receiving a prescription. These findings show that disabled persons have the capability for prevention and rehabilitation, but it is used in only half of them. One possible reason might be the financing of the remedies, which burdens the budget of the health insurance, where instead the nursing care insurance benefits from the possible delay of the utilization of nursing care.

Activities of Daily Living↗
PubMed2005

Genetic evaluation and counseling of couples with recurrent miscarriage: recommendations of the National Society of Genetic Counselors.

The objective of this document is to provide recommendations for genetic evaluation and counseling of couples with recurrent miscarriage (RM). The recommendations are the opinions of the multidisciplinary Inherited Pregnancy Loss Working Group (IPLWG), with expertise in genetic counseling, medical genetics, maternal fetal medicine, internal medicine, infectious disease, cytogenetics, and coagulation disorders. The IPLWG defines RM as three or more clinically recognized consecutive or non-consecutive pregnancy losses occurring prior to fetal viability (<24 weeks gestation). These recommendations are provided to assist genetic counselors and other health care providers in clinical decision-making, as well as to promote consistency of patient care, guide the allocation of medical resources, and increase awareness of the psychosocial and cultural issues experienced by couples with RM. The IPLWG was convened with support from the March of Dimes Western Washington State Chapter and the University of Washington Division of Medical Genetics. The recommendations are U.S. Preventive Task Force Class III, and are based on clinical experiences, review of pertinent English-language published articles, and reports of expert committees. This document reviews the suspected causes of RM, provides indications for genetic evaluation and testing, addresses psychosocial and cultural considerations, and provides professional and patient resources. These recommendations should not be construed as dictating an exclusive course of medical management, nor does the use of such recommendations guarantee a particular outcome. The professional judgment of a health care provider, familiar with the circumstances of a specific case, should always supersede these recommendations.

Abortion, Habitual↗
PubMed1994

Physicians' implementation of dietitians' recommendations: a study of the effectiveness of dietitians.

OBJECTIVE: To determine how often dietitians' recommendations were implemented by physicians and to identify workplace and demographic factors that correlated with successful implementation of recommendations. DESIGN: A cohort of hospitals was surveyed by mail. Dietitians recorded recommendations written in five consecutive medical record entries and sent them to the chief clinical dietitian. Seventy-two hours later, physicians' order sheets were reviewed to assess implementation. Dietitians completed demographic questionnaires. SUBJECTS: Forty-four general hospitals in Philadelphia and the surrounding area were surveyed. To ensure similar standards of nutrition care, only hospitals approved by the Joint Commission on Accreditation of Healthcare Organizations were selected. STATISTICAL ANALYSIS PERFORMED: chi 2, Fisher's exact test, and the Kruskall-Wallis test were used to correlate demographic variables with implementation rate. MAIN OUTCOME MEASURE: Implementation of the dietitians' recommendations by physicians' orders. RESULTS: Responses were obtained from 35 of the 44 hospitals and 98 (70%) of the clinical dietitians. Of the 865 recommendations, 42% were implemented. Significantly higher implementation rates were noted for recommendations solicited by (50%) or discussed with the physician (65%). Dietitians were more successful in teaching hospitals and when they reported to a hospital-operated foodservice rather than a contract foodservice. Success correlated with a lower workload when measured by the ratio of admissions to staff but not when measured by the ratio of beds to staff. CONCLUSIONS: Dietitians could have a greater effect on nutrition care by discussing recommendations with physicians. Further research is needed about staffing formulas and methods to improve the effectiveness of dietitians.

Adult↗