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PubMed2003

Puccinia tanaceti: specialist or generalist?

Rust is reported for the first time in North America on tansy (Tanacetum vulgare), a widespread and invasive Eurasian plant that was introduced into North America in the 17th century. Morphologically, the rust fungus corresponds exactly to Gäumann's description of Puccinia tanaceti, and to European specimens of P. tanaceti on T. vulgare. An inoculation study confirmed the narrow host specialization of P. tanaceti that Gäumann described, in that T. vulgare was successfully inoculated whereas four other species of the tribe Anthemidae of the Asteraceae were entirely resistant, i.e. Leucanthemum maximum (Shasta daisy), L. vulgare (ox-eye daisy), Artemisia absinthium (wormwood), and A. tridentata (sagebrush). This confirmation of a specialized P. tanaceti invalidates P. tanaceti s. lat. The latter complex has resulted from synonymies, and compilation of host records of rust fungi resembling P. tanaceti on at least 105 species representing 19 genera from six tribes of the Asteraceae from both New and Old Worlds.

Asteraceae↗
PubMed2004

Generalization of a habituated feeding deterrent response to unrelated antifeedants following prolonged exposure in a generalist herbivore, Trichoplusia ni.

The possibility of generalization of habituated response to unrelated feeding deterrents following prolonged exposure was examined in third instar Trichoplusia ni (Lepidoptera: Noctuidae) larvae by rearing them on antifeedants and then testing with other unrelated antifeedants. We introduced neonate larvae (< 24-hr old) onto cabbage leaves treated with crude seed extracts of Melia volkensii (Meliaceae) or oil of Origanum vulgare ("oregano") (Lamiaceae) and allowed them to feed until early in the third instar. Naive larvae were reared on cabbage leaves treated with carrier solvent alone. Both experienced and naïve larvae were tested for feeding deterrent response with the same and the different extracts in a leaf disc choice bioassay. Habituation was generalized to both M. volkensii and oregano following prolonged exposure to either plant extract and also to a pure allelochemical, thymol, following prolonged exposure to either digitoxin or xanthotoxin. However, there was no generalization of the habituated response to oregano following prolonged exposure to digitoxin or thymol, or to thymol or xanthotoxin following prolonged exposure to oregano or M. volkensii. Our results demonstrate that habituated response to feeding deterrents in a polyphagous insect herbivore can be generalized among and between plant extracts and pure allelochemicals, but not in all situations. The implications of such behavioral plasticity in herbivorous insects for the use of antifeedants as crop protectants or for host plant shifts is discussed.

Animals↗
PubMedDate not supplied

Achieving clarity in evaluation of community/public health nurse generalist competencies through development of a clinical performance evaluation tool.

Community/public health nursing practice is complex and based on interventions targeted at individuals, families, populations, and communities. Evaluating clinical practice involves a comparison of predetermined standards, such as those developed by American Nurses Association (ANA), against competencies associated with the practice of the specialty. In this study, 301 performance evaluation records from a locally developed clinical performance evaluation tool were examined for construct validity and reliability based on the ANA Standards for Community and Public Health Nursing.

Adult↗
PubMed2002

Telephone reporting in the consultant-generalist relationship.

RATIONALE, AIMS AND OBJECTIVES: The aim of this paper is to examine the issue of telephone reporting by consultants in the medical community, which is rarely used in medicine today. METHODS: The paper reviews principal publications addressing this field that have shown that communication between consultants and primary care physicians has many shortcomings, frequently leaving the primary care physician with unanswered questions. DISCUSSION AND CONCLUSIONS: We present the value of routine telephone reporting by consultants to their primary care counterparts and also discuss possible future implications of communication via electronic mail.

Communication↗
PubMed2000

Neonatology for the generalist: human milk banks and evidence-based medicine.

Human milk (HM) banks provide pasteurised milk from screened donors for infants in many countries but not in Australia. There are potential benefits and risks from feeding donor milk with the benefits most likely for preterm infants. A randomized clinical trial is required to provide conclusive evidence. Promotion of breast-feeding with the establishment of HM banks may prove to be an important primary health care activities for infants in Australia.

Australia↗
PubMed2003

Quality of generalist vs. specialty care for people with HIV on antiretroviral treatment: a prospective cohort study.

OBJECTIVES: To describe health-care use by persons with HIV in an urban area of Switzerland (Zurich). Further, to compare the different health-care settings. DESIGN: A 1-year prospective cohort study recruiting 60 patients at general practices and 60 patients at a specialized university outpatient clinic. METHODS: Patients and their treating physicians were interviewed or answered questionnaires, respectively, at baseline, month 6 and 12. RESULTS: During the study period, five patient groups were identified among the 106 enrolled patients, of whom (i) 42% saw a general practitioner exclusively, (ii) 31% were treated at the specialized outpatient clinic, (iii) 8% were in shared care, (iv) 10% changed health-care model, and (v) 9% were lost to follow-up. Baseline demographic, psychosocial and clinical data were similar among patient groups. At study end, the proportion of patients with HIV-1 RNA < 400 copies/mL was 72%, 74%, 88%, 55% among groups (i) to (iv), respectively (ns), and 22% at month 6 among those lost to follow-up. Indicators for quality of care were similarly good among all patient groups. CONCLUSIONS: A well-working system offers high-quality healthcare to persons living with HIV, where existing teams of specialty and primary health-care professionals efficiently and effectively co-operate.

Adult↗
PubMed1998

Effect of ambulatory utilization review on referrals from generalists to specialists.

We studied whether ambulatory utilization review (UR) alters how many patients internal medicine residents refer to sub-specialists, and whether the effect persists without reinforcement. We compared referral rates of residents from a firm that held UR meetings (intervention firm residents, n = 20) with those of residents from a firm that did not (control firm residents, n = 21). We then compared referral rates of 17 intervention firm residents while they were participating in UR with their rates after not participating for at least 4 weeks. Intervention firm residents submitted 30% fewer referrals than control firm residents (9% vs 13%, p = .05). However, the effect was short-lived; after 4 weeks without UR, intervention firm resident referral rates were similar to control firm referral rates.

Ambulatory Care↗
PubMed2003

Teaching women's health skills: confidence, attitudes and practice patterns of academic generalist physician.

OBJECTIVE: This study assesses the readiness of academic general internists to perform and precept a commonly utilized women's health examination, and procedural and management skills. DESIGN: Full-time faculty from divisions of general internal medicine and departments of family practice in 9 states reported their encounter frequency with, comfort precepting, and the importance they ascribe to several examination, procedural, and management skills relevant to women's health care; and their attitudes toward performing the pelvic exam and obtaining a Pap smear. MEASUREMENTS AND MAIN RESULTS: A total of 331 general internal medicine physicians (GIMs) and 271 family medicine physicians (FPs) completed questionnaires, with response rates of 57% and 64%, respectively. More than 90% of GIMs and FPs indicated they were confident precepting the breast and Pap/pelvic examinations. A relatively small percentage of GIMs expressed confidence precepting the management of dysfunctional uterine bleeding (22%), initiating Depo-Provera (21%), and initiating oral contraceptives (45%), while a substantially larger percentage indicated that these skills were important to primary care practice (43%, 44%, and 85%, respectively). Although GIMs indicated they were confident precepting the Pap/pelvic exam, they were less likely than FPs to agree with the following statements: "Performing routine Pap smears is a good use of my time" (GIMs 65%, FPs 84%); "It is a waste of health care dollars for primary care physicians to refer patients to gynecologists for routine Pap/pelvic exams" (GIMs 69%, FPs 90%); "I feel very well trained to do a routine bimanual exam" (GIMs 71%, FPs 98%), and "The clinic where I practice is well equipped to do a Pap smear" (GIMs 78%, FPs 94%). CONCLUSIONS: Although most academic GIMs are confident precepting the breast and pelvic examination, only a minority are confident precepting the management of dysfunctional uterine bleeding, initiating Depo-Provera, and initiating oral contraceptives. These findings suggest that a number of academic GIMs may not be prepared or willing to perform or precept important women's health skills.

Adult↗
PubMedDate not supplied

Making connections: linking generalist and specialist essentials in baccalaureate community/public health nursing education and practice.

Nurse educators and potential employers of baccalaureate nursing graduates are challenged by the constant change in health care today. This change mandates competencies for professional nursing practice that preserves the relevant and useful skills and knowledge of the past, yet incorporates skills and knowledge for practice today and in the future. As in previous eras of health system change, identifying essential knowledge and competencies for baccalaureate graduates must begin by collaboration between nursing education and nursing service. This article reports the work of a task force of nurse educators whose charge was to revise "The Essentials of Baccalaureate Nursing Education for Entry Level Community/Public Health Nursing". An overview of their experience is presented with the aim of contributing to current best thinking between one nursing specialty organization and the American Association of Colleges of Nursing.

Clinical Competence↗