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PubMed1975

[Transcultural aspects of the clinical-psychiatric pictures of foreign workers (guest workers) and their significance for neurological practice].

Referring to a previous clinical and sociopsychiatric investigation on 130 foreign workers, the transcultural psychiatric factors determining forms and contents were studied. It is stressed that remains of magic thinking and rigid tribe-centered sociocultural structures are the main factors, in addition to the beginning of the loosening of these structures accompanied by initial assimiltion of occidental ways of life in the homeland, and integrational crises through collision of Old and New after immigration. Atypical psychosis, outweighting affective and somatic factors, obliteration of the limits between classic etiological units, and the possibility of confounding magic contents with psychosis are illustrated by case histories. New criteria for diagnosis and therapy of foreign workers are suggested.

Adjustment Disorders↗
PubMed1997

Nursing wound care survey: sterile and nonsterile glove choice.

PURPOSE: The application of sterile and clean procedure to the practice of wound care nursing was examined. DESIGN: This prospective, descriptive study surveyed staff nurses regarding glove use. SUBJECTS AND SETTING: Seven hundred forty-three staff nurses from five health care agencies in the San Francisco Bay Area responded to the survey. INSTRUMENTS: A self-report wound care survey instrument was developed by Nursing Consortium for Research and Practice members from information adapted from the wound care literature. The questionnaire comprised 31 questions and required approximately 10 minutes to complete. METHODS: Nursing Consortium for Research and Practice members obtained approval from their respective institutional human subjects committees and distributed questionnaires among all nurses engaged in direct care. Some agency representatives personally handed the survey instruments to subjects, but most distributed them through their agencies personnel mailing systems. RESULTS: Seven hundred twenty-three (38%) of 1900 questionnaires were completed and returned to the five site coordinators. Differences were found between acute care and home health nurses. Acute care nurses were more likely than home care nurses to use sterile gloves in all wound care situations. CONCLUSION: Greater variation was found with regard to sterile technique in wound care practice than in previously reported studies. Although patient risk factors and wound type significantly influenced the choice of sterile or clean gloves, additional environmental and personal factors exerted considerable influence. These included health care setting, degree of professional education, and nurses' experiential background. Attempts to modify practice through policy change alone may not be sufficient to overcome resistance to change. Instead, it may be necessary for nurses to "unlearn" lessons from basic nursing education before they can adopt to new practices and clinical policies.

Adult↗
PubMed2005

Assessment of OASIS reliability and validity using several methodological approaches.

The Outcome Assessment and Information Set (OASIS) plays an essential role in home healthcare. To date, few researchers have investigated the psychometric properties of the OASIS in actual clinical practice. This study used several methodologies to estimate reliability and validity of OASIS when clinicians were conducting assessments as part of the routine care process. Analyses from a delayed assessment approach (n = 259), a simultaneous assessment approach (n = 105) and an assessment of consistency between OASIS and the Centers for Medicare and Medicaid Services (CMS) 485 (n = 141) provided insights into OASIS reliability and validity. Reliability for many items was considerably lower than prior studies and there were notable inconsistencies between several domains of OASIS and the CMS 485. Based on these findings it was also unclear whether prior reliability findings could be generalized to practice because the previous research did not account for the stresses and unpredictability of the home healthcare setting. Further, the inconsistencies between the OASIS and CMS 485 suggested that the OASIS might not truly reflect the patient's condition. Implications for improving the use of the instrument in practice settings are discussed.

Aged↗
PubMed1997

Evaluating family practice residencies: a new method for qualitative assessment.

BACKGROUND AND OBJECTIVES: This study reports on a novel qualitative method for evaluating family practice training programs. Previous evaluation techniques have generally been quantitative in nature and have limited their scope to a few isolated elements of residency education. METHODS: A guest faculty, working in conjunction with local faculty, conducted a site analysis of an East Coast and a West Coast family practice residency. Multiple qualitative techniques were used, including participant observation, focus groups, long interviews, and analysis of key texts. Program strengths and weaknesses were analyzed, and a discrepancy model was used to compare program goals and ideals to the actual training realities. The analysis used a process of immersion/crystallization, and triangulation of the multiple data sources was achieved through repeated comparisons. RESULTS: This report focuses on the process of the evaluations, rather than on their content. In general, the sites have achieved most of their objectives, but notable limitations are present at both programs. This is particularly apparent in terms of multiple demands on faculty, the lack of a shared vision, and program isolation. CONCLUSIONS: Significant lessons were learned from these initial assessments, which can be used to further refine the method. Comprehensive qualitative reviews may provide unexpected insights and identify program limitations and strengths.

Data Collection↗
PubMed2003

Herd management practices associated with paratuberculosis seroprevalence in Dutch dairy herds.

We describe the paratuberculosis management practices applied in dairy herds in the Netherlands. The findings from paratuberculosis seronegative and seropositive herds were compared to discover possible risk factors. In total, 370 randomly selected herds with > or =20 dairy cows were surveyed. A questionnaire was used to collect data on current and previous paratuberculosis management practices. All cattle aged > or =3 years were serologically tested for paratuberculosis using an enzyme-linked immunosorbent assay. Herds with >33 tested cattle, of which only one was seropositive, were excluded to reduce the risk of including false-positive herds in the analysis. A comparison of the management data of the seronegative herds (n = 166) and the seropositive herds (n = 143) showed that in both groups important management measures for the prevention of paratuberculosis, such as calving in a cleaned calving area, removing the calf immediately after birth, and feeding paratuberculosis non-suspect roughage to calves, were used only rarely. However, such measures should be regarded as the critical first step to control the disease and/or reduce its prevalence. Using univariable analysis, four factors were statistically different between seronegative and seropositive herds: herd size, cows with clinical signs of paratuberculosis, prompt selling of clinically diseased cattle and feeding milk replacer. Using a multivariable logistic regression model, only herd size was a significantly different factor. These results indicate that most of the paratuberculosis preventive management measures were executed on these Dutch dairy farms only to a limited extent.

Animal Husbandry↗
PubMed1993

Impact of the acquired immunodeficiency syndrome epidemic on the practice of laryngology.

In only 10 years, the acquired immunodeficiency syndrome epidemic has already had an enormous impact on many aspects of the practice of medicine. The practice of laryngology typifies the changes that have occurred. Heightened clinical vigilance has been required as the laryngologist encounters new and unusual manifestations of the disease and must take more extensive histories regarding social, behavioral, and sexual practices than were previously necessary. The performance of physical examinations and surgical procedures has also changed as a result of experience with the lethal human immunodeficiency virus. Numerous legal, ethical, and social issues have also been raised by the epidemic and have had a major influence on how medicine is practiced and regulated. In this paper we review the laryngeal and pharyngeal manifestations of acquired immunodeficiency syndrome and discuss illustrative patient examples that demonstrate the impact of the disease. We also consider the diverse groups of issues that attend this epidemic and that continue to modify practice patterns.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Experimental determination of practical peak voltage.

In diagnostic radiology the practical peak voltage was initially derived by postulating that, for a given combination of X-ray tube and contrast geometry, a constant X-ray tube voltage should produce the same low level contrast as an arbitrarily pulsating X-ray tube voltage. It has been shown previously that the practical peak voltage can be properly defined as a weighted average of the X-ray tube voltage. Up to now the concept of practical peak voltage was based entirely on the results of calculations. The present paper describes the experimental investigations for measuring and comparing the contrast-equivalent X-ray tube voltage and practical peak voltage derived from an invasive measurement of the time-dependent X-ray tube voltage. Within the experimental uncertainties, the results demonstrate the mutual equivalence of the practical peak voltage and the contrast-equivalent X-ray tube voltage.

Algorithms↗
PubMed1991

Paediatric cardiology. A proposed training programme.

In January 1989, The Royal Liverpool Children's Hospital, Myrtle Street, moved to the Alder Hey branch site. This involved all paediatric in-patient services, including the Supra-Regional Paediatric Cardiac Unit. As a result of this amalgamation, the cardiac theatre nursing staff became part of the general theatre complex and an integration of theatre staff occurred. This identified a need by the general theatre nursing staff for paediatric cardiology experience. This programme of paediatric cardiac experience is designed to ensure the integration of theory and practice. The participants of the programme are seen as autonomous learners who will be supported throughout the programme by a facilitator who will be an experienced nurse within the cardiac unit or cardiac theatre. It is therefore envisaged that the programme will be flexible and acknowledge the participants previous theoretical and practical nursing skills.

Cardiac Surgical Procedures↗
PubMed1992

Weight Cycling Practices and Long-term Health Conditions in a Sample of Former Wrestlers and Other Collegiate Athletes.

Weight cycling (repeated episodes of weight loss and regain) has been shown to reduce the resting metabolic rate in some chronic dieters. Concerns have been raised that wrestlers' repeated patterns of weight loss and gain may reduce metabolic rates and increase long-term health risks. We conducted this study to assess previous weight loss practices, current body weight, and incidence of chronic disease in a sample of male athletes who earned athletic letters in intercollegiate sports at the University of Wisconsin-Madison between 1950 and 1988. Survey questionnaires were mailed to 79 ex-wrestlers and 153 nonwrestling athletes, with responses from 60 wrestlers (76%) and 104 nonwrestlers (68%). We found no significant differences in weight gained after graduation (10.2 pounds for wrestlers and 8.6 pounds for nonwrestling athletes), current exercise practices, incidence of chronic disease, prevalence of obesity, and current dieting rates in this sample of former college athletes. Collegiate wrestlers gained an average of 16 pounds during the off-season. Most wrestlers reported that they lost between 3 and 11 pounds per match and that they used a combination of five or more weight loss techniques. Most frequently reported techniques included increasing exercise, restricting food, exercising in a hot environment, using a steam room or sauna, restricting fluids, and exercising in a rubber or plastic suit. Fewer wrestlers than nonwrestlers reported that they smoked tobacco. The health effects of changes in proportions of fat-free body mass after weight cycling were not addressed in this survey. The hypothesis that numerous cycles of weight loss and regain among wrestlers may result in long-term weight gain and/or increased risk of chronic disease was not supported by the results of this survey.

Journal Article↗
PubMed2001

A national general practice census: characteristics of rural general practices.

OBJECTIVES: The aim of the present study was to describe, using a national census, the characteristics of rural general practices and compare these with city and town general practices. METHODS: A previously piloted, anonymous but linked, questionnaire was issued to all GPs in Ireland. A liaison network covering the country was developed to increase the response rate. Respondents were asked to designate the location of their main surgery as being city (>20 000 population), town (>5000) or rural (<5000). Each responding practice was asked to nominate one partner to complete a specific section on practice information. RESULTS: Completed individual questionnaires were returned from 2093 GPs (86% response rate). Information on 1429 practice centres was provided; 488 (34%) of these were designated as city, 405 (28%) as town and 536 (38%) as rural. Rural practices reported fewer private patients (P < 0.001) and more socio-economically deprived patients (P < 0.001) than those in towns or cities. The mean number (SD) of total scheduled hours per average week per GP was 77.95 (37.0) for city practices, 80.6 (35.9) for town and 103.6 (39.0) for rural (P < 0.001). Rural practices are more likely, in comparison with those in cities and towns, to have attached staff working from purpose-built premises which are publicly owned. Rural practices also have more contacts with members of the primary care team such as Public Health Nurses, and the quality of these contacts is described more positively. The range of available services is broadly similar, with emergency medical equipment being available more frequently in rural practices. CONCLUSION: This study suggests that rural practitioners and their practices differ from their urban counterparts in many important aspects. Consideration should be given to the development of formal under- and postgraduate rural general practice programmes to prepare new, and continue to enthuse present, rural GPs.

Censuses↗
PubMed2006

Contextual interference effect on acquisition and retention of pistol-shooting skills.

The effects of contextual interference on learning pistol-shooting skills in a natural training environment were examined. The shooting skills consisted of three "stages" with different requirements for the skill variations commonly used in the field. 12 participants were randomly assigned into one of two practice conditions, blocked vs serial. Following a 20-min. safety and skill instructional session, Blocked group practiced 10 trials in a row at each stage, while Serial group performed 5 trials in a row for each of the three stages and then repeated the cycle. Both groups completed a total of 30 practice trials over the three stages. A 10-min. rest interval was provided prior to a retention test which included 9 trials (3 trials at each stage in a blocked format). Results based on the data of Stage III, the most complex skill among the three stages, showed a pattern consistent with previous findings that practicing in the serial schedule depressed performance during initial training but maintained the performance better at retention, relative to the blocked practice.

Adolescent↗
PubMed1980

A comparison of surgical assisting in a prepaid group practice and a community hospital.

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.

General Surgery↗
PubMedDate not supplied

Health behavior changes in the United States, the United Kingdom, and France.

OBJECTIVE: To determine changes in health behaviors in the United States, the United Kingdom, and France over the previous two years. DESIGN: Cross-sectional survey of nationally representative samples. SETTING/PARTICIPANTS: Surveys conducted between June and November 1988 on persons aged 16 to 50 years in the United States (n = 1,940), the United Kingdom (n = 1,833), and France (n = 2,294) regarding health behaviors, attitudes toward health, and changes in health practices during the previous two years. MEASUREMENTS AND MAIN RESULTS: Using Bonferroni's adjustment for multiple comparisons, residents of the United States had significantly (p < 0.05) higher Quetelet indices and reported higher egg and red meat consumption, but had lower alcohol consumption, than did residents of either the United Kingdom or France. Americans were also significantly more likely to report attitudes accepting personal responsibility for their health and much more often endorsed the role of health behaviors (e.g., exercise) for decreasing the risk of cardiovascular disease. Changes in health behavior over two years were consistently more likely in the United States for weight loss, decreased alcohol consumption, decreased red meat and egg consumption, and increased exercise. Americans were also much more likely to have changed at least three health behaviors in the previous two years (United States 41.5%, United Kingdom 25.5%, France 13.8%, p < 0.002). A multivariate linear model confirmed the high likelihood of health behavior changes in the United States compared with the United Kingdom or France. CONCLUSIONS: The findings confirm that changes in health behaviors are continuing to occur in the United States, but remain comparatively modest in the United Kingdom and France. These international variations in health behaviors parallel differential declines in mortality rates in ischemic heart disease.

Adolescent↗
PubMedDate not supplied

Reduction of nitrate leaching with haying or grazing and omission of nitrogen fertilizer.

In some high-fertility, high-stocking-density grazing systems, nitrate (NO(3)) leaching can be great, and ground water NO(3)-N concentrations can exceed maximum contaminant levels. To reduce high N leaching losses and concentrations, alternative management practices need to be used. At the North Appalachian Experimental Watershed near Coshocton, OH, two management practices were studied with regard to reducing NO(3)-N concentrations in ground water. This was following a fertilized, rotational grazing management practice from which ground water NO(3)-N concentrations exceeded maximum contaminant levels. Using four small watersheds (each approximately 1 ha), rotational grazing of a grass forage without N fertilizer being applied and unfertilized grass forage removed as hay were used as alternative management practices to the previous fertilized pastures. Ground water was sampled at spring developments, which drained the watershed areas, over a 7-yr period. Peak ground water NO(3)-N concentrations before the 7-yr study period ranged from 13 to 25.5 mg L(-1). Ground water NO(3)-N concentrations progressively decreased under each watershed and both management practices. Following five years of the alternative management practices, ground water NO(3)-N concentrations ranged from 2.1 to 3.9 mg L(-1). Both grazing and haying, without N fertilizer being applied to the forage, were similarly effective in reducing the NO(3)-N levels in ground water. This research shows two management practices that can be effective in reducing high NO(3)-N concentrations resulting from high-fertility, high-stocking-density grazing systems, including an option to continue grazing.

Animals↗
PubMed1993

The 1990 Comprehensive Blood Bank Surveys of the College of American Pathologists.

The performance of participants on the 1990 Comprehensive Blood Bank Surveys of the College of American Pathologists was consistent with the high quality of past surveys. The surveys include challenges in ABO and Rh typing, crossmatching, transfusion decisions, unexpected antibody detection and identification, and supplemental questions to assess contemporary practices. As in previous years, a recurrent serologic problem has been the reporting of antibodies not present in serum (anti-E in Set J-B, and anti-K in Set J-D). Such overidentification of antibodies has little implication for transfusion safety and may, in fact, represent an artifact of the survey's samples and reporting practices.

Blood Banks↗
PubMed1996

An evaluation of risk factors for in-patient falls in acute and rehabilitation elderly care wards.

Falls occurring in elderly in-patients during periods of hospitalization are common, and attempts have been made to predict and prevent them based on risk factor analysis. These have not looked extensively at specific elderly care wards. We have investigated in-patient falls in mixed acute and rehabilitation elderly care wards in a case-controlled study. Fifty fallers were paired with fifty non-fallers, and their risk factors for falling evaluated. Only three risk factors were significantly more common in the fallers. These were: a previous history of falls; the presence of confusion/disorientation, and needing help to toilet/incontinence/diarrhoea. Prediction of falls based on the presence of the first two of these risk factors gives a sensitivity of 68% and a specificity of 88%. A risk factor approach to the prediction of falls in an in-patient elderly care setting seems to be less practical than was previously hoped.

Accidental Falls↗
PubMed2005

Long-term improvement in unsafe injection practices following community intervention.

BACKGROUND: A study in 1994 identified frequent unsafe injections as the cause of widespread hepatitis C virus infection in Hafizabad, Pakistan. A simple low cost community education program was assessed to see if it improved injection safety. METHODS: A local health organization developed educational materials on hepatitis C including advice on how to avoid unnecessary injections and, when injections were necessary, to use a new syringe and needle. Beginning in 1995, this advice was communicated through multiple channels including health education meetings, announcements in mosques, and via pamphlets. In 1998 study workers revisited controls from the 1994 case-control study (along with three of their neighbors of a similar age) to collect information on injection practices in the previous 12 months. RESULTS: Thirty-three percent of the study's participants in 1998 received >or=5 injections in the preceding 12 months compared to 40% of the hepatitis C virus negative controls reported in the year prior to the 1994 study (p=0.85). In 1998 52 persons (34%) brought their own syringe for their most recent injection, a practice that was unreported in 1994. Overall, in 1998 59% of patients received their most recent injection with a new syringe and needle compared to 24% in 1994 (p=0.003). CONCLUSIONS: Following this low cost health communication effort, community members took steps to protect themselves from unsafe injections.

Adult↗