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At least 541 records · Page 30Linked to original sources
PubMed1995

Female circumcision among Egyptian women.

Although a remarkable degree of consensus has been reached among international agencies, policymakers, and women's health advocates that the practice of female circumcision should be eliminated, such consensus is not necessarily shared by those who perform the operation or the families responsible for having girls excised. The surgical procedure is nested in a complex set of beliefs about identity, moral behavior, and the working of the female body. This article describes the dominant themes produced in 85 extensive interviews with mother and operators representing the broad spectrum of Egyptian society. The interviews detailed the operation itself, women's emotional response to the operation, and the rationales put forth in support of the practice. Although institutional efforts to eliminate the practice will meet with resistance, significant demographic shifts already taking place are producing changes in family systems and the opportunity structure that coincide with the abandonment of excision in key sectors of the urban population.

Adolescent↗
PubMedDate not supplied

[Psychiatric nursing practice at a public institution in Brazil].

This is a social and historical study whose objectives were to identify characteristic features of the psychiatric nursing practice from the point of view of nursing professionals working at a public psychiatric hospital in Rio de Janeiro over the course of a psychiatric care reform process, and to analyze the changes occurred in the nursing practice of those professionals. Their oral statements were used as the source for this study. Our findings showed that during the 'psychiatric care reform process, the nursing care provided by professionals kept presenting the segregating characteristics commonly-linked to the asylum care model, and that changes happened due to the influence of new routines and training these professionals were exposed to.

Brazil↗
PubMed2000

A comparison of patient satisfaction among current and former dental school patients.

Patient satisfaction is becoming an increasingly important indicator of quality dental care. However, most patient satisfaction surveys target only the current patients of the dental practice or institution, which may give an inflated estimate of satisfaction with care, since dissatisfied patients are likely to have left the practice or institution. The purpose of this study was to compare the satisfaction of three categories of dental school patients with several aspects of care received at the school. Data were collected using a telephone survey of 291 patients, systematically selected from the dental school's computer listings of all current, recall, and former patients. The survey instrument sought information about why respondents came to the school for dental treatment, why respondents who were no longer in treatment had dropped out of care, and respondents' opinions on eleven aspects of quality of care provided at the dental school. Dental students who had completed a training session served as interviewers. Results indicate that, overall, patient satisfaction with the care received was high, with none of the means for any category of patient falling into the dissatisfied range. Respondents who had dropped out of care were less satisfied than active or recall patients in five areas: quality of care, length and number of appointments, treatment explanation, and fees. Results have implications for dental school administrators and educators in their efforts to provide high quality patient care and to retain an adequate patient pool to ensure optimal clinical experiences for students.

Dental Care↗
PubMedDate not supplied

Academia and the medical group practice interface: the 2003 Institute of Medicine quality report and medication management.

University Physicians, Inc., has been impacted by the rising cost of professional liability insurance in recent years. Our internal risk management program needed to be enhanced to heighten provider sensitivity to the challenges certain practice processes (e.g., paper medical records) posed, and to tie this information to new patient and risk management strategies. The Institute of Medicine's 2003 report Priority Areas for National Action: Transforming Health Care Quality and the Agency for Healthcare Research and Quality's 2004 report Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies were used to establish priorities and develop indicators for measurement. A case study is presented on how these reports, combined with the Joint Commission on Accreditation of Healthcare Organization's 2006 National Patient Safety Goals for ambulatory care, were used to assess the group's risk profile and to implement practice changes to minimize risk.

Academic Medical Centers↗
PubMed2003

Biological explanations and social responsibility.

The aim of this paper is to show that critics of biological explanations of human nature may be granting too much to those who oppose such explanations when they argue that the truth of genetic determinism implies an end to critical evaluation and reform of our social institutions. This is the case because when we argue that biological determinism exempts us from social critique we are erroneously presupposing that our social values, practices, and institutions have nothing to do with what makes biological explanations troublesome. My argument is that what constitutes a problem for those who are concerned with social justice is not the fact that particular behaviours may be genetically determined, but the fact that our value system, and social institutions create the conditions that make such behaviours problematic. Thus, I will argue that even if genetic determinism were correct, the requirement of assessing and transforming our social practices and institutions would be far from superfluous. Biology is rarely destiny for human beings and the institutions they create.

Aggression↗
PubMedDate not supplied

[Institutional factors contributing to the utilization of breast clinical examination].

OBJECTIVE: To identify factors associated with utilization of breast clinical examination (BCE) and their relationship with institutional medical practice. MATERIAL AND METHODS: This is a qualitative study conducted between 1996 and 1997 in medical units of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) and Secretaria de Salud (Ministry of Health). Eight focus groups were included: four groups of female users and four groups of health professionals; in total, 47 users and 29 physicians and nurses participated. Interpretations of information were based on the organizational ability to respond to the user's expectations, "ability/knowledge" within the organization and the institutional medical practice, at the light of the Grounded Theory. RESULTS: Service demand was conditioned on the perception of poor quality of care, lack of trust in physicians, and organizational aspects. When providing care, male physicians were not interested and felt uneasy about performing the BCE. Female physicians seemed more interested and were well accepted by users. CONCLUSIONS: Psychological, cultural, social, and institutional barriers exist in the access and utilization of BCE. Identifying these barriers and their origins could support the development of actions to improve the physician-patient relationship. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Adult↗
PubMed1999

Pharmacists' job satisfaction and perceived utilization of skills.

The relationship between job satisfaction and perceived utilization of skills among pharmacists practicing in institutional and ambulatory care settings in Arizona was studied, and factors thought to influence pharmacists' perceived utilization of skills were evaluated. Questionnaires on job satisfaction and perceived utilization of skills were mailed to a random sample of 600 pharmacists. Information on workplace factors such as hours worked, practice setting, and job title was collected. A 4-item measure of general job satisfaction and a 10-item measure of perceived utilization of skills were used. Responses were measured on a five-point Likert scale ranging from "strongly disagree" to "strongly agree." The response rate was 35%. There was a significant positive relationship between job satisfaction and perceived utilization of skills and between job satisfaction and adequate staffing, where "staffing" referred to factors such as competence of coworkers and workload. Pharmacists with training beyond a B.S. degree in pharmacy were more satisfied with their job than those whose highest degree was a B.S. in pharmacy. Pharmacists practicing in institutional settings, pharmacists with management titles, and older pharmacists perceived that they were utilizing their skills to a greater extent than did pharmacists practicing in ambulatory care settings, pharmacists with a general staff title, and younger pharmacists. Among a sample of Arizona pharmacists in institutional and ambulatory care settings, job satisfaction was influenced by perceived utilization of skills, staffing, and education; practice setting, job title, and age were significantly related to perceived utilization of skills.

Adult↗
PubMed2002

Organizing a hospitalist program: an overview of fundamental concepts.

This article has discussed several fundamental concepts in the development and implementation of a hospitalist program. Perhaps the two most important barriers to the success of hospitalist practices are lack of buy-in from PCPs and other physicians (which is becoming much less common) and the inability to gain durable financial support from the hospital or other sponsoring entity. These issues always should be addressed before starting a program. Systems for adequate communication between hospitalists and community physicians will ensure buy-in is maintained. Unique challenges for those administering a hospitalist group include physician scheduling that balances continuity with a sustainable career track. Finally, providing leadership with a medical director increases the likelihood that operational problems are quickly managed, and that strategic planning takes place to ensure the future success of the program.

Attitude of Health Personnel↗
PubMed1986

The cost implications of academic group practice. A randomized controlled trial.

We evaluated the reorganization of a general medical clinic into several group practices, using equivalent groups of patients and physicians in a randomized controlled trial. The group practice, unlike the traditional clinic, provided decentralized registration, clinic coverage five days a week, and telephone coverage at night and on weekends. Residents worked in small groups with an attending physician, nurse practitioner, and receptionist. All financial activity involving a sample of 2299 patients was followed during the 11-month intervention. The total hospital charges per patient were 26 percent lower for the patients seen in the group practice than for those seen in the traditional clinic (P = 0.003). This difference was primarily attributable to inpatient charges, which were 27 percent lower per patient hospitalized (P = 0.004). The mean length of stay was 8.3 days among group-practice patients and 10.5 days among traditional-clinic patients (P = 0.011). We conclude that organizational changes to improve outpatient access and to integrate inpatient and outpatient services can decrease medical charges.

Academic Medical Centers↗
PubMed1975

Continuity of care in a university-based practice.

Effects of changes in a pediatric practice--expansion of the number of pediatricians and incorporation into a university hospital setting--on continuity of care and utilization were examined by means of a longitudinal study of a sample of 63 families. Continuity of care was measured by the following index: the number of visits with own physician divided by the total number of pediatric visits per year. Although continuity of well-child visits remained unchanged at the university setting, the continuity of sick visits declined markedly. An increased use of doctor visits for illness care was observed; its relationship with the decline in continuity is analyzed and discussed. While continuity is inherent in a small partnership practice, it is not so in a larger medical organization, particularly when involvement in patient care is part time. In such an organization, deliberate arrangements that enable patients with acute needs to receive care from their own doctors are needed.

Child Health Services↗