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PubMed2000

Advanced practice 101: a "PERLL" for practice.

As advanced practice nursing students begin and continue their programs of study, they are often asked, "What is an advanced practice nurse, and what are the distinguishing characteristics?" For many students, articulating an answer is somewhat difficult, and some even fumble. Therefore, we have developed an acronym to help students organize their thinking in answering these questions. This acronym is a useful tool to help students discuss the characteristics of advanced practice nurses in an organized and well-thought-out manner, keeping in mind that some of these talking points should be customized to the individual state or regional requirements for advanced practice nursing.

Abbreviations as Topic↗
PubMed2003

Evidence-based practice in rural and remote clinical practice: where is the evidence?

OBJECTIVE: To critically review the evidence regarding barriers to implementing research findings in rural and remote settings, and the ways those barriers have been addressed. DESIGN: A systematic review that included searching several electronic databases, Internet sites and reference lists of relevant articles, assessment of methodological quality of the studies, and data extraction and analysis where possible. Eligibility for the review was not limited by study design. SETTINGS/PARTICIPANTS: Studies that reported on: (1) barriers to the implementation of evidence by health professionals in rural and remote areas, or (2) interventions for implementing evidence-based practice or an element of evidence-based practice in rural and remote areas. RESULTS: There were no experimental data available on the implementation of research findings in rural and remote clinical settings. The small amounts of empirical research undertaken (surveys) showed that some of the problems experienced by general practitioners were exacerbated by rural and remote location, particularly with relation to isolation, lack of time and locum cover, and poor information technology infrastructure. CONCLUSION: There is a paucity of empirical literature on implementing evidence-based practice in rural and remote settings. This is in contrast to the large amount of literature available on implementing evidence in other clinical settings. A clear finding from the literature was that getting evidence into practice needs to be context-specific and yet very little research has been conducted into the rural and remote context. Research is needed into how evidence can be implemented in contextually specific ways in rural and remote areas.

Data Interpretation, Statistical↗
PubMedDate not supplied

Predictors of health practices within age-sex groups: National Survey of Personal Health Practices and Consequences, 1979.

Health promotion-disease prevention programs share with health behavior research the common objective of identifying population subgroups toward whom services can be targeted. For this report, six age-sex groups were examined to determine similarities and differences in the predictors of eight health practice indices. Data were from the 1979 National Survey of Personal Health Practices and Consequences. Results showed very little similarity of predictors across the three age cohorts (20-34, 35-49, 50-64), between men and women, and among the six age-sex groups. No predictor achieved significance consistently for several health practices in any of the six groups, although years of education made the best showing. The lack of overlap among predictors helps to explain why health promotion messages and recruitment strategies may not appeal to as diverse an audience as initially intended. Possible explanations for the absence of similar predictors include differences in the nature of the various practices themselves, absence of data on intentions behind a person's behavior, and the "over-determined" character of an individual person's behavior.

Adult↗
PubMedDate not supplied

Family practice physicians' perceptions and practices regarding health promotion for the elderly.

This study assessed 321 family practice physicians' perceptions and practices regarding health promotion in the elderly; specifically, whether health promotion is perceived to be beneficial for this segment of the population. A random sample of 250 male and 250 female members of the American Academy of Family Physicians was surveyed. The internal reliability of the questionnaire was assessed, yielding a Cronbach alpha of .84. Respondents were 46% male and 54% female, and 67% of them had completed a residency program. Three-fourths (77%) of the respondents were between 25 and 50 years of age. The majority believed that health promotion counseling is of value to patients of all ages (88%) and that medical schools should devote more attention to preventive medicine (69%). These physicians identified lack of third-party payment, lack of sufficient staff, lack of competence in prescribing prevention programs for the elderly, and finding counseling the elderly about preventive health issues not professionally gratifying as barriers to health promotion of the elderly. All health promotion practices but one listed on the questionnaire were perceived as important by at least half the physicians. Until compensation for health promotion is available and physicians perceive themselves as competent concerning health promotion in the elderly, it is likely their clinical practices and recommendations will lag behind their favorable attitudes toward the topic.

Adult↗
PubMed1996

Scope of practice in audiology. Ad Hoc Committee on scope of Practice in Audiology.

This scope of practice in audiology statement is an official policy of the American Speech-Language Hearing Association (ASHA). The document was developed by the ASHA Ad Hoc Committee on the Scope of Practice in Audiology and approved in 1995 by the Legislative Council (8-95). Members of the ad hoc committee include David Wark (chair), Tamara Adkins, J. Michael Dennis, Dana L. Oviatt, Lori Williams, and Evelyn Cherow (ex officio). Lawrence Higdon, ASHA vice president for professional practices in audiology, served as monitoring vice president. This statement supersedes the Scope of Practice, Speech-Language Pathology and Audiology statement (LC 6-89), Asha, April 1990, 1-2.

American Speech-Language-Hearing Association↗
PubMed1996

Scope of practice in speech-language pathology. Ad Hoc Committee on Scope of Practice in Speech-Language Pathology.

This scope of practice in speech-language pathology statement is an official policy of the American Speech-Language-Hearing Association (ASHA). It was developed by the Ad Hoc Committee on Scope of Practice in Speech-Language Pathology: Sarah W. Blackstone, chair; Diane Paul-Brown, ex officio; David A. Brandt; Rhonda Friedlander; Luis F. Riquelme; and Mark Ylvisaker. Crystal S. Cooper, vice president for professional practices in speech-language pathology, served as monitoring vice-president. The contributions of the editor, Jude Langsam, and select the widespread peer reviewers are grateful acknowledged. This statement supersedes the Scope of Practice, Speech-Language Pathology and Audiology statement (LC 6-89), Asha, April 1990, 1-2.

American Speech-Language-Hearing Association↗
PubMed1997

[Professional conditions and satisfaction in general practice in 1993. Practice profile of Norwegian primary physicians].

European study of General Practice (GP) task profiles was carried out in 30 European countries in 1993. We analyzed the Norwegian results. 164 primary care physicians, 51% of a random sample, answered a questionnaire. 147 kept a diary on their practice for one week. Compared with results from two earlier studies performed 15 years ago, the proportion of female GPs had doubled to 25%, there were more group practices, more time was spent on vocational training and continuous education, and night service was less frequent than in 1978. 45% were specialists in general practice and 7% in community medicine. Job satisfaction was high, and highest for women, fee-for-service GPs on contract, and GPs who cooperated with other health professionals.

Adult↗
PubMedDate not supplied

The impact of the "Put Prevention into Practice" initiative on pediatric nurse practitioner practices.

INTRODUCTION: Pediatric nurse practitioners (PNPs) are committed to health promotion and disease prevention, especially for children and adolescents. In this project the "Put Prevention into Practice" materials, developed by the Office of Disease Prevention and Health Promotion of the United States Public Health Service, were disseminated to members of the National Association of Pediatric Nurse Associates and Practitioners and evaluated for their impact on child health outcomes. METHOD: The evaluation was conducted by chart review of patients seeing PNPs during the first year of national implementation of the project. Data were collected on a form designed for the study at the time of introduction of the materials into the PNPs' practice and 6 months later. Numbers of visits for health maintenance, illness, and emergency department use were compared before and after introduction of materials. Whether the parent brought the Child Health Guide to the visit was also compared before and after materials were introduced. In addition, immunization status, recording of height, weight, developmental screening, and hearing and vision screening were compared before and after introduction of materials. To obtain information about the materials and their applicability to patients, focus groups were used to elicit information from PNPs at two national meetings. RESULTS: Usable data were received from 14 PNPs representing 194 patients. The results indicated that use of the "Put Prevention into Practice" program increased immunization rates, health maintenance visits, documentation of developmental, hearing and vision screening, and car seat use. No change was seen in documentation of height, weight, and emergency department and illness visits. Members found that the materials were difficult to implement in some populations. Despite the small numbers of participants, these data suggest that use of the "Put Prevention into Practice" materials can improve consistency of preventive care for young children.

Child↗
PubMed2000

Dermatology practice management assures practice development and efficiency.

This article provides an overview of the disciplines involved in managing a dermatology practice today. Several key management processes, including strategic planning, financial analysis, advertising and public relations, information systems management, and compliance program development and monitoring are addressed. This article explores several possible tactics that can be used to help guide your practice in the right direction without overtaxing your resources. Also offered are possible solutions for creating an organization that is poised for success, and a management team capable of steering the practice through the sea of change ahead.

Advertising↗
PubMed2000

From clinical recommendations to mandatory practice. The introduction of regulatory practice guidelines in the French healthcare system.

In an effort to control ambulatory care costs, regulatory practice guidelines (références médicales opposables or RMOs) were introduced by law in France in 1993. RMOs are short sentences, negatively formulated ("it is inappropriate to..."), covering medical and surgical topics, diagnosis, and treatment. Since their introduction, physicians who do not comply with RMOs can be fined. The fine is determined by a weighted combination of indices of harm, cost, and the number of violations. The impact of the RMO policy on physician practice has been questioned, but so far few evaluations had been performed. At the end of 1997, only 121 physicians had been fined (0.1% of French private physicians). The difficulty of controlling physicians, the large number of RMOs, and the lack of a relevant information system limit the credibility of this policy. The simultaneous development of a clinical guideline program to improve the quality of care and of a program to control medical practice can lead to a misunderstanding among clinicians and health policy makers. Financial incentives or disincentives could be used to change physician behavior, in addition to other measures such as education and organizational changes, if they are simple, well explained, and do not raise any ethical conflict. But these measures are dependent on the structure and financing of the healthcare system and on the socioeconomic and cultural context. More research is needed to assess the impact of interventions using financial incentives and disincentives on physician behavior.

France↗
PubMed2006

Application of The APA Practice Guidelines on Suicide to Clinical Practice.

This article presents charts from The American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors, part of the Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, and a summary of the assessment information in a format that can be used in routine clinical practice. Four steps in the assessment process are presented: the use of a thorough psychiatric examination to obtain information about the patient's current presentation, history, diagnosis, and to recognize suicide risk factors therein; the necessity of asking very specific questions about suicidal ideation, intent, plans, and attempts; the process of making an estimation of the patient's level of suicide risk is explained; and the use of modifiable risk and protective factors as the basis for treatment planning is demonstrated. Case reports are used to clarify use of each step in this process.

Adult↗
PubMed2000

Is Australian rural practice changing? Findings from the National Rural General Practice Study.

The National Rural General Practice Study (NRGPS) was the first comprehensive national study covering rural and remote general practitioners throughout Australia. It was undertaken in 1996-1997 and drew on data from existing sources such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, together with a postal survey of general practitioners in rural and remote areas. There was a 75% response rate to the survey, which covered professional issues, personal and social issues, personal background, patient issues, recruitment and retention programs and changing health services. Overall, the study findings confirmed those of previous individual State-based studies in the early 1990s and showed that there had been some changes since those previous studies. In particular, access to continuing medical education has improved, the rural medical workforce appears to be ageing, the proportion of women rural doctors is increasing and the projected length of stay in rural practice is decreasing. Whereas in the early 1990s the projection for rural doctor numbers was continuing decline, the NRGPS projected overall numbers in rural practice as staying approximately the same over the next 5 years. In the light of these trends, the challenge is to implement targeted initiatives that improve the recruitment and retention of rural and remote general practitioners.

Adult↗
PubMed2002

Marrying modern health practices and technology with traditional practices: issues for the African continent.

One of the main sessions at the 2001 22nd Quadrennial Congress of the International Council of Nurses in Denmark explored the harnessing of modern health technologies for contemporary health care. The session theme of 'marrying the old and the new' is particularly important in societies where modern medicine and technology coexist with traditional approaches to health care; in this instance, its coexistence with traditional medicine in African societies. This coexistence has not been easy for many African countries. For some, overt exclusion from health care systems through prohibitive legislation has become the order of the day for traditional practitioners. On the other hand, there has been an increasing interest in traditional practices among modern health practitioners and a willingness to collaborate. Similarly, traditional practitioners are slowly beginning to incorporate aspects of modern medicine into their practice; notably the use of science and technology. This report describes the interface of modern medicine and technologies with traditional approaches to health care. Benefits and concerns raised by genetic, information, solar and environmental technologies at this interface, are discussed. Selected traditions and the challenges these bring to the practice arena, research, education and policy, are presented together with suggestions to reconcile old and new.

Africa↗
PubMed2002

Nutrition and physical activity counseling practices of family practice residents.

BACKGROUND: Nutritional behaviors and physical activity can influence risk for the development and prognosis of cancer. This study reports findings of a literature review and a survey of nutrition and physical activity counseling practices of family practice (FP) residents. METHODS: 110 FP residents (response rate = 93.2%) from four clinics that received funding from the Texas Department of Health completed the survey. Hierarchical linear regression models were used to identify determinants of nutrition and physical activity counseling practices. RESULTS: About a fifth of the residents reported that they usually or always asked their patients about nutrition and physical activity. In general, residents were most likely to address these issues with asymptomatic obese adult patients. Perceived effectiveness was a significant predictor of both assessment and counseling, except for nutrition counseling for asymptomatic patients. Attitude toward behavioral counseling predicted assessment, but not counseling. Use of resources predicted counseling on both topics with all patients. CONCLUSION: FP residents assess and counsel about nutrition and physical activity at suboptimal rates. There is a need to convince residents of the value of such assessment and counseling and to increase their belief that patients will follow through on their recommendations.

Adolescent↗
PubMed2001

Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers.

OBJECTIVE: The aim of this study was to ascertain opinions, current practices, likely readiness to change and perceived barriers to change among Australian GPs in order to develop a plan to implement national guidelines for smoking cessation advice. METHOD: A postal survey of randomly selected GPs in New South Wales, Australia was carried out. RESULTS: We received 311 returned questionnaires (73% response rate). Only 34% of respondents reported providing cessation advice during every routine consultation with a smoker, in accordance with national guidelines. Specific evidence-based approaches recommended in guidelines were under-utilized, with only 54% 'always' or 'frequently' arranging follow-up, 32% providing written materials and 28% setting a 'quit date'. Respondents were no more likely to advise quitting completely than the less effective method of nicotine fading. More than one in four respondents (28%) indicated readiness to change their behaviour. Respondents rated their patients' lack of motivation and uninterest as the most important barriers to smoking cessation advice in general practice. Neither uncertainty about effective smoking cessation strategies nor lack of reimbursement for smoking cessation advice were identified as barriers. CONCLUSIONS: A multicomponent intervention to address suboptimal behaviour and barriers as revealed by this survey holds considerable potential to plan effective implementation of smoking cessation guidelines in general practice. The use of readiness to change as a tool to 'individualize' strategies for guideline implementation should be explored.

Adult↗
PubMed1997

Medical superintendents with right of private practice in Queensland: practice, training and support.

This article presents the findings of a 1993 study into the work patterns, training and support needs of Medical Superintendents with Right of Private Practice (MSRPP), in Queensland funded by the Southern Queensland Rural Division of General Practice. These doctors form a small but significant subset of the medical workforce with a diverse range of duties, and until now there has been no formal study of their professional and family circumstances. Survey and interview data indicate that MSRPPs are a group subject to considerable professional and social pressure, usually in isolated practice and therefore vulnerable to attrition. This study aimed to provide a clearer identification of what MSRPPs do, what they need and how these needs can be met; and thus to contribute to more favourable retention rates for this sub-set of the rural medical workforce.

Adult↗
PubMed2004

Practice, clinical management, and financial arrangements of practicing generalists.

OBJECTIVE: To describe the practice settings, financial arrangements, and management strategies experienced by generalist physicians and identify factors associated with reporting pressure to limit referrals, pressure to see more patients, and career dissatisfaction. DESIGN: Cross-sectional mail survey. PARTICIPANTS AND SETTING: Six hundred nineteen generalist physicians (62% response rate) caring for managed care patients in 3 Minnesota health plans during 1999. MEASUREMENTS AND MAIN RESULTS: Twenty-six percent of physicians reported pressure to limit referrals. In adjusted analyses, female physicians and those who were board certified acted as gatekeepers for most of their patients, received incentives based on performance reports and quality profiles, and received direct income from capitation, and were more likely than others to report this pressure (all P <.05). Sixty-two percent reported pressure to see more patients. In adjusted analyses, this pressure was more frequent among physicians in practices owned by health systems, those using physician extenders, and among physicians paid by salary with performance adjustment or those receiving at least some capitation (all P <.05). One-quarter (24%) of physicians were dissatisfied with their career in medicine. In adjusted analyses, physicians reporting pressure to limit referrals (risk ratio, 1.12; 95% confidence interval, 1.01 to 1.19) and those reporting pressure to see more patients (risk ratio, 1.37; 95% confidence interval, 1.08 to 1.66) were more likely to be dissatisfied than other physicians. CONCLUSIONS: Pressures to limit referrals and to see more patients are common, particularly among physicians paid based on productivity or capitation, and they are associated with career dissatisfaction. Whether future changes in practice arrangements or compensation strategies can decrease such physician-reported pressures, and ultimately improve physician satisfaction, will be an important area for future study.

Adult↗
PubMed2004

Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee.

Guidelines for clinical practice are intended to indicate preferred approaches to medical problems as established by scientifically valid research. Double-blind placebo-controlled studies are preferable, but compassionate use reports and expert review articles are utilized in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identified as a consensus of experts. Guidelines are applicable to all physicians who address the subject without regard to the specialty training or interests and are intended to indicate the preferable but not necessarily the only acceptable approach to a specific problem. Guidelines are intended to be flexible and must be distinguished from standards of care, which are inflexible and rarely violated. Given the wide range of specifics in any health-care problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. Each has been extensively reviewed and revised by the Committee, other experts in the field, physicians who will use them, and specialists in the science of decision of analysis. The recommendations of each guideline are therefore considered valid at the time of their production based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at the publication in order to assure continued validity.

Adult↗