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At least 577 records · Page 32Linked to original sources
PubMedDate not supplied

The role of the renal specialist nurse in prevention of renal failure.

This article will investigate the care required for those with reduced renal function before renal replacement therapy (RRT) commences. Renal nurses are often involved with the technical, monitoring and evaluative aspects of RRT for those with end stage renal failure. However, many patients may experience reduced renal function many years before reaching the stage of needing RRT. Renal nurses are already involved in the preparation of patients for RRT, but are not presently exercising their specialist skills in the period before this time by contributing to the prevention of end stage renal failure (ESRF). Screening programmes carried out in various parts of the world demonstrate that many members of the population have undetected renal insufficiency, and may benefit from intervention from the nephrology team to prevent further renal dysfunction. It is for this group of patients that this article will consider the potential for the renal nurse to expand their scope of practice.

Diabetes Complications↗
PubMed1997

Implications of managed care for health systems, clinicians, and patients.

The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to the for-profit sectors and from hospitals and doctors to private corporations. It has also raised issues about the future structuring and financing of medical education and research and about practice ethics. However, managed care has also accorded greater prominence to the assessment of patient satisfaction, profiling and monitoring of doctors' work, the use of clinical guidelines and quality assurance procedures and indicated the potential to improve the integration and outcome of care.

Choice Behavior↗
PubMed1999

The virtue of nursing: the covenant of care.

It is argued that the current confusion about the role and purpose of the British nurse is a consequence of the modern rejection and consequent fragmentation of the inherited nursing tradition. The nature of this tradition, in which nurses were inducted into the moral virtues of care, is examined and its relevance to patient welfare is demonstrated. Practical suggestions are made as to how this moral tradition might be reappropriated and reinvigorated for modern nursing.

Education, Nursing↗
PubMed2005

False dichotomies: EBM, clinical freedom, and the art of medicine.

According to numerous commentators, clinical freedom, the art of medicine, and, by implication, a degree of patient welfare, are threatened by evidence based medicine (EBM). As EBM has developed over the last fifteen years, claims about better evidence for medical treatments, and improvements in healthcare delivery, have been matched by critiques of EBM's reductionism and uniformity, its problematic application to individual patients, and its alleged denial of the continuing need for clinical interpretation, insight, and judgment. Most of these attacks on EBM and defences of clinical freedom fail. They are based on erroneous understandings of the relationships between inductive knowledge, clinical uncertainty, and action. Evidence based medicine is a necessary condition for clinical freedom, not a threat to it, and EBM is not something to be balanced with either clinical experience or patient preferences. The art and science of medicine are more conceptually and practically connected than the defenders of clinical freedom, whatever they conceive that to be, are willing to admit.

Biomedical Research↗
PubMed1999

Dutch occupational physicians and general practitioners wish to improve cooperation.

OBJECTIVES: To investigate cooperation between occupational physicians (OPs) and general practitioners (GPs). METHODS: Literature review; structured interviews; questionnaires sent to randomised samples of OPs (n = 232) and GPs (n = 243). RESULTS: Actual cooperation is poor. However, more than 80% of both groups responded that they want to improve their cooperation, aiming at better quality of care. Obstacles identified by OPs include insufficient knowledge among GPs about occupational health services (OHSs) (57%) and their patients' working conditions (52%). OPs also consider that GPs suspect them of serving employers more than employees (44%) and of verifying reasons of absence, with information from GPs (34%). Responses from GPs confirm these two suspicions (48%, response 58%), adding obstacles like commercialisation of OHS, lack of financial incentives, etc. Both groups are unanimous about prerequisites for improvement, especially guaranteeing the professional autonomy of OPs (OPs 86%, GPs 76%). CONCLUSION: As a first step to overcome obstacles to cooperation, OPs must clarify their position to GP colleagues. Initiatives have been taken after presenting this study.

Family Practice↗
PubMed2002

The impact of reimbursement systems on occupational therapy practice in Canada and the United States of America.

Different funding and cost-control mechanisms in Canada and the United States of America (USA) have a powerful influence on occupational therapy practice in each country. Canada's public health insurance system emphasizes access to health care services based on medical need. Costs are controlled at the provincial government level by limiting the capacity of facilities and personnel. Occupational therapists in publicly-funded settings have considerable professional autonomy to use occupational therapy theoretical models and to be client-centred. The measurement of outcomes is not always required and the interventions of individual occupational therapists are infrequently scrutinized. The USA has no universal, publicly-funded, comprehensive health insurance. Health care policies are driven by financial priorities and cost control occurs at the service delivery level. Insurance companies define the scope of occupational therapy practice by identifying what services they will pay for and they scrutinize occupational therapy interventions. The emphasis on effectiveness and efficiency leads to critical examination of interventions by therapists. Canadian occupational therapists can learn much from their colleagues in the USA in this area.

Canada↗
PubMed1996

The moral foundations of scientific ethics and responsibility.

Any significant involvement of AADR/IADR in ensuring responsible research among their members must be grounded in a widely accepted consensus that there are good moral reasons for such involvement. One important source of such reasons is AADR/IADR's identity as a scientific research, a professional, and a dental association. These identities and the commitments to society and to clients implicit in them generate several mutually reinforcing reasons for taking responsibility for the reliability of members' research. With regard to scientific research, these reasons arise from what it means to do such research, and from the various ways the larger society supports that activity. With regard to the professional dimension, the reasons arise from what it means to be a profession in this society and can be best seen in relation to the four major characteristics of professions. With regard to AADR/IADR's being a dental profession, such reasons arise from dental researchers' specific role in the dental family of professions' goal of delivering optimal care to the clients of practitioners. The clients' perspective, specifically the need to be able to trust that one will receive the best care possible, is a final source for such reasons. Two current issues, the sharing of findings and commercial/industrial support for research, give new urgency to this question of the Association's role in ensuring responsible research.

Biomedical Research↗
PubMedDate not supplied

Diabetes educators: assessment of evolving practice.

A survey evaluating the professional characteristics and practice patterns of diabetes educators was distributed across the United States. The specific survey aims were to assess whether (1) there continues to be a growing trend among US health professionals who consider themselves diabetes educators to obtain certification as certified diabetes educators (CDEs), (2) duties/services associated with diabetes self-management training (DSMT) and medical/medication management differ between diabetes educators who are CDEs versus those who are non-CDEs, and (3) educator practice patterns differ across the major geographic regions of the United States. Of the 507 diabetes educators completing the survey, 83% identified themselves as CDEs. Diabetes educators responding to similar surveys done in 1992 and 1999, 51% and 63%, respectively, identified themselves as CDEs. In this survey, a similar percentage of CDEs and non-CDEs employed DSMT practices of relatively low complexity (eg, general diabetes education) whereas a significantly higher percentage (P < .001) of CDEs employed DSMT practices of relatively high complexity (eg, insulin pump training). Significantly (P < .001) more CDEs provided medical/medication management services compared to non-CDEs. Finally, the practice patterns among CDEs were minimally influenced by region of the country. These results suggest that (1) the trend toward increased certification among diabetes educators has continued, (2) certification is associated with a greater likelihood of delivering complex DSMT services and medical/medication management, and (3) this pattern is consistent across the nation as a whole.

Certification↗
PubMed2002

Satisfaction and well-being of primary care providers in managed care.

We compared perceptions about the practice environment and the job satisfaction of physician assistants (PAs), nurse practitioners (NPs), and primary care physicians in a large group-model HMO. The data source was a self-administered mail survey (average response rate = 79%). PA/NPs and primary care physicians reported that professional autonomy was not a problem and were satisfied with most aspects of practice in this setting. Common areas of dissatisfaction included patient load and amount of time with patients. PA/NPs were more likely than the physicians to experience stress on a daily basis, however, and were less likely to report that they would choose the practice setting again. They also were significantly less satisfied than the physicians with their incomes and fringe benefits. Our findings suggest that more attention should be given to practice conditions and compensation of PAs and NPs in managed care.

Adult↗