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At least 631 records · Page 35Linked to original sources
PubMed2006

Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records.

BACKGROUND: The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems. OBJECTIVES: To investigate whether a high stroke quality score is associated with adherence to RCP guidelines. DESIGN: Examination of computer and written medical records of all patients with a diagnosis of stroke. SETTING: Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age-sex profile and prevalence of stroke. RESULTS: One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%. CONCLUSIONS: Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice.

Adolescent↗
PubMed2004

Family physician workloads and access to care in Winnipeg: 1991 to 2001.

BACKGROUND: Current perceptions of family physician (FP) shortages in Canada have prompted policies to expand medical schools. Our objective was to assess how FP supply, workloads and access to care have changed over the past decade. METHODS: We used an anonymized physician and population registry and administrative health service data from Winnipeg for the period 1991/92 to 2000/01. We calculated the following measures of supply and workload: ratios of FPs to population, of population to FPs and of FP full-time equivalents (FTEs) to population, as well as FP activity ratios (sum of FTEs/number of FPs), annual number of visits per FP and visits per FP per full-time day of work. Trends in FP remuneration were analyzed by age and sex. We also measured standardized visit rates and stratified the analysis by populations deemed at risk of needing FP services. RESULTS: In 2000/01 FPs between 30 and 49 years of age (64% of the workforce) provided 20% fewer visits per year than their same-age peers did 10 years previously. Conversely, FPs 60 to 69 years of age (11% of the workforce) provided 33% more visits per year than the corresponding group a decade earlier. On a per capita basis, the number of FPs declined by 5%, from 97 per 100 000 population in 1991/92 to 92 per 100 000 population in 2000/01, which paralleled changes in national estimates of FP supply. Per capita visit rates among Winnipeg citizens (3.5 per year in 2000/01) and average workloads among FPs (4193 visits per year in 2000/01) were stable over the decade. INTERPRETATION: Despite relative homeostasis in aggregate FP supply and use, there have been substantial temporal shifts in the volume of services provided by FPs of different age groups. Younger FPs are providing many fewer visits and older FPs are providing many more visits than their same-age predecessors did 10 years ago, a finding that was independent of physician sex. Given these data, the perpetual focus of policy-makers and care providers on increasing numbers of FPs will not help in diagnosing or treating issues of supply, workloads and access to care.

Adult↗
PubMed2003

The moderating effect of alcohol intake on the relationship between work strains and psychological distress.

OBJECTIVE: This study investigated the extent to which alcohol intake modified the associations between psychological distress and work strains. METHOD: The data were obtained from a sample of 10,387 employees nested in 422 occupations. Four types of alcohol drinkers were defined according to drinker status measured by alcohol intake over the last week (1) abstainers, (2) drinkers who abstained from drinking in the last seven days, (3) low-risk drinkers (according to the Canadian guidelines), (4) high-risk drinkers. The Ilfeld scale was used to measure the level of psychological distress (referencing the last week). Work strains were measured according to Karasek's skills utilization, decision authority and psychological demands, as well as by regularity of work schedule, number of working hours per week, exposure to physical and chemical risks, job status and type of remuneration. Multilevel logistic regressions were conducted with adjustments for gender and age. RESULTS: 6.1% of the logit variance of psychological distress was between occupations. Alcohol intake showed a U-shaped relationship with psychological distress, and it was a moderator of skills utilization and exposure to physical risks. Decision authority, psychological demands, work schedule, gender and age were linked to psychological distress. CONCLUSIONS: Moderate alcohol intake is not associated with psychological distress and does not intensify the effect of work strains. The results give some support to the positive effect of moderate alcohol consumption on stress reduction and mental health.

Alcohol Drinking↗
PubMed2003

Evaluation of a peer-reviewed career development and compensation program for physicians at an academic health science center.

OBJECTIVE: The Department of Pediatrics at the Hospital for Sick Children, which is funded by an alternative payment plan, has implemented a novel career development and compensation program (CDCP). Job activity profiles were used to more clearly define job expectations, benchmarks guided career development, and peer review was used to assess performance. The objective of this study was to evaluate the departmental pediatricians' satisfaction with the CDCP. METHODS: Pediatricians, all of whom had undergone CDCP annual reviews, could participate if they had undergone the in-depth triennial CDCP review. Each received a 5-point Likert scale-based questionnaire that asked how well the CDCP had conformed to the principles identified by the department during the development of the CDCP. Anonymous, confidential responses were collated and used to guide focus groups that discussed areas of greatest concern and attempted to identify solutions. Focus groups were led by external facilitators who were experienced in qualitative research. They audiotaped the sessions, transcribed the comments, and analyzed the data with the assistance of a qualitative analysis application. RESULTS: Sixty of the eligible 88 pediatricians participated, and 74% of their responses were that the CDCP had addressed the original principles "somewhat," "to a great extent," or "extremely well." The remainder indicated that some of the principles were either "not addressed" or "only to a small extent" by the CDCP. Results from the 11 focus groups (46 participants) indicated that the CDCP was an improvement over the previous method of career development and determination of the rate of remuneration. Most were also still in agreement with the purpose and design principles. Although they did not want the CDCP to undergo a major redesign, they identified areas that need improvement. Short-, medium-, and long-term action plans to address these areas are under way. CONCLUSION: Pediatricians at the health science center of the Hospital for Sick Children remain supportive of the CDCP.

Academic Medical Centers↗
PubMed2006

Payments to children and adolescents enrolled in research: a pilot study.

OBJECTIVES: The goal was to identify current payment practices in research involving children. METHODS: A 4-page survey was mailed to the first author or corresponding author of pediatric research studies. Questions concerned whether children enrolled in research and/or their parents received any form of payment, values and types of remuneration, federal categories of pediatric research under which studies were approved, institutional policies regarding payments to children and/or their parents, institutional review board review of payment plans, factors that influenced payment decisions, prorating of payments, purposes of payments, perceived effects of payments on recruitment, and investigators' attitudes toward payments and the perceived risks and discomforts of studies. RESULTS: Payment practices varied, and the reasons for which investigators adopted particular payment practices varied. Approximately one half offered payment. The most popular form of payment was cash. The number of institutions with policies addressing directly payments for children enrolled in research has increased, but still only approximately one half of institutions studied had such policies in place. CONCLUSIONS: Awareness of the variations in payment practices and policies and additional study of the ethical issues surrounding payments for research participation are essential for building consensus and developing the guidelines the Institute of Medicine has said are necessary. Additional research also is needed to understand why parents enroll their children in research, how payments affect research participation decisions, and what the relationship between a study's risks and discomforts and payment should be.

Adolescent↗
PubMed1992

[The elderly person and retirement].

The present aimed at characterizing the retired old population (members of the retired people and pensioners Association of Ribeirão Preto, São Paulo) who live in this town. The study was carried out from 01/01/89 through 31/12/89. This population was composed of 38 retired and old age pensioners: 30 (78.9%) males and 8 (21.1%) females. It was used the method for data collecting which was the questionnaire with close and open questions; the used technique was the recorded interview. As in our country the retired benefit is inferior to be work's remunerations in the period of activity, the retired person is obliged to look for other ways of income to complement that benefit, and the medical assistance, where it was not expected by the population.

Age Distribution↗
PubMedDate not supplied

[The practice of teaching in the Alfredo Pinto Nursing School: press report (1946)].

UNLABELLED: This social historical study aims to analyze the content of reporting about teaching in the Alfredo Pinto Nursing School (1946). The theoretical reference is based on the language of word and image. METHODOLOGY: Organization of the reporting data was analyzed based on 13 subtitles and 14 photographic images, of which we single out four based on methodological criteria. RESULTS: The study indicated: 1) the fulfillment of basic requirements declared by the Ministry of Education and Health for the teaching of nursing, and: 2) the contribution of the EEAP (Alfredo Pinto Nursing School) to the teaching of nursing, which in addition to professional training, remunerated its students and offered a guaranteed place in the labor market.

Brazil↗
PubMedDate not supplied

[Genesis of hospital nursing in Goiás State].

The Hospital de Caridade São Pedro de Alcântara was created in the City of Goiás, being the first hospital institution implanted in the state. The work purposes to understand the historical-social context in which the "São Pedro" was implanted, looking for information about the structure and operation, especially what concerns to the nursing. The used approach was the dialectics. The results demonstrated the existence of ten nursing workers and that those were separate to patients' attendance according to gender. The work delivered by the male workers was better remunerated than the one delivered by female workers. The hospital and their servants, gradually, were assuming the responsibility for the ordering and cleanliness of the physical spaces, workers, prisioners, burials, etc. The work was arduous and badly paid.

Brazil↗
PubMed1993

[Arterial hypertension and possible risk factors].

The results of a cross-sectional (prevalence) study of high blood pressure, carried out in 1987 in Araraquara County in the north of S. Paulo State, Brazil are presented. The group studies numbered 1,199 people, including 533 men and 666 women, of from 15 to 74 years of age. The results show a high prevalence of the disease (32.0% for men and 25.3% for women), with a tendency to increase with age, up to the 40's (men) and the 50's (women). There was also a greater percentage of hypertensives in the mulatto and black groups, in the obese, and among those of lower family income, with a lower level of schooling and with less well remunerated jobs. However, the logistic regression showed very small odds ratios associated with these risk factors, which could be attributed to the way these factors were considered.

Adolescent↗
PubMed2001

[Home care for the elderly: profile of the formal caregiver -- Part I].

The frail elderly, maintained in its home, request specific cares, which are accomplished many times by people contracted, denominated formal caregivers, With the increase of offer of these people's work and the shortage on its profile, we developed a study with 41 advertisers that offered its services in two newspapers of larger circulation in the city of Campinas, São Paulo, with the following objectives: 1. to characterize these caregivers and 2. to verify the activities proposals for care to the elderly. In the present work the referring data are presented the caregivers' characteristics as: to the sex, the age, the formation and previous experience, schedule readiness and demanded remuneration.

Adult↗
PubMed2003

[Expected and unexpected absence of the nursing team of a university hospital at the university of Sao Paulo, Brazil].

The objective of this exploratory-descriptive study was to identify expected and unexpected absences of the nursing team at the inpatient units of the University Hospital at the University of Sao Paulo. Data regarding unexpected absences of the nursing staff employees of these inpatient units were assessed on a monthly basis for the year 2000. The percentage of the expected absences regarding remunerated weekly time off, holidays and vacations corresponded to 19%, 3:9% and 8.9%, respectively. The survey of percentage of unexpected absences showed a variation among indices found in each unit, thus indicating the possibility of an excess workload in some inpatient units.

Absenteeism↗
PubMedDate not supplied

[Professional medical identities in contention: The National Practitioners' Congress, Brazil (1922)].

The object of this paper is the debate among the Brazilian medical elite during the National Practitioners' Congress (Congresso Nacional dos Práticos - 1922). The article begins by analyzing a specific moment in the medical profession's history in early 20th-century Brazil, specifically Rio de Janeiro's 1922 National Practitioners' Congress. The author presents three profiles of medical practice observed in that context: generalists, specialists, and hygienists. He further analyzes their characteristics, similarities, and differences, as well as the strategies for professional affirmation adopted by physicians with these profiles. The article addresses the following issues: What were the relationships between the specialization process, forms of remuneration, and the construction of new professional identities? What identities did medical doctors create for themselves? What were the rivalries between these different professional identities? How did they portray outside competitors, such as the so-called traditional healers? Finally, the author presents several methodological suggestions that may contribute to historical research on the medical profession.

Brazil↗
PubMedDate not supplied

[The meaning of specialization for the nurse in the field of stomas].

This study aimed at knowing and understanding the meanings and perceptions of the enterostomal therapist (ET) about this specialty, using the methodological framework of Social Representation Theory. Three major Units were identified: the ET as a professional, the ET and the client, the ET as a person from an analysis of 12 ET's discourse. In relation to Enterostomal therapy, mainly positive representations were identified among nurses, such as: valorization, recognition, remuneration, promotion, satisfaction, ambition, professional prominence, improvement of care quality and client safety. On the other hand, demands and lack of recognition emerged as negative representations. These representations indicate specialty as an important dimension in professional evolution, a fact that has positively influenced the career of the nurse and that of the Enterostomal Therapist in particular. The ET's construct their existence, write their own history, driven towards autonomous and credible action, which allows them to conquer their space and give a new meaning to care--the basis of Nursing art and science.

Adult↗
PubMed2004

[Daily life and work: conceptions of chronic renal insufficiency (CRI) patients and their relatives].

This descriptive and exploratory research aimed to know the conceptions, attitudes and behaviors about work as reported by 16 chronic renal insufficiency patients and their relatives. Data were collected from April to August 2000 through semi-structured interviews. The results revealed that work is valued by all families as a source of health and financial resources, besides being important for individuals' character formation; that most CRI patients do not carry out any remunerated activities and, when they do, they count on the help and understanding of the boss and relatives. We conclude that CRI and its treatment do not directly or absolutely impede the realization of this kind of activity, but entail important limitations. We consider it is necessary for health professionals to join in the search for support by relatives and society, so that these people can be inserted in the labor market when they want to and are in the right conditions.

Activities of Daily Living↗
PubMed2005

[Profile of adolescents with repeated pregnancies attended at a prenatal clinic].

This study identified the biopsychosocial profile of adolescent with repeated pregnancies, who were attended at a prenatal clinic. Data were collected through patient records and interviews and were subject to quantitative analysis. Based on the obtained results and in accordance with literature, factors that are strongly associated with the occurrence of pregnancy repetition were selected in the adolescents' profiles. These are: early menarche; first sexual intercourse shortly after menarche; school repetition; school dropout; non remunerated occupation; low family income; involvement with older partners; living with the partner; consensual union with the partner; one partner; low condom use; family history of adolescent pregnancy; father's absence because of death or abandonment; positive family reaction to previous pregnancy; previous abortion; adolescent's positive concepts about previous delivery; and absence from previous postpartum consultations.

Adolescent↗
PubMed2005

[Adhesion to anti-retroviral therapy by individuals with HIV/AIDS seen at an institution in the interior of São Paulo].

Inadequate adherence to highly active anti-retroviral therapy (HAART) provokes important secondary effects in people living with aids. The objective was to identify the factors that make HAART adherence easy or difficult, according to aids patients attended at a university hospital in the state of São Paulo, Brazil. We interviewed 200 diagnosed aids patients using HAART for at least 6 months. Patients were interviewed individually, using a semi-structured design. Qualitative and quantitative analysis was used. 59% of the participants were men; average age was 38.2 years; 51% did not finish basic education; 50.5% did not perform any remunerated work. Patients had been using anti-retroviral agents for an average time of 5 years. The number of anti-retroviral pills ranged from 3 to 24. The main difficulties mentioned for adherence were: taste, size, number, smell of pills (40.0%); intense collateral effects (14.4%); psychological factors (13.7%); different times to take the pills (10.8%). Patients mentioned the following facilitators: coincidence of times to take the drugs (26.2%), no facility (16.4%), and administration associated to some habit (16.0%). The nursing group needs to reinforce supervised surveillance, educational and intervention actions.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[Quality of life at work among nursing professionals at surgical wards from the perspective of satisfaction].

This transversal and descriptive study aimed at evaluating the life quality of nursing professionals working at a surgical ward, using the Index of Work Satisfaction. Study participants were 105 workers; most of them women (82.9%), with an average age of 38. In this group, 69.5% were nursing auxiliaries and 11.4% were nurses. As to quality of life at work, scores varied between 114 and 227 (possible range of 44 to 308), with an average score of 169.7+/-25.9. The average score for the 44 items was 3.85, showing that workers were either dissatisfied or neither satisfied nor dissatisfied with the aspects mentioned in the instrument on quality of life at work. Satisfaction levels were lowest for remuneration and highest for the professional status domain. Authors found the instrument reliable for the study population, with a Cronbach's alpha of 0.81.

Adult↗
PubMedDate not supplied

Availability, safety, and quality of blood for transfusion in the Americas.

OBJECTIVES: This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. METHODS: We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. RESULTS: There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38% of the Regional population but 68% of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. CONCLUSIONS: The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized.

Blood Banks↗