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PubMed1999

[Attempts at innovations in the practice of teaching and practicing psychiatric nursing].

In the context of recent changes that are taking place in the field of mental health care in Brazil, the University has the responsibility to redimensioning human resources qualification of mental health workers. At the Mental Health Care and Educational Program of the University of São Paulo and São Paulo Health Office (São Paulo/Brazil), an experience still in course, the nursing students attending to psychiatric nurse training evaluated that theoretical-practical education dealing with health care issue in the field of Psychosocial Rehabilitation purpose, at the same time that directly interferes in the qualification of practices, simultaneously develops the students attitudes and knowledge that qualify them to perform coherent practices in accordance with rehabilitation models of care.

Attitude of Health Personnel↗

PubMed2004

From dialysis outcomes quality initiative to kidney disease outcomes quality initiative: new clinical practice guidelines in nephrology--what the practicing pharmacist needs to know.

The use of clinical practice guidelines (CPGs) to guide rational treatment of patients is hardly novel to most areas of medicine or pharmacy but is a relatively new concept in nephrology where practice patterns have been dictated predominantly by opinion. This situation has undergone significant and dramatic change in the last few years, however, and CPGs have now been produced to address the management problems that face clinicians caring for patients with kidney diseases. This is the first of a series of planned articles designed to review these new kidney-related CPGs that are most likely to affect the practice of pharmacy in many areas. This article provides a broad overview to the background of the development of CPGs in nephrology and the methodology used. Subsequent articles will identify in some detail current and pending CPGs that relate to pharmacotherapy.

Humans↗

PubMed2006

Public health asks of systems science: to advance our evidence-based practice, can you help us get more practice-based evidence?

Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice. We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice. What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?

Evidence-Based Medicine↗

PubMed1980

Part and whole practice for a tracking task: effects of task variables and amount of practice.

Whole and part methods were compared to test Naylor's hypothesis that, in a task of high organization, whole methods should become more efficient with increased complexity. Task complexity was varied by having two levels of display-control relationship. The part versus whole comparisons were made in two conditions, one requiring early changeover, the other later changeover to whole task practice. In the early changeover condition no significant differences were found between part and whole methods at either level of complexity. With later changeover, on the other hand, pure part training was inferior to whole training in the high complexity task. This result was present only in the first block of whole practice. No differences were found with the low complexity task. The experiment offers limited support for Naylor's hypothesis. The predicted superiority of the whole method in the high complexity task was only short lived and disappeared with further practice. Furthermore, this prediction was upheld only with later changeover to whole task performance.

Humans↗

PubMed1989

Perceived and presented morbidity in general practice. A study with diaries in four general practices in The Netherlands.

In four general practices in The Netherlands, 277 respondents reported in a diary on perceived morbidity during four weeks. Data of presented morbidity were provided by the general practitioners in these practices, who were accustomed to morbidity registration. As a mean, one complaint was reported every three or four days. Most complaints concerned disorders of the musculo-skeletal system, psychological disorders, and disorders of the upper respiratory tract and the digestive tract. About one-third of all complaints led to medicine taking. According to the GPs' records, one in five of the respondents consulted their GP. Approximately 10% of the complaints were reported to the GP. There was a connection between family members with respect to the frequency of reporting complaints. Because of selection of participating practices, families and respondents, the result can not be applied to the Dutch population as a whole. The results of this study agree with most of the literature on this subject.

Family Practice↗

PubMed1992

Reasons for contact in family practice. An Icelandic multicentre study on content of practice.

To establish data on the patient's reasons for a contact, as a part of data on content of Icelandic family practice, a prospective practice audit was made of 16 Icelandic health centres with computerized contact data from 1 January to 31 December 1988. The study comprised 16 community health centres in Iceland and their target population, 12 rural and four urban. The reasons for contact in the study group are analysed. A total of 284348 reasons for contact were analysed; 36-39% were for symptoms and 44-50% were initiated by health professionals. The latter included renewal of prescriptions, which comprised 17-18% of all reasons for contact. Musculoskeletal symptoms were the most common symptomatic complaint, 6.6-7.3% of all reasons for contact. The five most often stated symptoms were: rash, cough, cold, lower limb symptoms, and fever. A "reason for contact" record increases the understanding of the patient's presenting complaint, as well as the patient's agenda in each contact. This record gives an opportunity to follow the presenting complaint in the continuous process of care i. e. reason for contact diagnosis, management, and follow-up. We are reminded that common things are common in family practice; nevertheless more research is needed to understand the process of care.

Community Health Centers↗

PubMed1993

Group practices and hospital affiliation of medical practices.

Federal reimbursement systems, state constitutional amendments, and fiscal responsibilities are driving physicians and hospitals into alliances that were unheard of a decade ago. How those alliances are established is critical to the success of those new affiliations. James Unland explores several forms of physician groups and physician-hospital alliances. The "Group Practice Without Walls," "The Mutual Service Corporation" and others are explored in this article. In a world of changing health-care programs, Unland states there is a middle ground where group-practice ownership and control are shared. The exact type of structure, ownership, and control will depend upon many factors. Unland makes a point-by-point evaluation of a hospital-group alliance that integrates numerous medical practices into a single operational entity.

Costs and Cost Analysis↗

PubMedDate not supplied

Physicians and managed care: practical ways hospitals can contribute to medical practice stability.

Running a medical practice in today's managed care environment is difficult even for seasoned physicians. In fact, it can turn a medical practice into a financial nightmare. Healthcare executives can help strengthen hospital-physician relations by offering physicians several management solutions to help stabilize and control their medical practices.

Hospital-Physician Joint Ventures↗

PubMed2001

Otitis externa in UK general practice: a survey using the UK General Practice Research Database.

BACKGROUND: Otitis externa is a common clinical problem in general practice and yet there are remarkably few data available on the demographic characteristics of patients with this condition and the approaches used by general practitioners (GPs) in the United Kingdom (UK) to manage it. AIM: To define the descriptive epidemiology of otitis externa in the general population, to describe the first-line drug treatment used by UK GPs, and to determine factors related to second disease episodes. DESIGN OF STUDY: Epidemiological data survey. SETTING: All cases of otitis externa occurring in 1997 in practices contributing data to the UK General Practice Research Database. METHOD: Data were extracted on age, sex, date of episode of otitis externa, treatment prescribed, co-existing diagnoses of eczema and diabetes, referral to ear, nose, and throat departments and occurrence of subsequent episodes of disease. Arbitrarily a second episode of disease was defined as persistence if it occurred at 28 days or fewer after the first episode and recurrence if it occurred at more than 28 days after the first episode. RESULTS: A diagnosis of otitis externa was common in all age groups and, except in the elderly, was more common in females than males. There was an increase in disease episodes at the end of the summer in all age groups except the 60 years and over group. In the majority of cases GPs prescribed ear drops (85%), but a significant proportion of patients were also prescribed oral antibiotics (21%). Referral to secondary care was uncommon (3%). Among patients prescribed ear-drop formulations, those containing both steroid and antibiotic or steroid alone were used most commonly and were associated with the lower rates of disease persistence but not recurrence. Among patients prescribed antibiotics, penicillins were prescribed most commonly. Disease persistence rates, and to a lesser extent disease recurrence rates, were higher in patients prescribed oral antibiotics. CONCLUSION: Otitis externa is a common condition and GPs can expect to see an excess of cases at the end of the summer. Topical ear drops are the most common treatment used in the UK. Patients prescribed steroid or steroid/antibiotic combination ear drops have fewer subsequent consultations for otitis externa over the following 28 days.

Adolescent↗

PubMed2001

Missed appointments in general practice: retrospective data analysis from four practices.

Little is known about which patients miss appointments or why they do so. Using routinely collected data from four practices, we aimed to determine whether patients who missed appointments differed in terms of their age, sex, and deprivation scores from those who did not, and to examine differences between the practices with respect to missed appointments. The likelihood of someone missing at least one appointment was independently associated with being female, living in a deprived area, and being a young adult. Living in a deprived area was associated with a threefold increase in the likelihood of missing an appointment, and the extent of this association was the same across all four practices. Interventions aimed at reducing missed appointments need to be based upon these findings.

Adolescent↗

PubMed1975

Matched controls in surveys of the use of general practice. Another use for research practice age-sex registers.

This paper describes how an age-sex register may be used as a sampling frame for the selection of matched controls in studies of the use of general practice. It discusses both the analysis of data collected in this way and the advantages and limitations of the method itself. The application of the method to a case-study suggests that patients who use hospital accident departments are also high users of general practice. Although care is needed in the interpretation of such results, it is concluded that matched controls can be used to ameliorate some of the problems of research in general practice.

Age Factors↗

PubMed1975

Continuity of care in family practice. Part 4: implementing continuity in a family practice residency program.

Although continuity of care is an important goal of family practice residency programs, there are many factors which inevitably prevent its full achievement by individual residents in any program. Each resident is frequently faced with conflicting responsibilities involving the Family Practice Center, inpatient clinical services, and other parts of the residency training program. This paper explores this dilemma and suggests a variety of positive approaches to resolve the issue. All family practice residents must necessarily be intimately involved in providing continuity of patient care and develop the requisite skills and attitudes. However, full continuity of care must ultimately be provided on a program and group level, not exclusively by the individual resident.

Comprehensive Health Care↗

PubMed2003

Prevention of early childhood caries in North Carolina medical practices: implications for research and practice.

Early childhood caries is a significant public health problem in low-income children, with important negative consequences for the child and the family. The purpose of this paper is to describe the development, implementation, and preliminary outcomes of preventive dentistry programs in North Carolina that target low-income children from birth to thirty-five months of age. The focus is on Into the Mouths of Babes, a statewide program in which pediatricians, family physicians, and providers in community health clinics are reimbursed by Medicaid to provide preventive dental services for children (risk assessment, screening, referral, fluoride varnish application) and caregivers (counseling). The provider intervention includes continuing medical education lectures and interactive sessions, practice guidelines for the patient interventions, case-based problems, practical strategies for implementation, a toolkit with resource materials, and follow-up training. In the first two years of the statewide program, 1,595 medical providers have been trained. The number of providers billing for these services has steadily increased, and by the last quarter of 2002, the number of visits in which preventive dental services were provided in medical offices reached 10,875. A total of 38,056 preventive dental visits occurred in medical offices in 2002. By the end of 2002, only sixteen of the state's one hundred counties had no pediatrician, family physician, or local health department participating. The preliminary results from this program demonstrate that nondental professionals can integrate preventive dental services into their practices. The program has increased access to preventive dental services for young Medicaid children whose access to dentists is restricted. Assessments of effectiveness and cost-effectiveness of both the provider and patient interventions are under way.

Cariostatic Agents↗

PubMed2003

Explaining variations in reported diabetes prevalence in general practice: how much variation is explained by differences between practice populations?

There are large variations in reported diabetes prevalence within United Kingdom (UK) populations. Linear regression was used to investigate whether population characteristics could explain the variation in prevalence between 19 practices with relatively complete diagnostic recording. Population obesity and South Asian ethnicity largely explained observed variation in prevalence (adjusted R2 = 0.80). When adjusted for obesity and ethnicity, the deprivation score was no longer a predictor of diabetes prevalence. If true variation in prevalence between practices is largely predicted by population ethnicity and obesity, these population characteristics could be used to predict expected prevalence and to assess the completeness of practice registers.

Aged↗

PubMed2004

General practice east of Eden: an overview of general practice in Eastern Europe.

AIM: To review the status of family medicine in Eastern European countries, specifically the position of the discipline within the health care system, its academic status, and expected trends in the development of the discipline. METHODS: We used available data in the literature and information gathered from personal contacts with members of European Society of General Practice/Family Medicine (ESGP/FM) expert groups, European Academy of Teachers in General Practice (EURACT), and European General Practice Research Network (EGPRN). Personal interviews with key informants from countries that do not have members in these organizations were used. We also performed a Medline search using terms "primary health care" and "family medicine". RESULTS: It was difficult to get standardized information about the issues addressed. In some countries, contact persons and articles were impossible to find. Because of that, information from some countries is lacking (e.g. Belarus, Ukraine, the Kavkaz states and Central Asian republics). The information from the 14 countries showed that family medicine was formally widely recognized as a specific discipline. In 13 of them, there were some programs of vocational training. In 10 countries, academic recognition has resulted in rapid development in the past two decades, especially after 1989, but in Bulgaria and Moldova we found no evidence of family medicine departments. CONCLUSION: The position of general practice in most Central and Eastern European countries is formally adequate, but a lot of effort will still be needed to achieve the desired level of its recognition and quality.

Europe, Eastern↗

PubMedDate not supplied

[Health Search--Research Institute of the Italian Society of General Practice: the creation of a research database in general practice].

OBJECTIVE: To describe a database used in general practice by analysing the characteristics of the physicians providing the data and the completeness of the data recording on the basis of the indicators of interest (smoking habits, weight, height, and the prevalence of hypertension). DESIGN: Descriptive study and multiple linear regression analysis of the relationships between structural variables and outcomes. SETTING: General practitioners (GPs) belonging to the Italian Society of General Medicine (SIMG), and enrolled in Health Search (HS). POPULATION: Six hundred and ninety-five voluntarily enrolled GPs and their patients. PRINCIPAL OUTCOMES: Descriptive statistics (mean and median values, standard deviation, frequencies) concerning the general characteristics of the GPs, the ways in which they connect to the network and their use of the clinical data management software, and epidemiological measures concerning the prevalence of hypertension among their patients, and the recording of weight, height and tobacco smoking habits. RESULTS: The geographic distribution of the GPs is homogeneous: 317 in Northern Italy (12.52 physicians per 10(6) patients), 134 in Central Italy (12.30 physicians per 10(6) patients) and 244 in Southern Italy and the Islands (11.89 physicians per 10(6) patients). Five hundred and ninety-five (85.6%) are males; their mean age is 46.7 years (SD +/- 3.8); the mean number of patients per physician is 1128; 69% have at least one post-graduate specialisation; 49% practise alone; and they work for a mean of 30 hours per week (SD +/- 13). Five hundred and fifty-three GPs were actually connected to the network as of January 2003. The data relating to the years 2000-2001 show an increase in the number of connected physicians (34 in 2000 and 261 in 2001) and in the number of connections (a median of 12 in 2000 and 17 in 2001). The GPs contact more than 80% of their patients every year. The frequency of the recording of data concerning smoking habits, weight and height increases in proportion with the frequency of connections. The prevalence of hypertension among the patients included in the survey is 5.4%. Multiple regression analysis showed that the variability in the prevalence of hypertension was not influenced by the frequency of PC use but by the different structure of the age classes of the patients. CONCLUSIONS: This study of the variables relating to GPs, their clinical practices, and their use of computerised records (examined by means of the chosen indicators) shows that the regular and complete recording of the principal data of health interest is feasible insofar as it is not biased by the characteristics of the GPs, and advantageous. The construction of the database therefore represents a first step towards the initiation of routine research into general practice in Italy.

Biomedical Research↗

PubMed2006

[Fall incident reports in theory and practice: recommendations for developing of practice-oriented fall incident reports in nursing homes].

Nursing home residents are known to be subject to a special risk for falls and fall-related injuries. The collection and analysis of root-causes and conditions of a fall in fall incident reports represent a vital instrument for secondary prevention and quality management. Preceding falls are proven to be one of the most important risk factors for repeated falls. Therefore it is recommended to report and evaluate the situation, in which the fall happened, in order to develop strategies for preventing repeated falls and for minimising the consequences of a fall. The question arises, how a fall incident report should look like, to meet both the scientific requirements and the expectations of the user in practice. To answer this question, six fall incident reports selected from theoretical and practical sources were described and analysed. After systematic analysis of the related German-language literature and conduction of some partly-structured interviews with different user groups the goals and requirements for fall incident reports were identified. Based on these targets and requirements as well as on the recommendations of national experts and scientific literature, criteria for evaluating fall incident reports were developed. None of the selected reports meets all the criteria. Finally, based on the theoretical and practical recommendations, components for fall incident reports were developed which meet both the criteria found. These components are guidelines for healthcare action based on the care process and, if followed properly, an important tool for fall prevention and for protecting nursing homes against liability claims.

Accidental Falls↗

PubMed1995

Practicing pathology through multiple hospitals at multiple sites. Practice management issues.

OBJECTIVE: To describe a successful method of management for pathologists to use in an environment of hospital consolidation and managed care. DESIGN: This article draws on the experience of a large, pathologist-owned regional laboratory in applying management principles needed for practice in the future. SETTING: A group of 20 pathologists, with 19 affiliated pathologists (multiple groups) practicing in rural and urban areas of five states in the Southern Plains. PRINCIPAL FINDINGS: Planning, personnel management, organizational structure, finance, and information systems are necessary keys for pathology management in a dispersed system. CONCLUSION: The opportunity exists for a professionally and economically satisfying practice in the medical environment of the future.

Clinical Laboratory Information Systems↗