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At least 667 records · Page 37Linked to original sources
PubMed2000

Computer education. Don't forget the older GPs.

OBJECTIVE: To implement and evaluate a computer education and support program for GPs. METHODS: A 'hands-on' curriculum, based on small group learning in a clinical computing laboratory and supported via the Internet, was developed and implemented. Evaluation was threefold: observations during lessons; interviews; and participants completing a questionnaire before and six months after the course. A randomly selected group of GPs from the same region completed a modified version of the 'before' questionnaire at the same time as participating GPs were completing their six month questionnaire. Participants included 128 GPs in a computer education program in Victoria (Australia) plus 127 'control' GPs. Outcome measures were self reported computing skill, attitudes to and actual use of clinical applications. RESULTS: Six months after training, there was a significant increase in self reported computer skill (p < 0.01). Multivariate regression found that, after controlling for gender, practice characteristics, and previous training, the older (> 55 years) GPs reported greater change in their skills than their younger colleagues. The increased skill happened regardless of which or how many modules were completed, and included use of email, the Internet, computers for research and electronic prescribing. Awareness of relevant computer applications, confidence with computers and intention to use applications also increased. Participants found the dedicated clinical computing laboratory useful; however, there are significant issues with maintenance and keeping systems up-to-date. CONCLUSIONS: The computer education and support program was relevant to GP needs, deliverable and effective in improving skills and utilisation. Divisions and other GP organisations should be assisted to establish similar education and support programs and, perhaps, target older doctors.

Adult↗
PubMed2001

Combined homicide-suicide in Galveston County.

Combined homicide-suicides have been classified based on the psychopathology of the perpetrator and the nature of the relationship between perpetrator and victim(s). To further understand the nature of this tragic phenomenon and to test the validity and practicality of a previously suggested classification system, investigators systematically collected data on all combined homicide-suicide events that occurred in Galveston County, Texas over a continuous 18-year period (n = 20). The most common psychopathological finding for perpetrators was high serum alcohol levels that suggested intoxication. Most combined homicide-suicides fell into one of the relational categories and most of these, as predicted, were of the consortial type, possessive subtype. As expected, due to the small sample size, the less common types of combined homicide-suicide were not represented in this sample.

Adolescent↗
PubMed2002

Short term locum tenens for rural practice: a trial of a Japanese medical school.

This study investigated locum tenens dispatch to rural practices organised by a medical school. Locum tenens has not been studied previously in rural general practice, and little has been reported about locum dispatch from an academic institution. Since 1990, Jichi Medical School (JMS) has sent faculty members as locum tenens to rural practices where its graduates have been working. The details of all locum dispatches between 1990 and 1996 were reviewed and analyzed. Locum dispatches were performed 486 times for a total of 1233 days from April 1990 to March 1996. Locum relief was supplied to 15 group practices and 42 solo practices which are located throughout most of Japan. Most locum reliefs (98.1%) were short and less than one week. There was a wide variety of reasons for requesting a locum, ranging from official to personal. The three main reasons were practice support (30.5%), continuing medical education (13.8%) and physician absence (13.8%). These reasons were different between solo and group practices. Solo practices had a more diverse range of inquiries than group practices. In group practices, practice support amounted to over half of the inquiry reasons. Rural practices face a wide range of circumstances which necessitate locum dispatch. Organised locum dispatch by a medical school can provide practical support of rural practices through locum tenens dispatch.

Humans↗
PubMed2002

Human umbilical cord blood cells express neural antigens after transplantation into the developing rat brain.

Recently, our laboratory began to characterize the mononuclear cells from human umbilical cord blood (HUCB) both in vitro and in vivo. These cryopreserved human cells are available in unlimited quantities and it is believed that they may represent a source of cells with possible therapeutic and practical value. Our previous molecular and immunocytochemical studies on cultured HUCB cells revealed their ability to respond to nerve growth factor (NGF) by increased expression of neural markers typical for nervous system-derived stem cells. In addition, the DNA microarray detected downregulation of several genes associated with development of blood cell lines. To further explore the survival and phenotypic properties of HUCB cells we transplanted them into the developing rat brain, which is known to provide a conducive environment for development of neural phenotypes. Prior to transplantation, HUCB cells were either cultured with DMEM and fetal bovine serum or were exposed to retinoic acid (RA) and nerve growth factor (NGF). Neonatal pups (1 day old) received unilateral injection of cell suspension into the anterior part of subventricular zone. One month after transplantation animals were perfused, their brains cryosectioned, and immunocytochemistry was performed for identification of neural phenotypes. Our results clearly demonstrated that approximately 20% of transplanted HUCB survived (without immunosuppression) within the neonatal brain. Additionally, double-labeling with cell-type-specific markers revealed that some HUCB-derived cells (recognized by anti-human nuclei labeling) were immunopositive for glial fibrillary acidic protein (GFAP) and few donor cells expressed the neuronal marker TuJ1 (class III beta-tubulin). These findings suggest that at least some of the transplanted HUCB cells differentiated into cells with distinct glial or neuronal phenotypes after being exposed to instructive signals from the developing brain.

Animals↗
PubMed2003

The reliability of production strategy scores for the Ruff Figural Fluency Test.

This study examined the interrater and test-retest reliability of qualitative scoring indices for the Ruff Figural Fluency Test (RFFT) in a sample (N=90) of healthy college undergraduates. In addition to rotational and enumerative strategies proposed by, other supplemental indices were developed and examined. Seven raters scored protocols independently using guidelines proposed by and additional scoring examples developed by the primary investigator. Intraclass correlation coefficients (ICCs) were excellent, ranging from r(ICC)=.91 for number of strategic clusters, to r(ICC)=.79 for mean cluster size. Coefficients of stability (n=48; mean interval=7 weeks) for strategy scores were also acceptable (e.g., r(ICC)=.80 for enumerative, r(ICC)=.71 for rotational). This study is the first to examine the psychometric properties of these supplemental scores for the RFFT. Reliability coefficients obtained for traditional RFFT indices (e.g., unique designs, perseverations) were consistent with previous investigations. Modest practice effects were observed on unique designs produced, but not for strategy scores. The implications of using RFFT strategy scores for assessing executive functions are discussed and considerations for future research are presented.

Adolescent↗
PubMedDate not supplied

Effects of summer employment on student nurses: implications for recruitment and retention of staff nurses.

Nursing students often seek summer employment in hospital settings to practice and refine previously learned skills. Nursing administrators possibly view this employment as a means of relieving short-term staffing problems. However, if summer employment is seen as a potential strategy for recruiting future graduate nurses, then one needs to address the following: how to provide support for the student nurse to deal with the same concerns and issues as the new graduate (role confusion and reality shock); how to ensure that appropriate feedback is provided to enhance clinical skills. A pilot study of the effects of summer employment in a Quebec hospital on six second year CEGEP (diploma) nursing students explored these issues. The findings suggest actions which might suitably be taken by an agency in order to reinforce and facilitate the maintenance and promotion of excellence in patient care, as well as commitment to the profession and integration into the nursing culture.

Employment↗
PubMed2003

[Brazil's national immunization program: origins and development].

The article discusses the central aspects of the trajectory of the National Immunization Program as regards the dynamics of sectoral policy. Heir to successful experiences of the past yet conceived at an entirely different moment, the Program followed the triumphant Campaign to Eradicate Smallpox and inaugurated a new phase in the history of public policy in the field of prevention. Under one sole command, the Program came to articulate a set of practices that had previously been spread across a number of government agencies and jurisdictions. The article examines the process by which the Program was conceived, structured, and developed within government health policy, and also underscores the main determinants of this policy, its institutional actors, and the political and ideological conflicts born of its implementation, whose success was an important component in the structuring of a vaccine market in Brazil.

Brazil↗
PubMedDate not supplied

The single unit transfusion in post partum hemorrhage: A new perspective.

Every year, about 210 million women become pregnant. Postpartum hemorrhage (PPH) is one of the major complications of pregnancy, accounting for 14 million cases annually. Of these, it is estimated that around 140,000 women die, resulting in a case fatality rate of 1%. PPH is defined by WHO as a blood loss > or = 500 mls. Most instances of PPH occur suddenly and without warning even in women without any of the known risks for this condition. If women do not receive timely medical treatment, as is often the case in many parts of the world, death can occur within two hours. The chance of receiving a safe blood transfusion as part of the therapy for PPH varies enormously from country to country, depending on whether a safe blood transfusion program has been set up as a part of the national health policy. The increasing realization of the potential deleterious effects of blood transfusion, including exposure to HIV and other viral agents, has changed the practices that were previously acceptable for the transfusion of blood, as has the recent recognition of specific patients who will benefit from a single unit of blood. In countries with limited resources, where a majority of women have anemia at the onset of their pregnancies, the slightest deviation from normality during labor and/or delivery leading to excessive hemorrhage can put a women's life at risk. In these instances, the patient needs urgent resuscitation, stabilization and transfer to a nearby center. Available blood, preferably typed cross matched and screened for infections, should be given until the patient receives specific treatment. This is especially true in bled- out obstetrics patients, where one unit may make the difference between a near death state and the possibility of slow recovery and survival.

Anemia, Iron-Deficiency↗
PubMed1991

Economic effects of mastitis prevention strategies for dairy producers.

For efficient disease management in dairy production, the influence of disease prevention strategies on farm profitability must be known. A survey of mastitis control practices, milking machine function and maintenance, and cow environmental conditions was conducted with 406 dairy producers on the Michigan Dairy Herd Improvement-somatic cell counting program responding. These survey data, in conjunction with Dairy Herd Improvement production data, were used to develop a model estimating the marginal value products of mastitis control practices. Lost milk production associated with increased somatic cell count was calculated for each herd. Mastitis control practices, milking machine function and maintenance, and cow environmental conditions were used as independent variables in an analysis of covariance model with lost milk production as the dependent variable. Variables significant in explaining changes in production from increased somatic cell count were the use of teat dip, use of sanitizer in the wash water, milking cow bedding, summer nonlactating cow housing, summer calving locations, type of regulator, alternating pulsation, and rolling herd average milk production. The marginal value product (change in revenues received) from the use of iodine, chlorhexidine, and quaternary ammonium-type teat dips were $13.79, $16.09, and $22.17/cow/year, respectively, and these changes were statistically significant. However, sanitizer in the wash water was associated with a decrease in production. Management practices that have previously been shown to be economical and did not appear in the final model included nonlactating cow therapy and single-use paper towels.

Animals↗
PubMed1990

The reported prevalence of urinary symptoms in women in one rural general practice.

In May 1989 a questionnaire to determine the prevalence of urinary symptoms and vaginal discharge in the community was sent to all women patients born before May 1962 who had been registered with one rural practice for the previous two years. The response rate was 97%. The patients' clinical records were used to validate the replies of those who claimed to have consulted the doctor with these symptoms together with a sample of those who claimed not to have consulted. The reported prevalence of dysuria among the women over the previous two years was 27% and the prevalence of frequency was 34%. However, only 8% of women had received treatment for vaginal infections and 15% treatment for urinary symptoms (10% had confirmed bacteruria). Thirty four per cent of women said they would treat themselves prior to consulting a doctor and 17% would buy proprietary medicines. When asked how long they would wait between the onset of symptoms and seeking medical advice the responses ranged from one to 20 days, with 36% of women reporting that they would wait five days or longer before consulting. Fifty eight per cent of the women patients did not believe that urinary tract infections could have serious consequences and this figure increased to 76% among women who had consulted previously for a urinary tract infection. Patients with recurrent urinary symptoms did not consult any earlier than other women or treat themselves any less often. It can be concluded that there is a need for increased patient education in this area.

Adult↗
PubMed1990

[A comparative study of atenolol (Tenormin) and the combined preparation atenolol/chlorthalidone (Tenoretic Mite) in essential hypertension. A randomized double-blind study from general practice].

Two hundred and ninety-two hypertensive patients from general practice who had previously been treated with a diuretic with insufficient effect participated in a randomised trial for a period of three months. A total of 115 patients completed treatment with 50 mg atenolol (Tanormin) and 121 were treated with the combined preparation consisting of 50 mg atenolol and 12.5 mg chlothalidone (Tenoretic Mite) while 56 patients defected from the trial. In both of the groups, the average blood pressure was reduced significantly already after treatment for one month. A significantly greater number of patients receiving combined treatment achieved satisfactory diastolic blood pressures (less than 90 mmHg), the proportions being 78% and 54%, respectively. Better effects from combined treatment were found particularly in patients over 60 years of age and in females. No significant differences were observed between the side-effects of the regimes nor in the laboratory values registered during treatment.

Adolescent↗
PubMed1990

Risk managers see new regulations as boon and burden.

Health care risk managers have mixed feelings about the new regulations governing patient transfer and the National Practitioner Data Bank. Although cumbersome, the regulations give risk managers the teeth to enforce practices that may previously have been difficult to enact.

Legislation, Hospital↗
PubMed1989

Treatment for chronic CHD.

It seems likely that a number of medical and surgical treatments have had an impact on the overall mortality from ischaemic heart disease in recent years although there is comparatively little data upon which to base conclusions. The two forms of treatment which have been shown, in controlled trials, to reduce mortality are beta blockade after infarction and coronary artery bypass surgery in chronic ischaemic heart disease. It is of interest that these treatments seem to be most often applied in countries that have had the greatest fall in mortality, although it is not suggested that they have played more than a small role. It is likely that other influences on mortality have included the use of pacemakers and the avoidance of previously undesirable medical practices. Much more careful documentation of the use of treatments in different countries is highly desirable.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Diagnostic and therapeutic considerations on agitated depression understood as a mixed affective state].

Since they were first described, mixed affective states have created problems of differential diagnosis. In clinical practice various cases previously diagnosed as other conditions but identifiable as mixed states within a bipolar disorder have been encountered. In particular there are cases of agitated depression that can pose a serious clinical problem since the agitation may be exacerbated by the use of antidepressant drugs. In contrast it has been found useful to treat the maniacal component of these states, an approach that has obtained remissions and overall improvements in the clinical picture.

Adult↗
PubMed1988

Physician knowledge, attitudes, and behavior related to reporting adverse drug events.

Voluntary physician reporting of adverse drug events (ADEs) in their patients remains the single most important source of information on serious and rare ADEs. Yet, substantial underreporting exists and the factors producing it are unclear. We surveyed 3000 randomly chosen physicians by mailed questionnaire to determine their knowledge about the reporting system, attitudes toward reporting, and their past behavior in reporting the ADEs they had detected. Responses numbered 1121. Only 57% were aware of the Food and Drug Administration's reporting system. While 418 physicians had detected an ADE in their practices during the previous year, only 21 physicians reported these events directly to the Food and Drug Administration. The physicians appear to appreciate the safety issues involved in prescription drug use and view reporting as a professional obligation; however, the current reporting system is considered inconvenient.

Attitude↗
PubMedDate not supplied

[Relations between grandparents and their grandchildren in the preschool age].

In a pilot study 23 grandchildren in preschool age (9 boys, 14 girls) and 24 grandparents from the same families (8 grandfathers, 16 grandmothers) were interviewed in detail about the relations to each other. The informations were analyzed with a comprehensive system of categories. Most grandchildren and all grandparents considered the respective other person to be important in their life. The subjects were the more satisfied with their relation, the more often they were together without other relatives. The results are compared with previous findings, and practical consequences are drawn.

Aged↗
PubMed1986

A pilot home-based geriatric health screening project in primary care.

Regular multidimensional screening of the elderly for undetected health problems has the potential for delaying functional deterioration and improving the quality of life, but has not been evaluated rigorously. This pilot study examined the amount and type of unmet health care need discovered by home-based screening of 100 family practice patients aged 75 and over. Although 96 per cent of patients had some health problems, only 71 per cent had problems that needed further intervention. Of these, the majority were problems in the area of psychosocial function, independence, and lifestyle. Age, sex, and frequency of attendance at the practice in the previous year were not found to be useful markers for targeting screening efforts. Although it is potentially beneficial for detecting unmet need, home-based screening is resource-intensive and requires further examination in randomized trials in the North American context.

Aged↗
PubMed1995

[Action of Buflomedil on the cutaneous microcirculation studies by a cold provocation test. Multicenter, double-blind, placebo controlled trial].

The aim of this multicentre trial involving 136 cardiologists was to evaluate, in double-blind versus placebo design, the vasoactive effect of Buflomedil in out-patients with a very simple cooling-test from a practical standpoint and previously described (1). The authors have selected patients having a basal pulpar temperature below 30 degrees C by cutaneous thermometer and falling after immersion of the contralateral hand in water at 4 degrees C, with out complete recovery during 10 minutes following withdrawal. This study carried out 408 eligible patients with 398 finally included in double-blind period (200 in the Buflomedil group, 198 in the placebo group). After a run-in period of 7 days with placebo in single blind, to evaluate the stability of measures, the patients were then treated with either Buflomedil 600 mg a day or placebo at the same dosage, for 14 days. The patients in both groups had a Raynaud's phenomenon and were heavy smokers (> or = 20 packs/year), having either acrocyanosis or lower limbs arterial occlusive disease. The results have shown, after 14 days of oral treatment an increase of basal temperature of 2.01 degrees C in Buflomedil group, versus only 0.82 degrees C in placebo group. This warming-up give evidence of microcirculatory blood flux increasing. This significant difference between the both groups was the same each measurement time after immersion during the recovery phase. There also was a good parallelism between the cutaneous temperature and the global clinical improvement by visual analogic scale filled out by the investigator (p < or = 0.0001) and the patients (p < or = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗