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At least 667 records · Page 37Linked to original sources
PubMed1996

[Family practice diagnosis of patients with venous diseases in relation to severity, diagnosis and practice facilities. Results of the ASAM study "Physician status and factor evaluation study of ambulatory patient management"].

Although venous diseases are very common and represent frequent reasons for consultations in general practices, little is known about the actual ambulatory care for these patients. In a sentinel network consisting of general practitioners, 385 contacts with patients suffering from venous diseases (64% with varicose veins, 24% with phlebitis and 11% with ulcers) were documented. In 9% of the cases, the functional disability was "severe". The diagnostic procedures included laboratory tests in 23%, ECG in 11%, Doppler sonography in 8% and X-ray or angiography in 5%. The frequency of these diagnostic procedures correlated significantly with the degree of severity. The probability of a Doppler sonography in practices with ultrasound equipment compared to practices without it, was-stratified for the degree of severity, the unequal distribution of diseases and the level of acquaintance with the patient-between 2.2 and 2.6 (p always < 0.05), the probability of laboratory tests between 2.4 and 2.6 (p always < 0.001). This significant dependence of diagnostic procedures from the available equipment calls for the introduction of diagnostic standards as measures of quality assurance even for so-called trivial diseases.

Adult↗
PubMed1997

Ulcerative colitis practice guidelines in adults. 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 through 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 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 standard of care, which are inflexible and rarely violated. Given the wide range of specifies 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 intensely 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 publication to assure continued validity.

Acute Disease↗
PubMed1997

The extent of military medicine topics taught in military family practice residency programs: Part I. A survey of current military family practice residency directors.

The Military Unique Curricula (MUC) was published in 1988 as a guideline for instruction at military residencies in military-specific topics. To evaluate the degree of implementation and the perceived necessity of the MUC curricula and the attitudes and logistical factors relevant to military medicine instruction in military family practice residencies, questionnaires were sent to all 18 military family practice residency directors. The results reveal a wide range of opinions regarding the importance of military medicine and the amount of instruction of military medicine topics among the residency programs. The total number of topics taught was correlated (p < 0.05) with years as residency director, awareness of the MUC, and an opinion that the material would not be better taught at service-specific schools. There appears to have been little influence of the MUC on the curricula of military family practice residencies since its publication.

Attitude of Health Personnel↗
PubMed1997

Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee.

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America regarding the indications for polysomnography in the diagnosis of sleep disorders. Diagnostic categories that are considered include the following: sleep-related breathing disorders; neuromuscular disorders and sleep-related symptoms; chronic lung disease; narcolepsy; parasomnias; sleep-related epilepsy; restless legs syndrome; periodic limb movement disorder; depression with insomnia; and circadian rhythm sleep disorders. Whenever possible, conclusions are based on evidence from review of the literature. Where scientific data are absent, insufficient, or inconclusive, recommendations are based on consensus of opinion. The Standards of Practice Committee of the American Sleep Disorders Association appointed a task force to review the topic, the indications for polysomnography and related procedures. Based on the review and on consultation with specialists, the subsequent recommendations were developed by the Standards of Practice Committee and approved by the Board of Directors of the American Sleep Disorders Association. Polysomnography is routinely indicated for the diagnosis of sleep-related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep-related breathing disorders; for documenting the presence of obstructive sleep apnea in patients prior to laser-assisted uvulopalatopharyngoplasty; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep-related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep-related symptoms; to assist in with the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure-related; in a presumed parasomnia or sleep-related epilepsy that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with epilepsy who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.

Circadian Rhythm↗
PubMed1998

Will evidence-based nursing practice make practice perfect?

Evidence-based practice, or evidence-based decision-making, is rapidly developing as a growth industry in nursing and the health professions more widely. It has its origins in the work of the British epidemiologist Archie Cochrane and has recently been re-energized in Canada by the National Forum on Health and its call for a culture of evidence-based decision-making. Before we adopt evidence-based nursing (EBN) as a mantra for the 21st century, we should examine its origins and its consequences, and we should probe related concepts, 2 of which are the nature and structure of practice-based knowledge and the nature and structure of evidence generally. Findings of a recent survey of nurses in western Canada are used to illustrate that nurses use a broad range of practice knowledge, much of which is experientially based rather than research-based.

Adult↗
PubMed1976

An information system for family practice. Part 1: Defining the practice population.

Information systems for family practice are vital in its development as an academic discipline, in the teaching and learning process which ultimately improves the quality of care, and in the planning processes which must be used to rationalize the distribution of scarce resources in the health-care field. The provision of sufficient data for these purposes demands a flexible system, generally one based on the computer as a data storing and analyzing tool. Such a system has been developed in the teaching practices of the Department of Family Medicine, University of Western Ontario; the methods employed and the uses for that system are to be described in a series of four papers. This first paper describes the methods developed for gathering demographic information on the practice population.

Demography↗
PubMed1995

Skin cancer control practices among physicians in a university general medicine practice.

Physician counseling about sun protection and routine screening for skin cancer in high-risk individuals have been widely recommended. The purpose of this study was to assess the skin cancer control practices and knowledge among physicians in a university-based general medicine practice. Fifty-two physicians completed a survey on attitudes toward, behaviors in, and knowledge of skin cancer control. In addition, the ability of general medicine residents and attending physicians to correctly identify and make biopsy recommendations for ten photographed skin lesions was compared with that of third-year medical students and dermatology residents and attendings. The results of the survey illustrate a need for improving primary care physicians' knowledge and identification of skin cancer risk factors, and increasing the frequency and consistency with which they perform skin cancer prevention counseling and complete skin examination in high-risk patient groups.

Counseling↗
PubMed1999

Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices.

OBJECTIVE: To evaluate the feasibility and implementation needs of a cholesterol guideline by assessing the effectiveness of simple dissemination as well as extensive implementation of this guideline on actual performance of general practitioners (GPs). DESIGN: Randomized controlled trial. SETTING AND SUBJECTS: Thirty-two Dutch GPs in 20 general practices, 3950 patient records. INTERVENTIONS: Guideline dissemination to all 32 GPs, and a 5-month programme for improvement in the intervention group. This programme was developed after barriers to working according to the guideline had been investigated, and consisted of group education, desktop supportive materials, feedback on performance, and face-to-face instruction on location. MAIN OUTCOME MEASURES: The outcome parameters were defined as quality of selective case finding and quality of diagnostic procedures, and were measured by chart audit. RESULTS: The quality of selective case finding, especially the targeting of cholesterol testing to those with positive cardiovascular risk profiles, did not improve following intervention. Performance of the procedure necessary to diagnose hypercholesterolaemia even deteriorated. The quantity of cholesterol testing increased in both groups, but this was probably explained by the increased availability of desktop cholesterol analysers. CONCLUSIONS: Neither simple dissemination nor an intensive programme for improvement had measurable impact on actual performance on working according to the cholesterol guideline. Both the validity and the opinion about feasibility of the guideline in daily practice deserve more attention during guideline development.

Family Practice↗
PubMed2006

Environmental history-taking in clinical practice: knowledge, attitudes, and practice of primary care physicians in Italy.

OBJECTIVE: We investigated knowledge and attitudes of the PCPs about environmental risks and behaviours in regarding environmental history taking of the patients. METHODS: This study was designed as a cross-sectional mail survey and target population were 500 PCPs practicing in Calabria (Italy). Questions of the questionnaire focused on PCPs demographics and practice characteristics, knowledge of the major environmental risk factors and related health effects, attitudes about role of environment on human health and about performing an accurate environmental exposures history. RESULTS: 94% of PCPs correctly indicated noise exposures as a possible cause of irreversible hearing loss and more than half indoor radon exposure for lung cancer, but only 27.8% correctly recognized all health effects related to environmental exposures. PCPs who assign an important role to the environment were significantly more likely to have knowledge of environmental risk factors related to respiratory disease. A vast majority of PCPs reported to take a patient history on occupational exposures, but less than one third of PCPs reported to provide education material about environment and public health to their patients. PCPs who ask their patients about environmental exposures were significantly more likely to consider environmental health history a helpful tool to prevent exposures to environmental threats. CONCLUSIONS: Physicians are supposed to learn and then educate patients about the importance of preventing environment related diseases.

Adult↗
PubMed2001

Gonorrhoea screening in general practice: perceived barriers and strategies to improve screening rates.

OBJECTIVE: To investigate perceived barriers to gonorrhoea screening in general practice and suggest strategies to overcome them. DESIGN: Questionnaire-based survey. SETTING AND PARTICIPANTS: All 47 general practitioners (GPs) authorised to prescribe subsidised HIV drugs under the Pharmaceutical Benefits Scheme in inner, eastern and northern Sydney. MAIN OUTCOME MEASURES: Agreement on a five-point Likert scale with statements about attitudes and practices in relation to gonorrhoea screening of homosexually active men, and views on how testing rates could be increased. RESULTS: 32 GPs responded (68%). Perceived barriers to gonorrhoea testing included structural measures imposed by the Federal Government to limit pathology testing by GPs (the Medicare "three-test rule") (17 respondents agreed or strongly agreed), pressure from the Health Insurance Commission (HIC) to minimise pathology testing (15), concerns about confidentiality of notification procedures (8), clinical time pressure (8), and concerns about recriminations against HIV patients with gonorrhoea (6). Suggested measures to increase testing were education of gay men to request testing (25), relaxation of the three-test rule (25), easier tests (23), anonymous notification procedures, review of HIC policy on screening, and training about testing (21 each). CONCLUSIONS: Sydney GPs with high HIV caseloads perceived structural barriers to gonorrhoea testing and supported a range of achievable strategies to overcome these. As the sustained epidemic of gonorrhoea in Sydney may be directly promoting HIV transmission, these strategies should be considered urgently.

Adult↗
PubMed2003

[The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine].

The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general practitioners will regard it as too complex for use in daily practice and specialists will find it to be of limited use, as it does not cover all cases. Consultation between the general practitioner and the specialist will give the best answer in complicated cases. Patients who complain about tiredness or dizziness will expect their general practitioner to take a blood sample for a haemoglobin test. The general practitioner will consider the risk of false-positive test results in interpreting the patient's haemoglobin level. A few concrete remarks: the guideline does not mention that vegetarianism and a low meat intake can increase the risk of vitamin B12 deficiency, and iron suppletion is advised in premenopausal women with profuse vaginal blood loss, whereas there are several treatable disorders that may cause menorrhagia.

Algorithms↗
PubMed2004

[The practice guideline 'Pregnancy and puerperium' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice medicine].

The first revision of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium does not significantly differ from the first edition. The guideline is extensive, is well-worth reading and supports daily practice. There is a greater emphasis on the importance of cooperation and differentiation in primary care (midwifes and general practitioners). During the last decade many general practitioners stopped doing home deliveries and have therefore lost their experience in obstetric care and pathology. The guideline describes the general practitioner's tasks as a preconception counsellor, a professional expert on illnesses during pregnancy and after the delivery, and as the doctor of the newborn baby. It will hopefully stimulate a revived interest of and involvement in pregnancy and post-partum care among general practitioners.

Family Practice↗
PubMed2006

[The practice guideline 'Urinary-tract infections' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The Dutch College of General Practitioners recently published an update of the practice guideline on urinary-tract infections. This guideline provides a clear overview of the medical history, the diagnostic methods and the treatment options. Sixteen management modalities are presented in relation to specific patient characteristics. However, this revised guideline warrants some minor comments. According to the guideline, the dipstick (nitrite) test and dipslide form the two cornerstones of the diagnosis of urinary-tract infections. The value of the dipslide, however, seems to have been overestimated and that of microscopic examination of the urine by skilled physicians to have been underestimated. New in this guideline compared to that of 1999 is that nitrofurantoin (the treatment of first choice in uncomplicated infections) should be given for five instead of three days. The guideline motivates this change in policy on the basis of the numerous treatment failures seen in practice. The most convincing type of evidence, however, is not available due to the lack of relevant randomised clinical trials. The introduction of the prescription of phosphomycin, which is unusual in the Netherlands, as an alternative treatment for uncomplicated infections requires supportive evidence before it will be accepted by general practitioners. This well-documented guideline provides clear guidance for the general practitioner faced with patients with urinary-tract symptoms that could be caused by infection.

Anti-Bacterial Agents↗
PubMed2006

[The practice guideline 'Otitis media with effusion' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The usefulness of tympanotomy tubes in children with otitis media with effusion who also have speech and language retardation is doubtful in view of the natural development. The second revision of the practice guideline 'Otitis media with effusion' from the Dutch College of General Practitioners is still not in complete agreement with this. The indications for performing an adenoidectomy are now more limited. Pneumatic otoscopy and tympanometry are diagnostic aids that may deserve a permanent place in the general practitioner's medical practice in the future.

Acoustic Impedance Tests↗
PubMed2006

Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel.

On June 10, 2005, a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) formulated for use in adults and adolescents was licensed in the United States for persons aged 11-64 years (ADACEL, manufactured by sanofi pasteur, Toronto, Ontario, Canada). Prelicensure studies demonstrated safety and efficacy, inferred through immunogenicity, against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adults. To reduce pertussis morbidity among adults and maintain the standard of care for tetanus and diphtheria prevention and to reduce the transmission of pertussis to infants and in health-care settings, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adults aged 19-64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >or=10 years earlier and they have not previously received Tdap; 2) intervals shorter than 10 years since the last Td may be used for booster protection against pertussis; 3) adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel) should receive a single dose of Tdap to reduce the risk for transmitting pertussis. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. When possible, women should receive Tdap before becoming pregnant. Women who have not previously received Tdap should receive a dose of Tdap in the immediate postpartum period; 4) health-care personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. An interval as short as 2 years from the last dose of Td is recommended; shorter intervals may be used. These recommendations for use of Tdap in health-care personnel are supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC). This statement 1) reviews pertussis, tetanus and diphtheria vaccination policy in the United States; 2) describes the clinical features and epidemiology of pertussis among adults; 3) summarizes the immunogenicity, efficacy, and safety data of Tdap; and 4) presents recommendations for the use of Tdap among adults aged 19-64 years.

Adult↗
PubMed1998

Diagnosis and treatment of depression in primary medical care practice: the application of research findings to clinical practice.

Approximately 50% of persons experiencing clinical depression seek help for this disorder from their primary care physician. This pattern of help-seeking has stimulated interest in providing appropriate treatment for depressed primary medical care patients. While the efficacy of both psychotherapy and pharmacotherapy for depression have been demonstrated in the mental health specialty sector, current research endeavors to establish the effectiveness of such treatments when provided to primary medical care patients. We review and discuss the clinical, practical, and methodological issues pertaining to the transfer of depression research to routine primary care practice. Possible directions for future research which will inform the continued applicability of research findings to routine practice are discussed.

Delivery of Health Care↗
PubMed2005

Evidence-based nursing: making changes in the clinical practice through the collaboration of nursing students and practicing nurses.

The collaboration between student nurses and practicing clinical nurses on an evidence-based project is described. This collaboration sought to answer a question pertinent to the needs of the clinical nurses, while providing the students with an excellent practical learning opportunity. The changes in both knowledge and practice resulting from this partnership are described.

Cooperative Behavior↗