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PubMed1989

[Diagnosis and treatment in general practice. 4. General practitioners' knowledge of their patients].

The object of this work is to describe aspects of general practitioners' knowledge of their patients and to analyse the connection between this knowledge and certain activities involving the patients in the practice (examination in the practice, prescription of medicine, information and referral). Fifty-five practices with a clientele of 81,600 patients in the lower income group of the Danish National Health Insurance over the age of 15 years participated. A random sample of 1/30 of the insured persons were characterized by the practice prior to a period of observation of three months on the basis of the doctors' knowledge of the persons. During the period of observation, all practice-patient contacts were registered. The characteristics of the patients included: curation of attachment to the practice, degree of knowledge, previous problems etc. Contact data included information about diagnoses, symptoms, patient's wishes, prescriptions, referrals, information given and examinations in the practice. During the three months, a total of 1,974 episodes of medical care occurred. We did not find any connection between the duration of knowledge (as a measure of knowledge) and the number of abovementioned activities in the practice. This investigation, however, cannot exclude such a connection. Information is still required to illustrate the significance of the knowledge of the patients for the solution of their problems and, in particular, for the course of their health problems.

Denmark↗
PubMed2005

An exploration of student midwives' language to describe non-formal learning in professional practice.

The essence of non-formal learning in midwifery practice has not been previously explored. This paper provides an in-depth analysis of the language of a sample of student midwives' descriptions of their practice learning in a range of clinical settings. The students submitted audio-diaries as part of a national study (Pope, R., Graham. L., Finnerty. G., Magnusson, C. 2003. An investigation of the preparation and assessment for midwifery practice within a range of settings. Project Report. University of Surrey). Participants detailed their learning activities and support obtained whilst working with their named mentors for approximately 10 days or shifts. The rich audio-diary data have been analysed using Discourse Analysis. A typology of non-formal learning (Eraut, M. 2000. Non-formal learning and implicit knowledge in professional work. British Journal of Educational Psychology 70, 113-136) has been used to provide a framework for the analysis. Non-formal learning is defined as any learning which does not take place within a formally organised learning programme (Eraut, M. 2000. Non-formal learning and implicit knowledge in professional work. British Journal of Educational Psychology 70, 113-136). Findings indicate that fear and ambiguity hindered students' learning. Recommendations include the protection of time by mentors within the clinical curriculum to guide and supervise students in both formal and non-formal elements of midwifery practice. This paper will explore the implications of the findings for practice-based education.

Attitude of Health Personnel↗
PubMed1981

Optical information and practice in the discrimination of 3-D mirror-reflected objects.

Two studies of the discrimination of three-dimensional mirror-reflected objects were concerned with the influence of practice and stimulus information for shape, specifically binocular information and perspective transformations. In the first study subjects made 'same-different' responses to successively presented pairs of real objects, under binocular and monocular viewing conditions. In the second study subjects viewed object pairs on a rotating turntable, in five different displays. Neither binocular information nor perspective transformations contributed to isomorph discrimination. In both studies mental rotation and other less well specified strategies were employed. After practice, in contrast to previous reports, five of the six subjects in these studies produced reaction times unrelated to the orientation difference between the objects. These practice effects may reflect either extremely rapid rotation rates, the detection of rotationally invariant features, or the use of multiple strategies.

Cues↗
PubMed1999

Pharmacy practice acts: a decade of progress.

OBJECTIVE: This 10-year follow-up study of previously published surveys of pharmacy practice acts examines 50 state and the District of Columbia pharmacy practice acts to assess the range of statutory definitions and determine the direction and magnitude of statutory changes since 1988. DATA SOURCES: State codes for 50 states and the District of Columbia, with attention focused on the pharmacy practice acts; Puerto Rico and the Virgin Islands were excluded. DATA EXTRACTION: The focus on each statute was the statutory definition of the "practice of pharmacy." DATA SYNTHESIS: Comparing 1998 with 1988, codification of interpreting and evaluating prescriptions increased 22% (1998; 39/47, four states contain no definition of the practice of pharmacy), compounding 8% (47/47), consultation 19% (41/47), dispensing 2.5% (47/47), drug administration threefold (24/47), drug product selection twofold (45/47), drug utilization review 70% (35/47), patient assessment 6.5-fold (6/47), pharmacokinetic services threefold (3/47), pharmacist prescribing 4.6-fold (15/47), and participation in drug research 10.5-fold (10/47). CONCLUSIONS: Since 1988, state pharmacy practice acts have increased the codification of pharmaceutical care services as integral pharmacy functions. Although substantial progress has been made over the past decade, a number of states have not incorporated definitions of pharmaceutical care functions into their state statutes. Enactment of the National Association Boards of Pharmacy Model State Pharmacy Act is one way for pharmacists' practice to expand with the evolution of the practice of pharmacy.

Humans↗
PubMed2004

A functional MRI study of the influence of practice on component processes of working memory.

Previous neuroimaging studies have shown that neural activity changes with task practice. The types of changes reported have been inconsistent, however, and the neural mechanisms involved remain unclear. In this study, we investigated the influence of practice on different component processes of working memory (WM) using a face WM task. Event-related functional magnetic resonance imaging (fMRI) methodology allowed us to examine signal changes from early to late in the scanning session within different task stages (i.e., encoding, delay, retrieval), as well as to determine the influence of different levels of WM load on neural activity. We found practice-related decreases in fMRI signal and effects of memory load occurring primarily during encoding. This suggests that practice improves encoding efficiency, especially at higher memory loads. The decreases in fMRI signal we observed were not accompanied by improved behavioral performance; in fact, error rate increased for high WM load trials, indicating that practice-related changes in activation may occur during a scanning session without behavioral evidence of learning. Our results suggest that practice influences particular component processes of WM differently, and that the efficiency of these processes may not be captured by performance measures alone.

Adult↗
PubMed1989

A developmental study of practical problem solving in adults.

Previous research indicates that young and middle-aged adults perform better than other age groups on problems similar to those they might encounter in their everyday lives. However, elderly adults have not performed better than other age groups on problems designed to give them the advantage. In order to ensure that the problems used in the present study were ones that elderly adults might encounter, elderly adults were recruited to help develop the problems. The resulting problems were administered to adults between the ages of 20 and 80. Performance was found to increase from the 20- to 40-year-old age group and decrease thereafter. Thus, when elderly adults devise practical problems that are intended to give elderly adults the advantage, the elderly adults still perform less well than do middle-aged adults.

Adult↗
PubMed1998

Attitude and self-reported practice regarding hospice referral in a national sample of internists.

Systematic, nationally representative information about physicians' attitudes and behavior with respect to hospice care is not available. We sought to describe these previously unexamined attitudes and practices. We conducted a mail survey of a random national sample of 1311 internists, of whom 697 responded (an unadjusted response rate of 53%). We elicited physician's attitudes and self-reported practice with respect to hospice. Most internists (89%) felt that hospice care was a good form of terminal care. Physicians with longer definitions of what constitutes "terminal" illness and those whose patients were more accepting of their prognoses were more likely to hold this opinion. Over the course of a year, the median internist referred five patients to hospice. Specialists and those with longer definitions of "terminal" were more likely to have done so. When asked "If you knew exactly how long a patient had to live, how long before death would you refer them to hospice?" the average response was 12.1 +/- 8.5 weeks, but responses varied from 1 to 52 weeks, and the pattern of responses was bimodal, with one peak at about 13 weeks (73% of internists) and one at about 25 weeks (27%). Moreover, the distribution of hospice enrollment times implied by physician reports about ideal practice is significantly more compact than the distribution of survival that is actually observed; physicians support far fewer very short (<2 weeks) and very long (>6 months) stays in hospice than are observed. We conclude that internists show significant support for, and utilization of, hospice and they endorse a length of stay that is longer than currently observed. These findings suggest that it may be possible to increase both the number of patients using hospice and their duration of use of hospice.

Journal Article↗
PubMed1997

Cervical cancer screening practices among Latino women in Chicago.

Previous studies have determined that Latino women, especially Mexican women, have the lowest rates of cancer-screening practices of any racial and ethnic group in the United States (L. S. Caplan, B. L. Wells, & S. Haynes, 1992; L. C. Harlan, A. B. Bernstein, & L. G. Kessler, 1991). The purpose of this descriptive study was to identify factors associated with irregular Papanicolaou (Pap) screening among Latino women. The convenience sample consisted of 111 Mexican and Puerto Rican women ages 40 and older, recruited through two inner-city clinics, located in two major Latino communities in Chicago. The women were interviewed face-to-face by trained bilingual interviewers, using a structured questionnaire. Mexican ethnicity and older age were found to be associated with irregular cervical cancer-screening practices. These results suggest that interventions need to be developed for educating Latino women about the purpose and importance of Pap test-screening practices. Further research is needed to examine other barriers that impede these women from using cervical cancer-screening services.

Adult↗
PubMed2006

Children's nurses' post-operative pain management practices: an observational study.

BACKGROUND: Children continue to experience unrelieved moderate to severe pain post-operatively despite the evidence to guide practice being readily available. Previous studies have relied on self-report measures; there is a need to establish exactly how nurses manage children's pain in practice. OBJECTIVES: To ascertain how nurses actually manage post-operative pain in children and whether pain management practices adhere to current best practice guidelines. DESIGN: An observational study was carried out. Structured and unstructured data were collected. SETTING: A children's surgical ward in the English Midlands caring for children from birth to 16 years. PARTICIPANTS: Registered nurses (n=13) took part in the study. METHODS: Each participant was observed continuously for a period of 5 hours per shift for two to four shifts each. The role of the observer as participant was adopted whereby the researcher could shadow the nurse and act primarily as an observer. Data were collected for 36 shifts (185 hours). RESULTS: While nurses administered analgesic drugs when a child complained of pain, in most other areas practices did not conform to current recommendations and are in need of improvement. Nurses did not, for example, routinely assess a child's pain, nor use non-drug methods of pain relief on a regular basis. CONCLUSIONS: The sub-optimal pain management practices may be attributable to several factors. The professional culture of nursing and/or ward culture may result in poor pain management practices being perpetuated. Nurses may not have the requisite theoretical knowledge to manage pain effectively. A lack of priority may also be attributed to pain management. These areas need exploring further.

Adolescent↗
PubMed1991

[Occurrence of recurrence after regression of low-grade dysplasia in vaginal cytological smears].

329 females with regress of low-grade dysplasia were followed up by annual vaginal smears for a maximum of 14 years. 53 developed recurrence of dysplasia. The average annual risk of recurrence was greatest 2-4 years after regress, being 4.3%. The average annual risk of recurrence for those followed up for more than ten years was 0.5%. None of the females developed cervical cancer. It is concluded that annual controls may prevent females with regress of previous low-grade dysplasia from developing cancer. After ten years with no further dysplasia, the females are recommended to follow the general practice for persons without previous dysplasia or cancer.

Adult↗
PubMed2003

Priorities in behavioral science education: views of practicing family physicians.

BACKGROUND AND OBJECTIVES: The behavioral science curriculum in family practice residency programs consists of a wide range of diverse topics. Because of time limitations, not all topics receive equal emphasis. The goal of the present study was to replicate a previous study with family physicians practicing in a different geographical area. METHODS: Questionnaires were mailed to a sample of 543 family physicians in Mississippi. Respondents were asked to rate each of 28 behavioral science topics according to the priority to be given in residency education. RESULTS: One hundred eighty-five surveys were returned for a 34% response rate. The rank order of topics in the present study was highly similar to the rank order in the original study. Female physicians had higher overall mean ratings. CONCLUSIONS: This sample of family physicians in Mississippi provided similar ratings to those in a previous study of family physicians trained and/or practicing in Colorado. The results support that, regardless of geographic location and practice characteristics, family physicians hold similar opinions about which behavioral science topics should receive highest priority in residency training. The behavioral science curriculum in family practice residency programs consists of a wide range of diverse topics. Because of time limitations, not all topics receive equal emphasis. Published resources provide helpful lists of topics and teaching strategies but do not specify which areas should be given priority. Consequently, behavioral science teachers may have difficulty prioritizing the topics because there is no agreement on the core competencies to be given highest priority in residency education. In a previous study, investigators sent a survey to practicing family physicians to determine the topics of behavioral science considered to be most important in residency education. The physicians were able to identify specific topics to be given higher priority. While these previous results were useful, the study was limited by the homogeneity of the sample. All the family physicians had trained or were currently practicing in the state of Colorado. The goal of the present study was to replicate the original study with family physicians practicing in a different geographical area.

Attitude of Health Personnel↗
PubMed1986

Abstinence or controlled drinking in clinical practice: indications at initial assessment.

Previous research has suggested two leading hypotheses concerning which excessive drinkers can re-establish control: one based upon level of dependence, the other upon the client's personal persuasion. Using initial assessment data from 46 clients of a clinical psychology alcohol problems service (30 men, 16 women), an attempt was made to operationalize the concepts of dependence and personal persuasion using a variety of indicators of each. Although SADQ scores and Rand definite alcoholism were in general agreement, there were a number of borderline instances and cases of disagreement, and neither was in good agreement with estimates of problem duration, nor with reports of recent or earlier attainment of abstinence or control. Indicators of personal persuasion were more consistent. Those with dependence indicators for abstinence tended to prefer abstinence as a goal, but there were many departures from this pattern particularly for women. It is concluded that in clinical practice it will be very difficult to make a clear cut recommendation about treatment goal at initial assessment except in a few cases.

Adult↗
PubMed2000

British nurses in behavioural psychotherapy: a 25-year follow-up.

BACKGROUND: The National Service Framework for Mental Health has emphasized the need to prioritize the provision of cognitive behaviour therapy as the central evidence-based non-pharmacological intervention for mental health problems. For 25 years one programme (English National Board Course No. 650--Diploma in Behavioural Cognitive Therapy, formerly called Nursing in Behavioural Psychotherapy) has trained nurses in such methods. This is the only programme in nursing which qualifies graduates to be fully certified as a cognitive behaviour therapist by the British Association of Behavioural Psychotherapy and by the United Kingdom Council for Psychotherapy. The practice of these nurse therapists (most commonly known as nurse behaviour therapists, NBTs) is the most rigorously evaluated in mental health nursing, with several randomized controlled trials to testify to clinical and economic efficacy. AIM: The aim of this study is to continue the systematic follow-up of all NBT graduates previously undertaken in two earlier surveys published in 1986 and 1994. These previous surveys examined clinical practice, organizational context and career and professional development issues. This up-to-date picture of NBTs will provide useful baselines for the implementation of the National Service Framework, and may be used by the Department of Health, education providers and services. METHOD: A postal survey (using the same template for categories of information as the two earlier surveys) was used and questionnaires were sent to 237 of the 274 trained NBTs whose name appears on the Central NBT Register, maintained at the Institute of Psychiatry/Maudsley Training Centre. RESULTS: One hundred and five of 230 eligible respondents (45.6%) returned questionnaires and additional data were obtained from 27 NBTs who provided information to the Register in the year before the survey. Thus, some data were available for 57% of the sample. As in earlier surveys, it was found that the majority of therapists remain in clinical practice, undertake substantial further education and training and are involved in research and teaching as part of their overall role. The two central developments are an increasing move towards working in primary care and an increased emphasis on cognitive interventions. NBTs complete a substantial number of treatments per year and increasingly treat clients with difficulties not encountered during their basic training. NBTs now receive much more supervision than in previous surveys and continue to use valid and reliable measures of change in practice. However, the number of NBTs remains small and the impact on potential populations who would benefit from effective psychological interventions is minimal. This paper discusses the implications for service delivery.

Behavior Therapy↗
PubMed2005

Breastfeeding and the cultural configuration of social space among Vietnamese immigrant woman.

This study aimed to identify cultural factors involved in the abandonment of breastfeeding amongst Vietnamese immigrant women in Canada. Qualitative interviews were conducted with 19 mothers, exploring their perinatal experience from Vietnam to Canada. The results suggest that the decision to bottle-feed was not related to acculturation to local practices as has been claimed in previous studies but to conflicts between Vietnamese cultural practices and the configuration of the new social space in Canada. Living in Canada did not allow specific family members to conduct postnatal traditional rituals thus jeopardizing mothers' perceived health and the quality of their milk. Culturally appropriate strategies to promote breastfeeding among migrants must consider the social and spatial organization of cultural practices.

Adult↗
PubMed2006

A prospective study of stage of change for general health promotion action and health-related lifestyle practices among Chinese adults.

In a previous study we proposed the notion of general health promotion action (GHPA) defined as "a general intention and actual practices to take action aimed to promote health." GHPA is a subjective measure of health-promoting lifestyle which may reflect practices aimed to promote health and practices which are taken for non-health reasons but which nonetheless have health benefits. The present prospective study aimed to examine whether baseline stage of change for GHPA predicted health-related lifestyle practices at 24-month follow-up in a representative community-based cohort of 3129 Hong Kong Chinese adults. Overall, 37% of the subjects remained in the same stage, 43% had progressed to later stages, and 20% had regressed to earlier stages of change at follow-up. Baseline maintainers were the most likely to report desirable lifestyle practices at follow-up. They were significantly more likely to have exercised in the past month, consumed at least 2 portions of fruit a day, consumed at least 3 portions of vegetable a day, consumed at least 5 portions of fruit or vegetable a day, have had no episodes of binge drinking in the past month, and have had a dental examination at least once a year. The association remained significant after adjusting for age, gender, education, income and baseline level of respective lifestyle practices, with significantly increasing trends from precontemplation to maintenance stage. We conclude that the predictive validity of stage of change for GHPA was supported from these longitudinal findings, and further research on how GHPA can guide health promotion strategies is warranted.

Adolescent↗
PubMed2006

[Prevalence and characteristics of headache in a population of regular physical exercise practitioners].

BACKGROUND: The burden of headache may impede sufferers from adhering to a routine of physical activity. OBJECTIVE: To evaluate the prevalence and characteristics of headache in a health club population. METHOD: One hundred attendees of a health club were interviewed. They all were regular attendees for the previous 12 months and practiced aerobic exercises no less than 3 times a week. A questionnaire with characteristics of headache was applied to all who had a headache attack during the previous 12 months. MIDAS questionnaire was used as well. RESULTS: 57 men and 43 women were included. Eighty subjects had a headache attack, which was pulsatile in 63% of the sufferers. MIDAS was lower than 5 days in 83% of the subjects. CONCLUSION: Although retrospective and based on recall, this study suggests that most of the regular exercise practitioners presented clinical characteristics of migraine. It is uncertain whether the regular practice of physical exercise has a role in reducing the impact life or those suffering less are the ones who practice exercise.

Adolescent↗
PubMed1998

How does sumatriptan nasal spray perform in clinical practice?

Migraineurs (94F, 24M) with previous experience of subcutaneous sumatriptan and/or sumatriptan tablets were asked their opinion on sumatriptan nasal spray treatment particularly with respect to onset of action, total efficacy, tolerability, and user friendliness. The information was obtained by means of a self-administered questionnaire handed out at the time of prescription of the nasal spray. The results are based on the patients' cumulative experience of having treated at least two migraine attacks with the spray (20 mg). Sumatriptan nasal spray (20 mg) was perceived to have a faster onset of action and, with the exception of a bad taste, to have a better tolerability than the tablets. Compared with subcutaneous sumatriptan, the nasal spray was claimed to be less effective in reducing symptoms of migraine attacks but to cause fewer adverse events. A bitter taste was the most commonly reported side effect of sumatriptan nasal spray--reported by 68% (80 out of 118) of the migraineurs. The user friendliness of sumatriptan nasal spray was rated better than that of subcutaneous sumatriptan and/or sumatriptan tablets. The overall impression of sumatriptan nasal spray was reported to be better or equal to that of the tablet and the injection by 57% and 46%, respectively. It is concluded that the results obtained in clinical practice are very much in line with those obtained in controlled clinical trials. The overall impression of sumatriptan nasal spray is that it is user friendly and useful in the acute treatment of migraine attacks of moderate intensity.

Administration, Intranasal↗
PubMed1992

Ambulatory testing for capitation and fee-for-service patients in the same practice setting: relationship to outcomes.

Previous studies of the impact of varying reimbursement incentives on physician behavior have not explored the simultaneous implications for patients' health outcomes. Using a single group of physicians who provided care for hypertensive patients with either capitation (N = 99) or fee-for-service (N = 66) health insurance plans, physicians' test-ordering behavior and patients' subsequent health outcomes were examined. After controlling for patients' age, severity of hypertension, and level of comorbidity, it was found that patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes, specifically blood pressure control. The study concludes that capitation can result in reduction in charges associated with management of hypertension, without apparent compromise in proximate health outcomes.

Adult↗