Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Institutional Practice”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 793 records · Page 44Linked to original sources
PubMed2001

Role of family physicians in hospitals. Did it change between 1977 and 1997?

OBJECTIVE: To investigate whether hospital activities and attitudes toward hospitals of members of an urban family medicine department changed between 1977 and 1997. To explore whether these activities and attitudes are different among fee-for-service (FFS) and non-FFS physicians in 1997. DESIGN: Cross-sectional surveys by interview (1977) and self-administered questionnaire (1997). SETTING: Community-based family practices in Hamilton, Ont. PARTICIPANTS: In 1977, 88 of 89 (98.9%) and, in 1997, 66 of 88 (75.0%) members of the Department of Family Medicine at St Joseph's Hospital in Hamilton. MAIN OUTCOME MEASURES: Perceived reasons for involvement in hospital work; time spent and main activities in hospital; use of hospital privileges; attitudes toward family physicians' role in hospital, hospital work, and the Department of Family Medicine; perceptions of patients', consultants', and hospital administrators' attitudes toward family physicians' role in hospitals. RESULTS: In 1977 and 1997, patient care and continuing education remained key reasons for doing hospital work. In 1997, however, respondents spent a mean of 3 hours less per week in hospital; used the hospital less often for procedures, meetings, and teaching; and assumed less responsibility for their patients' in-hospital care. While perceptions of hospital work changed over the years, most physicians continued to see a need and have a desire to remain involved in hospitals. Fee-for-service and non-FFS physicians held different opinions on the needs of both hospitalized patients and family physicians. CONCLUSION: Although physicians' hospital activities and attitudes changed between 1997 and 1997, most continued to see a need and have a desire to remain involved in hospitals.

Attitude of Health Personnel↗
PubMed1994

Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns.

PURPOSE: This study evaluates the effect of the 1988 National Cancer Institute Clinical Alert regarding treatment of early-stage breast cancer on the patterns of treatment provided to patients. PATIENTS AND METHODS: Data analyzed were collected from the hospital and outpatient records of 12,534 female patients with a primary diagnosis of breast cancer (stages I and II) initially diagnosed during the years 1983 through 1989. RESULTS: Analyses revealed that the proportions of patients with a negative lymph node status diagnosed after the May 1988 Clinical Alert who received adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were significantly greater than predicted from treatment trends established before the Alert's release. Proportions of patients with positive lymph node status receiving adjuvant therapy subsequent to the Alert's release, in contrast, did not fall outside the projected confidence intervals for that group. Additional analyses showed a significant effect of the Clinical Alert among several subgroups of node-negative patients. CONCLUSION: Findings suggest that the Clinical Alert mechanism, followed by publication in the peer-reviewed scientific literature, is an effective way to communicate important research findings to practitioners in the community. However, the Alert mechanism is controversial and should be used judiciously to ensure its credibility.

Adult↗
PubMed1977

The attitudes of psychiatrists toward etiological theories of schizophrenia.

This study is an analysis of psychiatrists' opinions on the etiology of schizophrenia. A random sample of members of the American Psychiatric Association uncovers a general hesitation on their part to subscribe to any particular etiological theory. Only four theories are viewed as causally related to schizophrenia: social isolation, cognitive breakdown, biochemical imbalance, and maternal deprivation. Attitudes toward etiological theories are significantly different among psychoanalysts, behaviorists, and eclectics. Attitudes also are related to the setting in which the psychiatrist practices.

Attitude of Health Personnel↗
PubMed2005

Organizational commitment to professional practice models.

Magnet hospitals must show evidence of professional practice models. A professional practice organizational environment is necessary, but not sufficient, to create professional practice models. The authors analyze the relationship between a professional practice environment and a professional practice and explore organizational commitments required to ensure professional practice at the unit level.

Benchmarking↗
PubMed2004

Shared governance: Hartford Hospital's experience.

Shared Governance is the administration and deployment of the organization's services through a partnership model of managers and staff. A system is said to "live" where it provides service. In a health care organization this is the point of service known as the patient care unit. In that arena staff nurses engaged in a partnership model of governance should be acknowledged as the rightful owner of their clinical practice and the systems that support the delivery of patient care. This manuscript describes an acute care hospital's experience in the evolution of its governance structure that enabled staff nurses to assume greater levels of autonomy and control over their practice.

Connecticut↗
PubMed1993

A comparison of family physicians' and obstetricians' intrapartum management of low-risk pregnancies.

BACKGROUND: We hypothesized that family physicians' style of intrapartum management was less interventional than the management style of obstetricians, and that this would not adversely affect maternal or neonatal outcomes. METHODS: A retrospective, matched-pair study design was used to compare low-risk women cared for by community family physicians with those cared for by obstetricians at a small teaching hospital. The subjects were matched on the basis of age and parity. We compared the rates of intervention between family physicians and obstetricians. RESULTS: We studied 351 matched pairs of women. The demographic characteristics of patients were similar as were the rates for most labor and delivery procedures. Family physicians had lower rates for induction, external and internal fetal monitoring, narcotic analgesia use, and postpartum oxytocin use. Women cared for by family physicians spent less time in the hospital, both during labor and postpartum. CONCLUSION: This study supports the hypothesis that at our center family physicians intervene less than obstetricians in intrapartum management. Comparisons with similar studies conducted at other academic centers illustrate differences in styles of practice between institutions, not just between specialties.

Adult↗
PubMed2003

[Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the point of view of the hospital owners].

Structural changes in the financing of hospital-based health care in Germany make a revision of the currently existing strict separation between ambulatory and stationary patient care inevitable. The present monopolist situation of office-based physicians (organised in private practices without any legal or financial relation to a hospital) will be amended by the participation of hospitals and hospital-employed doctors in ambulatory services of a different kind. These may include the institutional authorization of hospitals to participate in ambulatory services, especially in the case of emergencies and first aid, and co-operations between doctors in private practices and hospitals. Such co-operations are now legally enabled to provide "integrated services", but still lacking acceptance by the parties involved in the health care services. Ambulatory medical care is an already huge and now rapidly growing market, whereas the classical hospital services represent a declining product. Therefore hospitals will have to act accordingly or they will even forfeit the opportunity to use the ambulatory care sector to improve the intensity of utilisation of their hospital beds. In addition, hospitals will have to accept that office-based doctors are their customers and have to be treated as such. The establishment of regional networks may be a solution to this problem. Integrated services can only be established if new ways of co-operation and knowledge transfer are introduced into this area step by step. The present article provides practical examples of co-operation models.

Germany↗
PubMed2006

Diagnostic CT scans: institutional informed consent guidelines and practices at academic medical centers.

OBJECTIVE: The purpose of this article is to characterize current informed consent practices for diagnostic CT scans at U.S. academic medical centers. MATERIALS AND METHODS: We surveyed 113 radiology chairpersons associated with U.S. academic medical centers using a survey approved by our institutional review board. The need for informed consent for this study was waived. Chairpersons were asked if their institutions have guidelines for nonemergent CT scans (by whom; oral and/or written), if patients are informed of the purpose of their scans (by whom), what specific risks are outlined (allergic reaction, radiation risk and dose, others; by whom), and if patients are informed of alternatives to CT. RESULTS: The study response rate was 81% (91/113). Of the respondents, two thirds (60/90) currently have guidelines for informed consent regarding CT scans. Radiology technologists were most likely to inform patients about CT (38/60, 63%) and possible risks (52/91, 57%), whereas ordering physicians were most likely to inform patients about CT's purpose (37/66, 56%). Fifty-two percent (30/58) of sites provided verbal information and 5% (3/58) provided information in written form. Possible allergic reaction to dye was explained at 84% (76/91) of sites, and possible radiation risk was explained at 15% (14/91) of sites. Nine percent (8/88) of sites informed patients of alternatives to CT. CONCLUSION: Radiology technologists are more likely to inform patients about CT and associated risks than their physician counterparts. Although most academic medical centers currently have guidelines for informed consent regarding CT, only a minority of institutions inform patients about possible radiation risks and alternatives to CT.

Academic Medical Centers↗
PubMed2004

Shared governance models: the theory, practice, and evidence.

Nursing practice models provide the structure and context to organize the delivery of care. Shared governance is a model of nursing practice designed to integrate core values and beliefs that professional practice embraces, as a means of achieving quality care. Shared governance models were introduced to improve nurses' work environment, satisfaction, and retention. The purpose of this article is to review representative published evidence of shared governance and to evaluate whether shared governance has lived up to its promise and potential. Theoretical and empirical evidence will be examined and discussed in an attempt to answer whether shared governance, as an organizational form of nursing practice, has achieved the positive outcomes it intended.

Decision Making, Organizational↗
PubMed1984

[Are physicians also sick? Results of a survey carried out in French-speaking Switzerland and Tessin].

The results are presented of a study among 466 physicians in French- and Italian-speaking Switzerland concerning their own health. It emerged that 77.7% of the physicians had had at least one disease during the year studied; in 50% of cases the morbidity was linked to stress and emotivity. Cardiovascular pathology was significantly higher than in the average population. The results reveal striking differences between the different categories of physicians: hospital doctors had more cardiovascular diseases and fewer infectious and pulmonary diseases than physicians running a private practice. Psychiatrists have a higher morbidity rate than the average. General practitioners, psychiatrists and surgeons appear to be especially exposed to stress and emotivity. Pediatricians suffer less from this group of diseases but present a morbidity correlated with that seen in practice, suggesting transmission from patient to doctor.

Adult↗
PubMed1998

Specialty training and the personal use of benzodiazepines by physicians affect their proneness to prescribe tranquilizers.

The decision on how to treat a patient does not depend on clinical matters or illness characteristics alone, but also on patient, physician and setting variables such as personality, training, or reimbursement. No research has yet been carried out to answer the question whether personal experience with medications also influences prescribing behavior. In this study, 124 physicians stratified according to specialty (neuropsychiatrists vs. general practitioners), type of institution (private practice vs. hospital), years of professional experience (young vs. old), and region (rural vs. urban) participated in a structured interview to evaluate their proneness to prescribe benzodiazepines for sleep disorders as well as their personal experience in taking benzodiazepines for their own sleep problems. Both specialty and personal experience were significantly related to proneness to prescribe. Other variables tested (region, institution, age, gender) did not help to explain the variance in benzodiazepine prescribing practice. Thus physician variables and, importantly, their own personal experience in taking the medication significantly influence treatment choice. Rational medical decision making and treatment guidelines must therefore take into account medical knowledge as well as knowledge of personal treatment preferences and professional biases.

Adult↗
PubMed2006

[Implication of nurses in transfusion safety: knowledge assessment and practice evaluation at the Gustave-Roussy institute].

BACKGROUND: A first survey on nurses transfusion practices at our Hospital revealed poor knowledge. Good Transfusion Practices were written, a training program was implemented and a second survey was carried out two years later. STUDY DESIGN AN METHODS: We conducted the second survey in which 4 of the questions were identical to those in the first survey in order to assess the impact of this training strategy. The 4 questions were on blood sample identification, checking patient identification, checking "use by date" on blood product bag and the pre-transfusion bedside compatibility test. Behaviours were evaluated by checking the pre-transfusion procedures, including interpretation of bedside compatibility tests. We investigated the impact of attendance at the training course, the period of employment, day versus night shift and attempted to correlate these factors with the results of the second survey. RESULTS: A significant improvement was observed in knowledge of Good Practices between the first and the second survey (P = 10(-4)). However, the multivariate analysis showed that the impact of training was heterogeneous. Pre-transfusion protocol checks have improved significantly (P = 0.05) as well as pre-transfusion bedside compatibility test interpretation of ABO compatibility (P = 0.007). CONCLUSION: In our study, the implementation of Good practices has significantly improved nurses' knowledge about transfusion safety requirements but it is essential to continue and adapt the training and cheek regularly the impact of these implementations.

Blood Transfusion↗
PubMed2006

Avoiding hyperoxia in infants < or = 1250 g is associated with improved short- and long-term outcomes.

OBJECTIVE: To determine the rate and severity of short- and long-term morbidity in very low birth weight infants treated before and after the implementation of a change in clinical practice designed to avoid hyperoxia. METHODS: Analysis of a prospectively collected database of all infants < or = 1250 g admitted to two Emory University NICU's from January 2000 to December 2004. A change in practice was instituted in January 2003 with the objective of avoiding hyperoxia in preterm infants with target O2 saturation (SpO2) at 93 to 85% (Period II). Before the change in practice, SpO2 high alarms were set at 100% and low alarms at 92% (Period I). Statistical analysis included bivariate analyses and multivariate logistic regression comparing outcomes between the two periods. RESULTS: From January 2000 to December 2004, 502 infants met enrollment criteria and 202 (40%) were born in period II, after change in SpO2 targets. Birth weight, gestational age and survival were similar between both periods. The rates for any retinopathy of prematurity, supplemental oxygen at 36 weeks post-conceptional age and the use of steroids for chronic lung disease were significantly lower in the infants born in Period II. There was no difference in the rates of necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia. At 18 months corrected age (CA), the infants treated during Period II had a higher Mental Developmental Index (MDI) scores (80.2 +/- 18.3 vs 89.2 +/- 18.5; P 0.02) and similar Psychomotor Developmental Index (PDI) scores (83.9 +/- 18.6 vs 89.4 +/- 17.2; P 0.08) than those treated during Period I. The proportion of infants with an MDI or a PDI less than 70 was similar between the periods. CONCLUSIONS: The change in practice to avoid hyperoxia is associated with a significant decrease in neonatal morbidity and does not have a detrimental effect on developmental outcomes at 18 months CA.

Child Development↗