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At least 811 records · Page 45Linked to original sources
PubMed1981

The social worker as educator of family practice residents: principles for practice.

Social workers have been involved in medical education for several decades. The field of family practice offers new opportunities and challenges for social work educators to help family physicians address not only the biological needs of their patients, but their psychosocial needs as well. To be successful, the educator will need to be familiar with resident learning styles and preferences, with their attitudes toward the behavioral sciences, and with differential teaching strategies. Research about the impact of training programs on the family practice resident will make for more effective curriculum planning efforts by social workers.

Family Practice↗
PubMed1998

Do clinical practice guidelines define good medical care? The need for good science and the disclosure of uncertainty when defining 'best practices'.

Practice guidelines, although important in promoting quality, can also be harmful if they do not advocate the best options for patients. The latter can occur because of uncertainties in scientific evidence, biases in guideline development, and patient heterogeneity. Guidelines must therefore accurately describe the quality of the evidence and the degree of uncertainty that underlie recommendations. Proper methods for developing practice guidelines are reviewed.

Decision Support Techniques↗
PubMedDate not supplied

Oral health practices among adolescents: a study from family practice clinics in Israel.

Dental caries and periodontal disease are highly prevalent among adolescents. Preventive dental visits and proper oral health practices effectively reduce the occurrence of these entities. The objective of this study was to determine the rates of tooth brushing, flossing, and visits to dentists and hygienists among Israeli adolescents in a family practice setting. One hundred and eighty-four 7th and 10th graders who attended preventive health visits completed questionnaires that included questions regarding dental visits and personal oral health habits. Structured counseling by the family nurse was provided following completion of the questionnaire. Ninety-seven percent of the teenagers brushed their teeth at least once a day, but only 7% used dental floss daily, 44.5% never flossed, and another 10% didn't know what dental floss was. Eighty-three percent had visited a dentist, but only 33% had been to a dental hygienist in the past two years. Twenty-nine percent did not know what a hygienist was. We conclude that primary care providers can promote oral health by screening and providing counseling to their adolescent patients.

Adolescent↗
PubMed2004

[Comprehensiveness in practice (or, on the practice of comprehensiveness)].

This article reflects on the manifestations or signs of comprehensiveness in health practice, seeking to facilitate recognition of experiences that are advancing in this direction and allowing them to be analyzed subsequently. The article is also intended to spawn increasing involvement by actors in practices based on comprehensiveness. The point of departure is the principle that what characterizes comprehensiveness is an expanded grasp of the needs and ability to recognize the adequacy of the health care supply in the specific context where the subject meets the health team; in addition, to foster comprehensiveness means defending the notion that health actions be attuned to the specific context of each encounter.

Comprehensive Health Care↗
PubMed2000

Developing clinical practice guidelines for heart failure: creative process and practice implications.

The rapid growth of medical knowledge has created many advances in therapeutics related to chronic disease. Translation of these advances into everyday care of patients with chronic disease has proven problematic. Guideline development offers a principal strategy to improve use of new and existing therapeutic modalities of proven benefit. To be effective, practice guidelines must not only deal with which therapies are efficacious but attempt to consider the many practical aspects necessary in the actual care of patients. In this way both the art and science of medicine can be employed to obtain optimal patient outcomes in many chronic diseases that have been associated with severe mortality, morbidity, and poor quality of life. The logical process of guideline development and its use in one specific chronic disease, heart failure, is examined.

Cardiac Output, Low↗
PubMed2001

'Do you speak practice-ese?' A discourse of practice for sharing communication.

Speech and language therapy (SLT) is absorbed in an empirical (or 'scientific') discourse. A case study, involving a single practitioner, is reported. SLT's application of an empirical discourse is critically investigated. Results reveal that SLT engages reductionism, essentialism, and 'dis-othering' in its practice discourse. Consequently, rich, textured lives are re-manufactured in a less than authentic manner. A critically oriented practice discourse is recommended to assist SLT in reconsidering its present immersion in a reductionistic, technical and utilitarian discourse and toward a discourse that assists an effective sharing of communication.

Humans↗
PubMed1998

Establishing a collaborative psychopharmacology practice: practical considerations.

Prescriptive authority for the advanced practice psychiatric nurse (APPN) is accompanied by the following advantages: expanded treatment repertoire, increased marketability due to the practicality of having one provider for psychotherapy and pharmacotherapy, and increased collaboration with colleagues. The disadvantages associated with prescriptive authority include: increased professional responsibility and associated liability, labor intensity due to continuing educational demands, medical record documentation, and time-consuming dialogues with referring clinicians. A preexisting relationship between the APPN and the psychiatrist that is based on mutual respect and similarities in treatment philosophies and ethical issues positively influence outcomes.

Drug Prescriptions↗
PubMed2002

Private practice--an advanced practice option.

Currently there is considerable debate on the role and function of nurses in Australia and internationally. This debate stems from developments within the nursing profession itself from political and economic issues in health platforms, due to restructuring of the health care system, consumer expectations of health care and nurses' expectations of a career. This paper provides the opportunity to reflect on the development of the role of the private practice (independent nurse) and where that role is situated in the nursing profession. This forms the basis for discussion of the development of specialty practice at an advanced level in Australia and to demonstrate its relationship with the nurse practitioner movement in Australia.

Attitude of Health Personnel↗
PubMed1987

Prepaid medical practice. Obvious and hidden tradeoffs in leaving private practice.

After 11 years of private practice this primary care physician objected to such growing distractions as increasing paperwork, governmental control, and liability concerns. His work consumed so much time that he had little left for his personal life--most importantly, his wife and children. He therefore made the decision to join the staff of a prepaid medical practice. Having already weighed the known advantages and disadvantages of doing so, he later found that there were additional pros and cons. The author tells how he has modified some of the drawbacks of working for an HMO in order to maintain his preferred standard of medical care, and how he has come to terms regarding his commitment to the field of medicine.

Decision Making↗
PubMed1976

Eighteen months general practice experience with urban practice nurses.

Experience working with practice nurses under the present urban practice nurse scheme is described very briefly. Financial matters are touched on briefly, as are points for and against the scheme. The personal conclusions reached with regard to patient acceptance, opportunities to practise a more preventive type of medicine and the relief of excessive pressures on the doctor, appear to make the continuance and extension of the scheme well worthwhile.

Community Health Nursing↗
PubMed2000

Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine.

Chronic insomnia is the most common sleep complaint which health care practitioners must confront. Most insomnia patients are not, however, seen by sleep physicians but rather by a variety of primary care physicians. There is little agreement concerning methods for effective assessment and subsequent differential diagnosis of this pervasive problem. The most common basis for diagnosis and subsequent treatment has been the practitioner's clinical impression from an unstructured interview. No systematic, evidence-based guidelines for diagnosis exist for chronic insomnia. This practice parameter paper presents recommendations for the evaluation of chronic insomnia based on the evidence in the accompanying review paper. We recommend use of these parameters by the sleep community, but even more importantly, hope the large number of primary care physicians providing this care can benefit from their use. Conclusions reached in these practice parameters include the following recommendations for the evaluation of chronic insomnia. Since the complaint of insomnia is so widespread and since patients may overlook the impact of poor sleep quality on daily functioning, the health care practitioner should screen for a history of sleep difficulty. This evaluation should include a sleep history focused on common sleep disorders to identify primary and secondary insomnias. Polysomnography, and the Multiple Sleep Latency Test (MSLT) should not be routinely used to screen or diagnose patients with insomnia complaints. However, the complaint of insomnia does not preclude the appropriate use of these tests for diagnosis of specific sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, and narcolepsy that may be present in patients with insomnia. There is insufficient evidence to suggest whether portable sleep studies, actigraphy, or other alternative assessment measures including static charge beds are effective in the evaluation of insomnia complaints. Instruments such as sleep logs, self-administered questionnaires, symptom checklist, or psychological screening tests may be of benefit to discriminate insomnia patients from normals, but these instruments have not been shown to differentiate subtypes of insomnia complaints.

Chronic Disease↗
PubMed1999

Clinical examination for abdominal aortic aneurysm in general practice: report from the Medical Research Council's General Practice Research Framework.

At the time of the 1992-1994 annual reviews in the thrombosis prevention trial, general practitioners (GPs) carried out clinical examination for aneurysms by abdominal palpation in 4171 men. When an aneurysm was suspected, the patient was referred to hospital for further investigation. Aneurysm was suspected in 60 men (1.4%) and confirmed in 25 (0.6%), the mean diameter of confirmed aneurysms being 5.0 cm (range = 3.1-8.0 cm). Of the 25 men in whom aneurysm was confirmed, 10 (40%) underwent elective surgery and one died while under investigation. Examination by abdominal palpation for aortic aneurysm, which is not widely used in either general practice or in hospital practice, other than vascular surgery, is clinically worthwhile even though not all aneurysms will be detected by this means.

Aged↗
PubMed2000

A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives.

OBJECTIVE: To summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive clinical interventions, and system changes to promote the treatment of tobacco dependence. PARTICIPANTS: An independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Quality. A consortium of 7 governmental and nonprofit organizations sponsored the update. EVIDENCE: Approximately 6000 English-language, peer-reviewed articles and abstracts, published between 1975 and 1999, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses. CONSENSUS PROCESS: One panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised. CONCLUSIONS: This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved. (2) Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must institutionalize the consistent identification, documentation, and treatment of every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief treatment. (5) There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective-practical counseling, social support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence-sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch-are effective, and at least 1 of these medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the updated guideline. JAMA. 2000;283:3244-3254

Cost-Benefit Analysis↗
PubMed2000

Do practice guidelines guide practice? A prospective audit of induction of labor three years experience.

BACKGROUND: To examine the effect of implementation of guidelines for induction of labor on the process of care and outcome measures. METHOD: Guidelines for induction of labor were implemented in January 1996 following an audit report identifying inconsistency in clinical practice. A prospective audit was carried out following the implementation of a new strategy directed towards pre-induction cervical ripening in nulliparae with unfavorable cervices and the use of low dosages of vaginal prostaglandin E2 for induction of labor. Level of compliance and outcome measures were compared before and after implementation of guidelines. RESULTS: In the period of January 1995 to November 1997, 1,230 women were induced with a singleton viable pregnancy in a cephalic presentation with a gestational age > or = 37 weeks with no history of rupture of membranes or cesarean section. Completed forms were available for 1,147 women (370, 421 and 356 in 1995, 1996 and 1997, respectively). Among nulliparous women, there was a reduction in the number of women who were admitted with cervical score of < or = 4 (24%, 40%, and 54% in 1997, 1996, and 1995, respectively; p=0.0001), an increase in the number of women who had amniotomy on admission (32%, 25% and 12% in 1997, 1996, and 1995, respectively; p=0.0001) and a shorter induction-delivery interval. No change in outcome measures was noted among multiparous women despite reduced dose of prostaglandin E2 used for induction of labor. A marginal reduction of both Cesarean section and failed induction rates were noted in both nulliparae and multiparae. Level of compliance improved with successive rounds of audit. CONCLUSION: Explicit guidelines do improve clinical practice, when introduced and monitored in the context of rigorous evaluations. However, the size of improvement could vary.

Adolescent↗
PubMed2002

[Systematic reviews in practice. IX. Determining their place in treatment recommendations in practice guidelines].

In a systematic review (SR), the available evidence for a clinical problem is systematically and comprehensively collected from different studies, the likelihood of bias is assessed and the results are summarised in a reproducible manner. The results of an SR can be used in either individual patient care or the formulation of a practice guideline. Throughout the world, (national) organisations for guideline development use systems for classifying the validity of evidence according to the study design ('levels of evidence'), and this is also the case in the Netherlands. In formulating a treatment recommendation, consideration must be given to the various factors which determine the strength of the evidence: study design, consistency of the results (if more studies are available), quality of the individual studies, magnitude and precision of the reported effect and the clinical relevance of the outcome measures. If insufficient studies with the same outcome measure are available, problems can arise in an SR. In practice, problems can also arise with respect to estimating the cogency of an SR compared to another review or primary studies. For the same subject, there might be discordant reviews, differences between reviews and megatrials might exist or just one randomised clinical trial might be available. These problems can often be solved with the aid of a systematic analysis. This requires both methodological and clinical expertise.

Bias↗
PubMed2002

The state of clinical pharmacy practice in family practice residency programs.

BACKGROUND: Clinical pharmacists have been involved with family practice residencies for more than 20 years. This survey was designed to evaluate the current state of clinical pharmacy services in the family practice residency program (FPRP) in the United States. METHODS: All FPRPs were contacted to identify clinical pharmacists involved with their programs. These pharmacists were directed to a password-protected Web address where the survey was posted. Completed surveys were submitted on-line, and data were retrieved for analysis. RESULTS: Of the 579 residencies, 155 (26.7%) acknowledged 174 clinical pharmacists working within their program. Responses were received by 130 of the pharmacists (74.7% response rate). These pharmacists held academic appointments in both their institution's school of pharmacy (80%) and the school of medicine (53.2%). The mean age of the respondents was 36.5 +/- 8.2 years, and the mean salary was $66,000 (range $46,000-$125,000). A majority of the pharmacists received their funding from a single source, and 32.2% received full salary support from the FPRP. The respondents spent more than half of their time with the residency program. Overall, their time was divided into teaching responsibilities (42.7%), patient care activities (37.1%), research (12.1%), administrative functions (11.8%), and drug distribution (< 5%). CONCLUSIONS: Pharmacists are actively involved in 26.7% of FPRPs. This survey demonstrates increased salary support from the FPRP in comparison to past surveys. Additionally, more pharmacists hold academic appointments within schools of medicine.

Adult↗
PubMed2002

[The Dutch College of General Practitioners' practice guideline, "Vaginal bleeding"; reaction from a general practice perspective].

The most important changes in the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' are the passages about the progesterone-containing 'intra-uterine device' (IUD), the combination of progesterone and oestrogen by prescribing, for example, a sub-50-pill for the treatment of menorrhagia, and advising the patient to undergo a transvaginal ultrasound to determine the amount of build-up in the endometrium. Vacuum aspiration of the endometrium to establish the cause of menorrhagia is not mentioned. This first revised version can contribute to the quality of care in general practice.

Female↗