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PubMed1988

Final funding priorities for grants for residency training in general internal medicine and general pediatrics--HRSA.

The Health Resources and Services Administration announces the final funding priorities for Fiscal Year 1989 for Grants for Residency Training in General Internal Medicine and General Pediatrics authorized under section 784, Title VII of the Public Health Service Act, as amended by Pub. L. 100-607. Section 784 authorizes the award of grants for planning, developing and operating approved residency training programs which emphasize the training of residents for the practice of general internal medicine or general pediatrics. In addition, section 784 authorizes assistance in meeting the cost of supporting residents who are participants in any such program, and who plan to specialize or work in the practice of general internal medicine or general pediatrics. Eligible applicants are accredited schools of medicine and osteopathy, public and private nonprofit hospitals, or other public or private nonprofit entities. To receive support, programs must meet the requirements of final regulations as specified in 42 CFR Part 74, Subpart FF.

Internal Medicine↗
PubMed2001

[Importance and possibilities of general guidelines in family practice strategies--do we need 'basic guidelines' in general practice?].

General practice is distinguished particularly by complex patient problems and generic competencies to act and counsel as a family practitioner. Guidelines which are only centered on clinical topics like diagnoses, treatments etc. are not sufficient to support action and decision in general practice. The article proposes the concept of generic guidelines (basic guidelines) for family medicine. A need for basic guidelines in general practice is established in three areas: 1) cross sectional patient problems (e.g. care for immigrants, common strain and distress, counselling of screening procedures), 2) basic skills and strategies in family practice (e.g. problem-oriented consultation, home visits, patient information and informed consent), and 3) practice management and documentation. The development of generic guidelines seems to be difficult as the efforts to evidence-based professional practice are only recently started, but this is matched by the high importance of guidance for general practice, and certain concepts of family medicine support it. It is concluded that the development of basic guidelines in general practice will have a considerable impact on structuring the framework and fostering the quality improvement of general practice.

Counseling↗
PubMedDate not supplied

[General physicians and general medicine: social image and public opinion].

During the last two decades, importance of general practice of medicine was more recognised. The kind of interest was different between Health decision makers and population. For Health decision makers, revalorisation of general medicine is the better solution we could develop in order to improve efficiency of the health care financing systems. However, From the side of population social image of the general physician is going down. In order to investigate the population view point about general practitioner, we conduct a trial next to 289 persons living Tunis area. Peoples recognized to the general practitioner some qualities: Useful for first aid, he integrates all aspects of the morbidity, initiates best relations with his patients and appropriately manages medical files. In the other side, He's less qualified than the specialist to take appropriate decision, for monitoring and for the quality of communication with patients. He' also lack of technicality and investigation procedures. Ours results indicate how it is urgent to lead a reform of teatching of general medicine in the country.

Adolescent↗
PubMed1990

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. The response was 70% (453 doctors). A majority of the respondents said they were well informed about the national standard setting initiatives instigated by the NHG (71%) and about the content of the first standards (77%). The general practitioners had a positive attitude towards the setting of national standards for quality of care, and this was particularly true for doctors who were members of the NHG. Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries.

Attitude of Health Personnel↗
PubMed1989

[Diagnosis and treatment in general practice. 5. Attitudes of general practitioners--a review].

The word "attitude" means continuing orientation of the individual towards the world. Attitudes consist of cognitive beliefs and affective reactions, which predispose the individual towards certain action patterns and which have emotional (positive/negative) value. Doctors' attitudes are developed by the joint influences of selection and socialization. Doctors are predominantly recruited from the middle classes and are therefore characterized by middle class attitudes, valuing hard work, activity, self-discipline and rationality. The curriculum of medical school has a further and independent influence on the personalities of physicians-to-be, shaping their attitudes towards patients and medical work. This study gives a review of the official professional ideology of general practitioners (GP's) which, in some respects, differs from the ideology of other doctors. The basic issues, according to general practitioners' commission reports, textbooks, and research can be subdivided into four main principles: 1. A holistic model of disease, 2. The GP as a family doctor (a continuous and personal doctor-patient relationship), 3. The GP as a "gate-keeper" (the central referring role), 4. General practice as a "free enterprise". The two first principles deal with the substance of the GP's work and they stress holism, continuity and dialogue. The two last principles on the other hand deal with the structure of GP's work, stressing freedom and power. Thus general practitioners' ideology and attitudes serve to emphasize differences between hospital medicine and general practice. Differentiation between GP roles and roles of their psycho-social co-workers in the primary health care is not equally marked. Demarcation of general practice ideology in this respect is needed.

Attitude of Health Personnel↗
PubMed1988

Psychiatric screening in general practice: comparison of the general health questionnaire and the hospital anxiety depression scale.

The prevalence of psychiatric disorder in 100 patients attending their general practitioner was found to be 33% based on the criteria of the DSM-3 diagnostic system. Using the DSM-3 diagnosis as a yardstick, the performance of the hospital anxiety depression scale was compared with that of the general health questionnaire. Relative operating coefficient analysis showed good discrimination between ;cases' and ;non-cases' for both questionnaires, and the optimum threshold score was found to be eight for the hospital anxiety depression scale and five for the general health questionnaire. Using these threshold scores the positive predictive value was 81% for the hospital anxiety depression scale and 77% for the general health questionnaire. The hospital anxiety depression scale appeared more sensitive than the general health questionnaire (90% versus 77%) and simpler to complete. In addition, it does not require a different threshold score for each population studied. The use of screening questionnaires in general practice is discussed.

Adult↗
PubMed1994

Near patient testing in general practice: attitudes of general practitioners and practice nurses, and quality assurance procedures carried out.

BACKGROUND: The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM: This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD: Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS: Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION: General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation.

Attitude of Health Personnel↗
PubMed1993

[General practitioners and smoking. General practitioners' knowledge, attitudes and smoking habits and the relationship between these assessed by a questionnaire study in the county of Aarhus].

The objects of the investigation were to investigate the smoking habits of general practitioners, their assessment of tobacco as a risk factor for ischaemic cardiac disease, attitudes to intervention to stop smoking and to assess whether there was a connection between these. The project was carried out as a questionnaire investigation in the County of Aarhus, where all of the general practitioners received questionnaires. A total of 313 general practitioners replied to the questionnaire which corresponds to 84% participation. 33% of the general practitioners smoked and nine were chain smokers. The majority of the general practitioners accepted that smoking was a risk factor for ischaemic heart disease and were prepared to make great efforts to combat smoking. A connection was present between smoking habits and attitudes: Non-smokers considered that smoking was of great significance as a risk factor for ischaemic heart disease and were prepared to make efforts to alter the smoking habits of their patients. General practitioners doubted the effect of their advice about stopping smoking.

Attitude of Health Personnel↗
PubMed1996

What do general practitioners and community mental health teams talk about? Descriptive analysis of liaison meetings in general practice.

BACKGROUND: Liaison meetings between psychiatrists and general practitioners are now well established. Much has been written about their purpose and structure but little about their content. AIM: A study aimed to describe the clinical focus of meetings between a community mental health team and general practitioners and the nature of the professionals' interactions. METHOD: Audiotapes of six consecutive monthly meetings between a community mental health team and general practitioners in two general practices were analysed. RESULTS: Attendance rates among professionals were over 70%. Over 90% of discussion time was focused on patient-centred clinical matters. Almost two thirds of interactions were focused on patients receiving ongoing joint care; few interactions were devoted to new referrals or to patients who had not been assessed. Psychotic patients, although accounting for 15% of referrals, occupied 54% of patient-centred discussion time. Most interactions consisted of reciprocal information exchange between members of the community mental health team and general practitioners. CONCLUSION: The high attendance rates indicate that both general practitioners and community mental health team members considered these meetings as high priority. The steady move towards management of severely ill psychiatric patients in the community rather than in hospital requires close collaboration between primary and secondary care teams. The meetings described in this paper appear to be a simple, manageable and sustainable response to this need.

Communication↗
PubMed2003

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales.

OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

Adult↗
PubMed1991

Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery.

The goal of this randomized study of high-risk surgical patients was to determine whether intraoperative thoracic epidural anesthesia in combination with light general anesthesia alters postoperative morbidity when compared to a standard technique of "balanced" general anesthesia. A total of 173 patients scheduled for abdominal aortic reconstruction were admitted to the study; 86 were to receive "balanced" general anesthesia (group 1) and 87 thoracic epidural anesthesia in combination with light general anesthesia (group 2). Preoperative evaluation included standard clinical tools, dipyridamole thallium gammatomography, and radionuclide angiography. In these patients, all of whom had peripheral artery disease, there were no significant differences in associated coronary artery disease, hypertension, and cardiovascular treatment. The distribution of left ventricular ejection fraction and the number of patients with thallium redistribution were not statistically different between the two groups. During the postoperative period, group 1 received analgesia of subcutaneous morphine (n = 35), epidural fentanyl (n = 30), or epidural bupivacaine (n = 21). In group 2, 6 patients with a nonfunctioning epidural catheter due to technical failure received a balanced general anesthesia and were eliminated from the study. During the postoperative period, group 2 received analgesia of subcutaneous morphine (n = 26), epidural fentanyl (n = 25), or epidural bupivacaine (n = 30). Cardiovascular morbidity did not differ between the two groups: 22 patients in group 1 and 19 patients in group 2 had a major postoperative cardiac event.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Specialism and generalism in the future of general surgery.

The progressive specialism that has characterized the practice of medicine over the last 100 years has occurred almost entirely in a scientific context. Societal needs and social changes have had little influence. As we near the end of the 20th century the benefits of scientific specialism are being questioned. New historical studies of specialism have shown that factors other than new knowledge are the driving force for the creation of some subspecialties. The process by which a new subspecialty is established requires both a national institute and a certification examination. Certification is intended to identify those with specific knowledge and skill by inclusion, but is being perceived increasingly as a process that works by exclusion. General surgery, one of the few "generalist" disciplines, finds itself at a crossroads. Further subspecialization with certification will fragment and destroy the discipline. There are cogent arguments, based on economics and care-delivery issues, to preserve general surgery. Making this choice will commit general surgeons to accept the concept of scientific generalism and to the development of the specialty of general surgery in a social context.

Canada↗
PubMed1992

On the use of the generalized t and generalized rank-sum statistics in medical research.

We have used Monte Carlo methods to compare the type I error properties of the conditional and unconditional versions of the generalized t and the generalized rank-sum tests to those of the independent samples t and Wilcoxon rank-sum tests. Results showed inflated type I errors for the conditional generalized tests but not for the unconditional tests. We also compared the power of the unconditional generalized tests to that of the t and Wilcoxon tests under a variety of conditions. Results showed the generalized tests to be much more efficient than their traditional counterparts in some circumstances, but substantially less powerful in others. Based on these and other considerations, we conclude that the application of these newer statistics in medical research needs further consideration.

Data Interpretation, Statistical↗
PubMed1983

Patient education in general practice: opinions of general practitioners.

Fifty-two general practitioners were interviewed regarding their task in patient education and various aspects of it. The view general practitioners have on patient education is complex. Although they consider it a central task, the range of methods they are willing to use is limited. Many general practitioners tend to overlook the fact that they are not the only source of information and explanation for patients. They would prefer to keep control over information given patients, fearing that patients might be confused. It is notable that many general practitioners have no clear standards of what patients need to know. Much depends on the questions the individual patient asks. There are several kinds of information that general practitioners are disinclined to give, particularly relating to uncertainties or information that might alarm the patient. The outlook for improvement must not be overestimated. Some directions are given for supporting the development of patient education.

Attitude of Health Personnel↗
PubMed2002

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project.

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.

Adolescent↗
PubMed1975

Severity of symptoms of psychiatric outpatients: use of the General Health Questionnaire in hospital ang general practice patients.

A sample of 91 new referrals to a community based psychiatric outpatient service was compared with a cross-matched control sample of 107 patients attending the general practitioner's surgery. The subjects in both groups completed the General Health Questionnaire and there was a very marked difference between the scores of the two groups. Seventy-five of the psychiatric group had a high score on the questionnaire, and a large number of these were extremely high, while 74 of the general practice group had a low score. The 'false' positives and negatives are discussed. It is considered that the validity of this questionnaire as a screening device for demonstrating psychiatric morbidity and severity in general practice is further established in this study by showing that in matched samples the expected psychiatric morbidity in general practice can be compared with the much greater morbidity in psychiatric outpatient referrals. For the psychiatric sample more patients showed high scores and these tended to be much higher.

Adjustment Disorders↗
PubMed1993

Auditory frequency generalization and a failure to find octave generalization in a songbird, the European starling (Sturnus vulgaris).

Many species of songbirds have absolute pitch perception. They memorize tones when discriminating between sequences and fail to generalize to novel frequency ranges. I examined frequency generalization in starlings (Sturnus vulgaris) that were trained to discriminate between individual frequencies. Starlings were tested for frequency generalization after training on 2- and 3-tone discriminations. There was no evidence for octave generalization, which is a hallmark of human absolute pitch perception. This suggests that avian absolute pitch perception must not be interpreted as identical with that in humans. A control experiment with 1-tone discriminations indicated that the presence of lit response keys affects the shape of the generalization gradients. Lit response keys are a common feature in avian auditory perception experiments, and this control experiment cautions that results may be affected by this seemingly minor procedural change.

Acoustic Stimulation↗
PubMedDate not supplied

The estimation of body density in men: are general equations general?

Regression equations for estimating body density and fatness from anthropometric measurements are usually specific to the populations from which they are derived, owing to methodological and biological factors. Some equations are, however, regarded as having general validity for subjects of different ages, levels of fatness and fitness. In this study, five such general equations were tested by comparing estimated body density (Dest) with measured body density (Dmeas) in 138 European men employed in an Italian shipyard. Body density was measured by underwater weighing with the simultaneous determination of lung residual volume. Measurements were also made of height, weight, eight skinfolds, four circumferences and seven diameters by standard techniques. Dest from the five general equations were significantly different from Dmeas (P less than 0.001). New prediction equations for estimating D were drawn up by simple and multiple regression of various combinations of skinfolds expressed as individual skinfolds, sums, log sums and the quadratic form. Equations were drawn up on a validation sample (N = 92) and tested on a cross-validation sample (N = 46). The form of skinfolds and the combination selected made little difference to the SEEs and R2 but the inclusion of age resulted in lower SEEs. Stepwise multiple regression produced an equation incorporating thorax and triceps skinfolds and age with an SEE of 6 kg/m3 and R2 of 79%. The derived equations were successfully cross-validated, Dmeas and Dest were not significantly different, ryy' and SEE were similar to those of the validation sample. When the cross-validation sample was divided into two according to age, density or VO2 max, the derived equations were applicable to the upper and lower groups for age or physical fitness but not to the groups differing in fatness. These equations should be validated further on other samples by studies performed with due regard to the methodological factors, both technical and statistical, that may result in specificity. However, the poor performance of the general equations tested and the specificity for fatness of the derived equations suggest that biological factors may preclude the development of general prediction equations for body density.

Adult↗