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At least 937 records · Page 52Linked to original sources
PubMed2005

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

The practice guideline from the Dutch College of General Practitioners regarding the diagnosis, treatment and follow-up of a patient with a cerebrovascular accident recommends the patient's referral to a so-called 'stroke-unit'. Thrombolysis within 3 hours after the onset of a stroke should be reconsidered, although its effectiveness remains disputable. The guideline does not explicitly address the GP's responsibility for secondary prevention. The role of the GP in the process of rehabilitation and follow-up in the years after the CVA is described in detail. In so doing, this phase gets the attention it deserves.

Humans↗
PubMed1990

Influence of clinical knowledge, organizational context, and practice style on transfusion decision making. Implications for practice change strategies.

Evidence shows that blood products, like other health care resources, are often used inappropriately, but the reasons for this have not been well studied. We conducted a face-to-face survey of 122 general surgeons, orthopedic surgeons, and anesthesiologists in three hospitals to evaluate the influence of several clinical and nonclinical factors on transfusion decision making. We found widespread deficiencies in physicians' knowledge of transfusion risks and indications. Each transfusion risk was estimated correctly by fewer than half of the physicians surveyed, and only 31% responded correctly to a set of four questions regarding transfusion indications. Attending physicians routinely had lower knowledge scores than did residents, yet they exhibited more confidence in their knowledge. Residents' transfusion decisions, however, were strongly influenced by the desires of their attending physicians, resulting in their ordering potentially inappropriate transfusions. Of the residents surveyed, 61% indicated that they ordered transfusions that they judged unnecessary at least once a month because a more senior physician suggested that they do so. These findings provide insights for the development of strategies to improve transfusion practices, which would address the dual concerns of quality of care and cost containment.

Analysis of Variance↗
PubMed1978

Organizational complexity in family practice: a sociological model of a family practice group.

The growth of a family practice goup is presented as a case study. Enlarging size and increasing functions require organizational change--from solo to collegial to bureaucratic to political systems. Organizational theory distinguishes between the characteristics and functions of individual, collegial, bureaucratic, and political organizations. Different styles and strategies are appropriate at different stages.

Decision Making↗
PubMed1993

Breast-feeding counseling practices of family practice residents.

BACKGROUND: Despite breast-feeding being the best newborn feeding method, the percentage of women in the United States who breast-feed has declined. Family physicians are in a unique position to counsel women about breast-feeding because their emphasis on continuity of care provides both prenatal and postnatal contact. Whether family physicians are trained sufficiently to offer such counseling is unknown. METHODS: A pretested questionnaire was distributed to all residents in 11 of 14 residency programs in North Carolina and Georgia. Data were analyzed with descriptive chi-square statistics and backward logistic regression to assess variables independently predictive of residents' counseling behaviors. RESULTS: One hundred fifty-five residents filled out usable surveys (response rate: 69%). The residents' primary teachers of breast-feeding were family physicians (34%) and nurses (33%). Most residents (93%) felt it was their personal responsibility to counsel women about breast-feeding; 67% believed their training was inadequate, and 48% stated they lacked necessary skills. Forty-one percent of residents counseled such women less than 50% of the time. Personal or spousal breast-feeding experiences gave residents more confidence in breast-feeding anticipatory guidance (P < .001), comfort in teaching techniques (P < .001), and effectiveness in counseling (P < .009) but did not lead to improved counseling rates. Multivariate analysis showed that female residents, those with high confidence in their breast-feeding counseling skills, and residents that had adequate training in breast-feeding counseling instructed women more often about breast-feeding. CONCLUSIONS: Breast-feeding counseling skills are an important but neglected aspect of family practice clinical training. Personal breast-feeding experience is an important indicator of breast-feeding counseling confidence and effectiveness, although it doesn't ensure that proper counseling skills are obtained. Family medicine training programs should incorporate breast-feeding educational programs into their residency curricula.

Breast Feeding↗
PubMedDate not supplied

The role of the licensed practical nurse and the licensed vocational nurse in the clinical practice of intravenous nursing. The Intravenous Nurses Society.

The Intravenous Nurses Society (INS) believes that the intravenous trained licensed practical nurse and the licensed vocational nurse can aid in the delivery of some aspects of intravenous therapy under the supervision of the registered nurse; however, the registered nurse shall be the primary practitioner in this specialty.

Humans↗
PubMed1996

Insomnia in general practice. Results from NSW General Practice Survey 1991-1992.

OBJECTIVE: To assess whether an educational visit to GPs providing information about the non-drug and drug management of anxiety and insomnia can reduce subsequent rates of benzodiazepine prescription. METHOD: A randomised controlled trial of 286 NSW general practitioners conducted during 1991 and 1992. RESULTS: The educational visit was statistically significant in reducing the number of new prescriptions recorded by general practitioners for new diagnoses of insomnia. However, the majority of benzodiazepine prescriptions were for patients continuing treatment for insomnia or anxiety/depression. Overall, benzodiazepines were the sole management of insomnia recorded by the surveyed GPs in most cases (93.5%). In comparison, non-drug management for anxiety and depression was offered to more than a third of patients with anxiety and depression. (Benzodiazepines were the only management of anxiety and depression in just over 50% of cases.) DISCUSSION: This study shows general practitioners can change their management of insomnia and that change is most likely to occur when the problem is new, rather than old. The decreased emphasis on drug treatment in the general practice management of anxiety and depression may reflect the change in psychiatric teaching for these conditions. Further, most of the publicity about benzodiazepines has been in relation to their use for anxiety disorders. Doctors were interested in learning about advances in the understanding of sleep disorders and their non-drug management.

Australia↗
PubMed1998

[Consultations in ophthalmological practice. A multi-practice study of referrals to private ophthalmologists in Denmark].

In Denmark the GPs act as gatekeepers for secondary health care services except for ophthalmologists and ear-nose-throat specialists. The aim of this study was to describe consultations and referral patterns to ophthalmologists in private practice in Denmark. Forty-four out of 143 practising ophthalmologists agreed to fill out a short questionnaire on a random sample of their patients. They recorded 1844 consultations. Forty percent of contacts were appointments arranged by the ophthalmologist, 35% were self-referred, 13% were referred by their GP and 12% by others. Cataract, glaucoma and refraction anomalies accounted for 51% of all diagnoses. The distribution of reasons for encounter and diagnoses among self-referred patients and patients referred by their GP does not argue in favour of a change from the present system with free self-referral to a system with gatekeeping by GPs.

Denmark↗
PubMed2005

Emerging credentialing practices, malpractice liability policies, and guidelines governing complementary and alternative medical practices and dietary supplement recommendations: a descriptive study of 19 integrative health care centers in the United States.

BACKGROUND: Little is known about policies governing the integration of complementary and alternative medical (CAM) therapies and providers. METHODS: To document emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing integration of CAM therapies and providers into conventional medical settings, we surveyed 21 academic medical centers and 13 non-academically affiliated hospitals that are nationally visible and are integrating CAM therapies into conventional medical settings. Of the 19 respondents, 11 were tertiary care hospitals, 6 were community hospitals, 1 was a freestanding center associated with a community-based hospital, and 1 was a university-based rehabilitation hospital. RESULTS: Institutions had no consistent approach to provider mix and authority within the integrative care team, and minimum requirements for professional liability insurance, informed consent disclosure, and hiring status. Less than a third had a formal (stated) policy concerning dietary supplements; those selling supplements in their pharmacy lacked consistent, evidence-based rationales regarding which products and brands to include or exclude. Although many hospitals confiscated patient supplements on admission, institutions had inconsistent criteria regarding allowance of home supply. CONCLUSIONS: Hospitals are using heterogeneous approaches to address licensure, credentialing, scope of practice, malpractice liability, and dietary supplement use in developing models of integrative care. The environment creates significant impediments to the delivery of consistent clinical care and multisite evaluations of the safety, efficacy, and cost-effectiveness (or lack thereof) of CAM therapies (or integrative models) as applied to management of common medical conditions. Consensus policies need to be developed.

Complementary Therapies↗
PubMed1996

Consensus conference. Medical treatment of peptic ulcer disease. Practice guidelines. Practice Parameters Committee of the American College of Gastroenterology.

OBJECTIVE: To integrate the realization that peptic ulcer most commonly reflects infection with Helicobacter pylori or use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) into a disease management approach. PARTICIPANTS: Guidelines were outlined by the author and presented for review to the American College of Gastroenterology (ACG) Practice Parameters Committee, selected by the president of the ACG, and a panel of experts in peptic ulcer, selected by the committee. EVIDENCE AND CONSENSUS PROCESS: These guidelines were formulated following extensive review of the literature obtained by MEDLINE search and presented for detailed review and revision to unpublicized committee meetings on three occasions and to experts by mail. These recommendations are an official statement of the ACG and have been approved by the American Gastroenterological Association and the American Society for Gastroenterological Endoscopy. Firm recommendations are discriminated from reasonable suppositions pending definitive data. CONCLUSIONS: Since cure of H. pylori infection decreases recurrence rates and facilitates healing, antibiotic therapy is indicated for all H. pylori-infected ulcer patients. No optimal, simple antibiotic regimen has yet emerged. Simultaneous conventional ulcer therapy is recommended to facilitate symptom relief and healing. For refractory ulcers, only maximal acid inhibition offers advantage over continued conventional therapy; cure of H. pylori infection is likely to facilitate healing of refractory ulcers. Only with complicated or refractory ulcers should conventional maintenance therapy be continued, at least until successful H. pylori eradication is confirmed. A search for NSAID use is indicated for all ulcer patients. For NSAID-associated ulcers these drugs should be discontinued if possible and H. pylori, if present, should be cured.

Antacids↗
PubMed2003

Practical application of educational rhetoric: a pathway to expert cardiac nurse practice?

Cardiac nursing takes place within various spheres of health care, reaching into primary, secondary and tertiary care within theses, cardiac expertise falls within four domains: health promotion, cardiac prevention and rehabilitation, acute, chronic and episodic care and palliative care. This paper sets out the possibility for a staged development of the cardiac nurse, which could promote homogeneity in role, skill and practice. A framework ('Expert Cardiac Nurse Pathway') for the United Kingdom, is proposed here, and views on its usefulness throughout Europe are sought.

Career Mobility↗
PubMed2002

Evidence-based practice guidelines--one way to enhance clinical practice.

Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.

Adult↗
PubMedDate not supplied

Comparison of ketoprofen, piroxicam, and diclofenac gels in the treatment of acute soft-tissue injury in general practice. General Practice Study Group.

The efficacy, tolerability, and acceptability of topical applications of ketoprofen gel (2.5% w/w), piroxicam gel (0.5% w/w), and diclofenac gel (1% w/w), when administered three times daily for 5 days, in the treatment of acute (within 48 hours) soft-tissue injury, were compared in an open-label, randomized, multicenter, general practice study. Of 1575 patients recruited, 1048 received ketoprofen gel (525 used the gel with a dose-measuring device), 263 received piroxicam gel, and 264 received diclofenac gel. Ketoprofen gel was significantly superior to piroxicam gel in terms of global assessment of treatment response (improvement in 74% vs 65% of patients) and the severity of the injury (38% vs 26% "greatly improved") and in improvements in stiffness (71% vs 64%), restriction of mobility (34% vs 22%), and pain on pressure (81% vs 78%) and movement (83% vs 77%). Ketoprofen gel also compared favorably with diclofenac gel, with a larger proportion of patients assessing a great improvement in the injury (38% vs 30%). Patient acceptability of ketoprofen gel was significantly better than piroxicam gel. More patients noted a significant cooling effect with ketoprofen gel (71%) than with either piroxicam gel (49%) or diclofenac gel (60%). Ketoprofen gel also showed excellent tolerability. In conclusion, ketoprofen gel may offer benefits over established therapies for the treatment of acute soft-tissue injury.

Acute Disease↗
PubMed2004

Policy implementation in practice: the case of national service frameworks in general practice.

National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

Family Practice↗
PubMed1994

Clinical practice guidelines for managing major depression in primary care practice. Implications for psychologists. U.S. Public Health Service Agency for Health Care Policy and Research.

Clinical practice guidelines are being developed by professional and governmental bodies to improve the quality of health care. The guidelines developed by the U.S. Public Health Service Agency for Health Care Policy and Research seek to improve the primary care physician's ability to diagnose and treat major depression. Clinical, educational, and research implications for psychologists are considered in light of how the recommended guidelines potentially will influence the nature and quality of care provided for mood disorders by generalist physicians.

Antidepressive Agents↗
PubMed2001

Practice-based criteria for assessing anaesthetists' habits of action: outline for a reflexive turn in practice.

BACKGROUND: From an ecological perspective, we have demonstrated two distinct logics of practice in anaesthesia. One reflected attitudes characteristic of traditional medical thinking, while the other an insight into the uncertainty of actual situations. OBJECTIVE: We explored interactions between anaesthetists and patients, i.e. anaesthetist's habit of action. By tools we mean information, drugs, and concepts. METHODS: For studying the expert anaesthetists' habits of action in clinical circumstances, wide-ranging material was necessary including video recordings, documented observations and interviews. For each anaesthesia, characteristic cycles between perceived information and regulative actions were constructed. Together with meanings of distinct actions, they constituted the material for analysis of the criteria for evaluation. RESULTS: Besides differentiating the two habits of action, the criteria might provide a perspective for assessing trainees' performances. The 'reactive' habit of action was qualified by conservative and monological ways of using tools and reluctance to construct subjective evaluations. A failure to recognise the semantic aspect of information contributed to the absence of learning. The 'interpretative' habit of action, however, was qualified by creative and interactive use of tools. Ongoing sense-making and anticipation were achieved through cumulative learning based on a dialogical and reflective way of constructing subjective interpretations. CONCLUSION: Professional behaviour was defined through selectivity, interpretation, and judgement. To argue for a professional artistry view is to argue for how we should use our conceptual and material tools in striving for excellence.

Anesthesiology↗
PubMed2004

Prescribing practices for seborrheic dermatitis vary with the physician's specialty: implications for clinical practice.

The prescribing practices of different medical specialties (dermatology, family medicine, pediatrics and other) for seborrheic dermatitis were analyzed using the National Ambulatory Medical Care Survey (NAMCS). The frequency of use of various antifungal and anti-inflammatory medications was found to differ greatly between specialties, with the greatest difference being seen between dermatologists (who frequently prescribe the antifungal ketoconazole) and non-dermatologists (who most frequently prescribe corticosteroids).

Adolescent↗