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At least 955 records · Page 53Linked to original sources
PubMed2006

How does current care practice influence the experience of a new diagnosis of motor neuron disease? A qualitative study of current guidelines-based practice.

Management during the diagnostic phase of MND is considered an important influence on the patient's further disease course. Guidelines for the management of MND have been developed, but little is known on how recommended practices influence patients' experience of a new diagnosis of MND. We undertook an interview-based study exploring issues surrounding the diagnosis of MND in a sample of consecutive patients recently diagnosed at a neurosciences centre. Data were analysed with Interpretative Phenomenological Analysis (IPA). Thirteen patients were recruited to the study. The major themes identified in descending order were 'Family/carers', 'Communication of the diagnosis', 'Reaction to the diagnosis', 'Physical difficulties', 'Time before diagnosis', 'Information', 'Future', 'Coping with the diagnosis' and 'Formal support'. Communication was perceived satisfactory if handled according to existing guidelines. Physical difficulties impacted considerably on patients' lives. Delays in the diagnostic process appeared in various interviews. Five patients were avoiding information following the diagnosis. Some patients commented on an increasing number of uncoordinated services becoming involved after their diagnosis. This study supports the current international guidelines for MND care around diagnosis from the patients' perspective and underlines the importance of a multi-disciplinary, coordinated approach for patients with MND from diagnosis onwards.

Adult↗
PubMed2000

Lung function measurement in general practice. General practice measurements compared with laboratory measurements during the DIMCA trial.

BACKGROUND: Lung function measurement in the general practice setting (GPS) is of growing importance. OBJECTIVE.:The aim of this study was to compare results from a lung function laboratory (LFL) with those in a GPS. METHODS: Comparisons were made for decline calculated from GPS and LFL measurements and intra-individual paired measurements. Test characteristics of the spirometer used in the GPS were also assessed. RESULTS: The mean decline in lung function was: -0.037 l/year [95% confidence interval (CI) -0.202 to 0.129] from LFL data and -0.027 l/year (95% CI -0.242 to 0.188) from GPS data. The mean intra-individual difference was -0.0025 l (95% CI -0.493 to 0.488 l). The test characteristics of the spirometer used in GPS did not meet all of the American Thoracic Society guidelines; in particular, the random error was too large. The difference in assessments between measurement in LFL and GPS were such that misclassification might occur if slopes were calculated. CONCLUSIONS. :Repeated measurement in this study showed that GPS measurements are not interchangeable with LFL measurements. Therefore, one has to be cautious when interchanging lung function data from an LFL and a GPS.

Clinical Trials as Topic↗
PubMed1996

Achieving 'best practice' in health promotion: improving the fit between research and practice.

This paper is based on the proposition that transfer of knowledge between researchers and practitioners concerning effective health promotion interventions is less than optimal. It considers how evidence concerning effectiveness in health promotion is established through research, and how such evidence is applied by practitioners and policy makers in deciding what to do and what to fund when addressing public health problems. From this examination it is concluded that there are too few rewards for researchers which encourage research with potential for widespread application and systematic development of promising interventions to a stage of field dissemination. Alternatively, practitioners often find themselves in the position of tackling a public health problem where evidence of efficacy is either lacking, or has to be considered alongside a desire to respond to expressed community needs, or the need to respond to political imperative. Several different approaches to improving the fit between research and practice are proposed, and they include improved education and training for practitioners, outcomes focussed program planning, and a more structured approach to rewarding research development and dissemination.

Diffusion of Innovation↗
PubMed1979

A survey of clinical practice in music therapy. Part II: Clinical practice, educational, and clinical training.

Part II of the clinical practice survey is concerned with the amount and quality of equipment available to music therapists, length of activity sessions, accountability procedures, patient or client referral sources, scheduling procedures, communication with other professionals, and the status of music therapy in institutions. Additional data include ratings of music therapy education and clinical training experiences, the master's degree in music therapy, and opinions concerning NAMT registration for music educators working in special education.

Attitude of Health Personnel↗
PubMed1999

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

Insomnia is the most common sleep complaint reported to physicians. Treatment has traditionally involved medication. Behavioral approaches have been available for decades, but lack of physician awareness and training, difficulty in obtaining reimbursements, and questions about efficacy have limited their use. These practice parameters review the current evidence with regards to a variety of nonpharmacologic treatments for insomnia. Using a companion paper which provides a background review, the available literature was analyzed. The evidence was graded by previously reported criteria of the American Academy of Sleep Medicine with references to American Psychological Association criteria. Treatments considered include: stimulus control, progressive muscle relaxation, paradoxical intention, biofeedback, sleep restriction, multicomponent cognitive behavioral therapy, sleep hygiene education, imagery training, and cognitive therapy. Improved experimental design has significantly advanced the process of evaluation of nonpharmacologic treatments for insomnia using guidelines outlined by the American Psychological Association (APA). Recommendations for individual therapies using the American Academy of Sleep Medicine recommendation levels for each are: Stimulus Control (Standard); Progressive Muscle Relaxation, Paradoxical Intention, and Biofeedback (Guidelines); Sleep Restriction, and Multicomponent Cognitive Behavioral Therapy (Options); Sleep Hygiene Education, Imagery Training, and Cognitive Therapy had insufficient evidence to be recommended as a single therapy. Optimal duration of therapy, who should perform the treatments, long term outcomes and safety concerns, and the effect of treatment on quality of life are questions in need of future research.

Academic Medical Centers↗
PubMed2004

Systematic review of published multi-practice audits from British general practice.

BACKGROUND: Audit has been a major part of attempts to improve patient care in Britain, with substantial resources devoted to it since the 1990 National Health Service reforms. Systematic reviews have considered audit to be of variable, but often moderate, effectiveness. However, these have included few studies from British primary care, and as quality improvement activities may be context specific, it is hard to judge how effective audit has been here. RESULTS: A search for audits published in peer-reviewed journals revealed 48 two-stage projects carried out in British general practice, of which 27 principally concerned chronic disease management and nine prescribing. Most audits showed some improvements in performance, and those using controls showed 27/56 (48%) parameters had changed significantly (P < 0.05). CONCLUSIONS: This review adds further evidence that audit can often be moderately effective. However, it is frequently used as one of a complex set of interventions making precise evaluation difficult. Those responsible for clinical governance will need to choose carefully the subjects they audit in order to use their limited resources to maximum effect. These projects are illustrative examples but once again do not identify any 'magic bullets' that would be highly likely to improve professional performance.

Family Practice↗
PubMed2006

Exploring the continuum: medical information to effective clinical practice. Paper II. Towards aetiology-centred clinical practice.

Contemporary clinical practice increasingly functions within a disease management paradigm aimed at finding and implementing therapeutic interventions that demonstrate efficacy in clinical trials. Disease prevention, elucidation of illness aetiology and proactive health promotion have taken a back seat. Current clinical care often includes a 'fast-food' type of medical encounter, which frequently neglects disease causality. The medical community is presently challenged by unique administrative and professional adversities as well as undue commercial influence; these factors contribute to a lethargic response to escalating rates of chronic illness and to mainstream medicine's relative inattention to emerging research about disease aetiology. Individual medical practitioners and the medical establishment must strategically seek to advance patient health and maintain professional relevancy by a renewed emphasis on the following principles: patient-based clinical care, aetiology-centred medicine, and proactive health promotion.

Chronic Disease↗
PubMedDate not supplied

Redesigning clinical office practices to improve performance levels in an individual practice association model HMO.

Independent Health, a large health maintenance organization in western New York, is participating in a national initiative to redesign the way healthcare is delivered in the clinical office setting. The Idealized Design of Clinical Office Practices (IDCOP) project aims to initiate profound change in the ways physicians deliver care and treatment in the office; the focus is on demonstrating improvements in access to care, patient care, patient and staff satisfaction, and financial performance. Two clinical prototype test sites have successfully implemented an "open access policy," which enables most patients to see their physician on the day an appointment is requested. The two test sites also found improved clinical indicators (for diabetes and coronary heart disease) that positively affected the health of patients; reduced waiting time, enriching the overall experience of the office visit; and improved patient and staff satisfaction with the operational and care delivery modifications. This article describes the findings of the IDCOP initiative at Independent Health.

Financial Management↗
PubMed1976

General practice observed. Child abuse and general practice.

In a general practice of 9250 patients with 1841 children under 10 there were 12 cases of actual abuse during 1973-6. In March 1976 30 children were at risk. A preventive scheme was set up and the short-term outcome was good. There were no cases of serious abuse among the children at risk.

Child Abuse↗
PubMed1984

Practice research. Training for general practice: clinical behaviour in trainers and trainees.

A study of 20 trainers and their trainees in general practice showed that trainees had a statistically significant improvement in their diagnosis of otitis media during their trainee year and also became quicker in the time taken for history taking and examination. There was a fall in trainees' prescribing of antibiotics for otitis media during the study but this was accompanied by a notable rise in prescribing of decongestant-antihistamine mixtures to a level similar to that of the trainers. Trainees seemed to accept readily their trainers' prescribing policies and were hesitant to challenge them. An important finding was that trainees had little influence on trainers' prescribing, the latter showing no appreciable changes during the study.

Anti-Bacterial Agents↗
PubMed1992

Medical audit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice.

OBJECTIVE: To estimate the effects of medical audit, particularly setting clinical standards, on general practitioners' clinical behaviour. DESIGN: Before and after study strengthened by a replicated Latin square. SETTING: 62 training general practices in the north of England. SUBJECTS: 92 general practitioner trainers, 84 (91%) of whom completed the study; random sample of 3500 children consulting one of these trainers for any of five conditions--acute cough, acute vomiting, bedwetting, itchy rash, and recurrent wheezy chest--stratified by doctor consulted, condition, and age. INTERVENTIONS: Clinical standard set by each of 10 small groups of general practitioner trainers for one randomly selected childhood condition. Each group also experienced a different type of medical audit, randomly selected, for each of the four other study conditions (receiving a clinical standard set by another trainer group, tabulated data comparing clinical performance with that of all other groups, tabulated data from only their own group, and nothing ("control" condition)). MAIN MEASURES: Content of initial consultation divided into: history, examination, investigation, diagnosis, and management (abstracted from medical records and "enhancement forms" completed by doctors). RESULTS: There was increased prescribing of bronchodilators for acute cough, oral rehydration fluids for acute vomiting, antibiotics for itchy rash, and bronchodilators and oral steroids for recurrent wheezy chest and reduced prescribing of antibiotics for acute cough and recurrent wheezy chest and tricyclic antidepressants for bedwetting. Fewer children were "discharged." Each change was consistent with the standard and either limited to doctors who set a standard for that condition or significantly greater for them than all other doctors. CONCLUSION: Setting clinical standards improved prescribing and follow up.

Acute Disease↗
PubMed1992

Medical audit in general practice. II: Effects on health of patients with common childhood conditions. North of England Study of Standards and Performance in General Practice.

OBJECTIVE: To estimate the effects of medical audit, particularly setting clinical standards, on patients' health. DESIGN: Before and after study strengthened by a replicated Latin square. SETTING: 62 training general practices in the north of England. PATIENTS: Random sample of 9000 children with any of five conditions--acute cough, acute vomiting, bedwetting, itchy rash, and recurrent wheezy chest--stratified by doctor consulted, condition, and age. INTERVENTIONS: Clinical standard set by each of 10 small groups comprising 84 general practitioner trainers for one randomly selected childhood condition. Each group also experienced a different type of medical audit, randomly selected, for each of the four other study conditions (receiving a clinical standard set by another trainer group, tabulated data comparing clinical performance with that of all other groups, tabulated data from only their own group, and nothing ("control" condition)). MAIN OUTCOME MEASURES: Condition specific, functional, psychological, and educational outcomes; together with parent satisfaction (recorded by home interviews and postal questionnaires). RESULTS: Children consulting trainers for recurrent wheezy chest after those doctors had set a standard for that condition improved both in drug compliance (79% (n = 33) before standard setting v 93% (30) after) and mean number of days of breathlessness (3.8 (SE 1.0) before v 1.7 (0.6) after) and wheeziness (4.7 (0.9) before v 1.8 (0.6) after), compared with those consulting doctors who had not (compliance 74% (144) before v 72% (146) after; breathlessness 2.4 (0.4) before v 2.3 (0.3) after; wheeziness 3.0 (0.4) before v 2.7 (0.4) after). There were no other significant effects of standard setting or audit on patients' health. CONCLUSION: Setting clinical standards improved drug compliance and respiratory function in children with recurrent wheezy chest.

Child↗
PubMed2006

Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database.

OBJECTIVE: To describe the contribution of primary care to the diagnosis and management of sexually transmitted infections in the United Kingdom, 1990-2000, in the context of increasing incidence of infections in genitourinary medicine clinics. DESIGN: Population based study. SETTING: UK primary care. PARTICIPANTS: Patients registered in the UK general practice research database. MAIN OUTCOME MEASURES: Incidence of diagnosed sexually transmitted infections in primary care and estimation of the proportion of major such infections diagnosed in primary care. RESULTS: An estimated 23.0% of chlamydia cases in women but only 5.3% in men were diagnosed and treated in primary care during 1998-2000, along with 49.2% cases of non-specific urethritis and urethral discharge in men and 5.7% cases of gonorrhoea in women and 2.9% in men. Rates of diagnosis in primary care rose substantially in the late 1990s. CONCLUSIONS: A substantial and increasing number of sexually transmitted infections are diagnosed and treated in primary care in the United Kingdom, with sex ratios differing from those in genitourinary medicine clinics. Large numbers of men are treated in primary care for presumptive sexually transmitted infections.

Adolescent↗
PubMed1990

The introduction of a practice formulary in a military general practice.

Over a 15 month period, all the scripts written by doctors in the Episkopi Garrison Medical Centre, Cyprus, were analysed. A formulary was produced by using the most popular items in that 15 month period and tested in a one month trial period. The idea was to find a practical and efficient method of producing a 'basic' formulary to which items could be added or removed after discussion with colleagues.

Cyprus↗
PubMed1983

The role of Chinese traditional medical practice as a form of health care in Singapore--IV. Physicians in private practice.

Although the government of the Republic of Singapore do not give official recognition to the estimated 1000 Chinese physicians in the country, these practitioners of traditional herbal medicine still enjoy the patronage of a certain segment of the population, 76% of whom are ethnically Chinese. In an earlier paper, we have reported on the characteristics of Chinese physicians who volunteer their service for institutions that provide Chinese traditional health care in Singapore. This complementary paper reports the findings of a survey of 55 physicians who run their own private practice about whom, prior to our study, very little was known.

Adult↗
PubMed2006

The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD.

BACKGROUND/AIMS: The National Kidney Foundation (NKF) recently published new guidelines and clinical practice recommendations for the diagnosis and management of patients with diabetes and chronic kidney disease (CKD). METHODS: Guidelines were developed using an evidence-based approach. When sufficient evidence was lacking, recommendations were developed that reflect expert opinion. RESULTS: Guidelines describe the process for screening and diagnosis of kidney disease in the setting of diabetes and the management of hyperglycemia, hypertension, dyslipidemia, and nutrition. Recommendations describe the management of albuminuria in the normotensive diabetic patient and the potential value of albuminuria as a marker of treatment efficacy; the impact of diabetes and CKD in special populations; the importance of behavioral self-management; and the value of intensive multifaceted intervention in these high risk patients. CONCLUSIONS: The new guidelines and recommendations update and extend the scope of the NKF's Kidney Disease Outcomes Quality Initiative (KDOQI(TM)).

Diabetes Complications↗
PubMed2002

The environmental history in pediatric practice: a study of pediatricians' attitudes, beliefs, and practices.

We conducted a mail survey of practicing pediatricians in Georgia to assess their knowledge, attitudes, and behaviors regarding recording patients' environmental histories. Of 477 eligible pediatricians, 266 (55.8%) responded. Fewer than one in five reported having received training in environmental history-taking. Pediatricians reported that they strongly believe in the importance of environmental exposures in children's health, and 53.5% of respondents reported experience with a patient who was seriously affected by an environmental exposure. Pediatricians agreed moderately strongly that environmental history-taking is useful in identifying potentially hazardous exposures and in helping prevent these exposures. Respondents reported low self-efficacy regarding environmental history-taking, discussing environmental exposures with parents, and finding diagnosis and treatment resources related to environmental exposures. The probability of self-reported history-taking varied with the specific exposure, with environmental tobacco smoke and pets most frequently queried and asbestos, mercury, formaldehyde, and radon rarely queried. The pediatricians' preferred information resources include the American Academy of Pediatrics, newsletters, and patient education materials. Pediatricians are highly interested in pediatric environmental health but report low self-efficacy in taking and following up on environmental histories. There is considerable opportunity for training in environmental history-taking and for increasing the frequency with which such histories are taken.

Adult↗
PubMedDate not supplied

Autonomy and clinical practice. 2: Patient privacy and nursing practice.

This article, the second in a series of three considering issues of autonomy, privacy and informed consent in nurse/patient interactions, focuses on the wider conceptions of patient privacy and confidentiality. Given that patients in institutional care are likely to suffer intrusions into their privacy which would be considered unusual in normal social interaction, it is interesting to note the dearth of literature in this area. Some definitions of privacy are considered in an attempt to begin to raise readers' awareness of the complexity of this notion. It can be argued that privacy is a pertinent notion to consider, both in order to gain a greater understanding of what is meant by the term and in terms of the implications of this understanding for clinical practice.

Confidentiality↗