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At least 973 records · Page 54Linked to original sources
PubMed1993

Functional dyspepsia versus other functional gastrointestinal disorders: a practical approach in Belgian general practices.

This paper identifies the symptom profile associated with the four main diagnoses of functional digestive disorders (dyspepsia, gastro-oesophageal reflux disease (GORD), gastritis, and constipation) made by general practitioners in Belgium. Results are also presented from a multicentre study in which the effects of cisapride, administered as an oral tablet or suspension, were evaluated in patients with these functional digestive disorders. Analysis of symptom patterns revealed that early satiety and postprandial abdominal bloating were the most prominent symptoms, followed by eructation (belching), heartburn, regurgitation, postprandial epigastric burning or discomfort, and nausea. These symptoms occurred in all diagnostic groups. However, different symptom patterns were associated with each of the disorders; for example, heartburn and regurgitation were the core symptoms in patients diagnosed as having GORD, early satiety and abdominal bloating were characteristic of patients diagnosed with dyspepsia, and fasting or postprandial pain were characteristic of patients given the diagnosis of gastritis. Therefore, it appears that these diagnoses used by general practitioners in Belgium closely correspond to reflux-like, dysmotility-like and ulcer-like dyspepsia, as defined by an international working party. Cisapride improved the core symptoms in about 80% of patients with GORD or dyspepsia, relieved all epigastric symptoms in about 80% of patients with gastritis, and significantly decreased the use of laxatives and increased stool frequency in constipated patients. Cisapride was well tolerated and thus appears to be a useful option in the treatment of functional digestive disorders in a general practice setting.

Adult↗
PubMed1995

Physical examinations and laboratory tests in antenatal care visits in Denmark. Do reported practice and current official guidelines concord with results of literature reviews? A nationwide study of the public scheme of shared antenatal care in general practice, centres of midwifery and hospital outpatients' clinics.

OBJECTIVE: To analyse physical examinations and laboratory tests reported in antenatal care visits in relation to official guidelines and reviews of appropriateness. DESIGN: A nationwide cross sectional study based on questionnaires completed by general practitioners (GPs), midwives, and hospital doctors. Physical examinations and laboratory tests in connection with one specific visit were reported. SUBJECTS: The questionnaires were completed by 722 GPs (61% of eligible from a random sample), 584 midwives (86% of eligible), 250 hospital doctors who made health examinations in pregnancy, week 16-18 (63% of eligible), and 181 hospital doctors who saw women with at-risk pregnancies (55% of eligible). RESULTS: General practice: weight, blood pressure (BP) measurement, and test for proteinuria were reported in more than 90% of visits. Urine culture was reported in 46%, and cervical smear in 41% of first visits. Rubella antibody test at the first visit was only reported in 23% of nulliparae. Vaginal examination was reported in 95% of first visits. Fewer were reported in second (27%) and third (48%) routine visits during pregnancy. Midwives: checks of BP, oedema, and proteinuria were reported in more than 95% of visits irrespective of week of gestation. Vaginal examination was reported in about a third of checkups. Hospitals: vaginal examination was reported in 66% of checkups in at-risk pregnancies. CONCLUSIONS: A surplus of resources were spent on (repeat) examinations and tests with little or no documented benefit. Cervical cytology was grossly overused. Urine culture and rubella serology were not sufficiently applied.

Clinical Laboratory Techniques↗
PubMed2000

Clinical preventive medicine in primary care: background and practice: 1. Rationale and current preventive practices.

Impressive evidence supports the value of clinical preventive medicine, defined as the maintenance and promotion of health and the reduction of risk factors that result in injury and disease. Primary prevention activities deter the occurrence of a disease or adverse event, e.g., smoking cessation. Secondary prevention (screening) is early detection of a disease or condition in an asymptomatic stage so treatment delays or blocks occurrence of symptoms, e.g., mammographic detection of breast cancer. Tertiary prevention attempts to not allow adverse consequences of existing clinical disease, e.g., cardiac rehabilitation to prevent the recurrence of a myocardial infarction. Preventive services have decreased morbidity and mortality from both acute and chronic conditions. However, these services are underutilized for numerous reasons. Barriers to their use include physician, patient, and health system factors. The traditional disease/treatment model should be modified to incorporate more preventive services. The subsequent 2 parts of this review will discuss suggestions for integrating primary preventive services and screening into primary care practice.

Cause of Death↗
PubMed1999

Methadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice: results from the National Treatment Outcome Research Study.

BACKGROUND: General practitioners (GPs) are increasingly urged to become more involved in the care and treatment of drug misusers. Little information is available about the effectiveness of treatments delivered in primary health care or specialist settings. The impact of treatment setting is investigated as part of the National Treatment Outcome Research Study (NTORS). This is the largest study of treatment outcome for drug misusers ever conducted in the United Kingdom (UK). AIM: This paper presents six-month treatment outcomes for patients who received community-based methadone treatment in either a specialist drug clinic or a general practice setting. METHOD: A prospective, multisite follow-up study of treatment outcome was conducted with 452 opiate addicts who had been given methadone treatment in primary health care and specialist clinic settings. Outcome data are presented for substance use behaviours, health, and crime. RESULTS: Improvements at follow-up were found among both the GP and the clinic-treated groups in drug-related problems, health, and social functioning. Problems at intake were broadly comparable among the clinic-based and the GP patients. Similar levels and types of improvement were found for both groups at six-month follow-up. CONCLUSIONS: Results demonstrate the feasibility of treating opiate addicts using methadone in primary health care settings, and show that treatment outcomes for such patients can be as satisfactory as for patients in specialist drug clinics. The GPs in our study are unrepresentative in their willingness to be actively involved with problem drug users; moreover, several services treated relatively large numbers of drug users. Issues surrounding the growth of 'GP specialists' are discussed.

Adolescent↗
PubMedDate not supplied

[Do health workers practice what they preach? A study of knowledge, opinions and practices of health care professionals, with respect to their own health, in Madagascar].

In this study, a questionnaire was used to study the individual behavior of a sample of fifty health workers, doctors and nurses from Tamatave (Madagascar) with respect to a number of current health issues. We used the results to assess the impact and efficacy of previous training and to obtain information about the extent to which health staff actually follow the recommendations and standards that they are given and expected to teach, as far as their own health is concerned. It was clear that the standard management procedures and instructions concerning basic health-preserving behavior were far from being universally accepted and followed by health workers themselves. This was the case even for common diseases and health issues for which specific training had been given, such as malaria, diarrhea, AIDS and STDs, tobacco use, HBP management and the use of antibiotics. More attention should be paid to involving health workers in their training programs so that they are really convinced by the recommendations given. So long as most health workers are not themselves committed to the recommendations and have inadequate behavior regarding their own health, they are unlikely to be effective at promoting good health practice.

Health Behavior↗
PubMed1975

The ophthalmologist's office: planning and practice. Location of practice.

A majority of positive responses to the questions posed in this chapter offers the comforting prospect of a wise and potentially successful decision in selecting the location of a practice. (Local Chambers of Commerce usually offer very useful information in answer to the nonmedical questions.) Finally, it should be remembered that this decision is a joint one-the ophthalmologist's spouse and children (if they are old enough) should be involved as much as possible. If they are happy, the intangible rewards will be inestimable.

Economics↗
PubMedDate not supplied

Comparison of adult and geriatric psychiatric practice patterns: findings from the American Psychiatric Association's Practice Research Network.

OBJECTIVE: The authors explored diagnostic and treatment patterns for patients under and over age 65 seen by a nationally representative sample of psychiatrists participating in the American Psychiatric Association's Practice Research Network. METHODS: Detailed patient information, including demographic and financial characteristics, diagnoses, service utilization, and treatment, was collected by 383 psychiatrists on 1,026 patients to assess the impact of patient age on pharmacotherapy and psychotherapy service use as well as treatment outcomes. RESULTS: Approximately 15% of the patient sample was over age 65. Compared with patients ages 19-64, a lower percentage of geriatric patients had Axis I comorbidity, but a higher percentage had Axis III comorbidity. Geriatric patients were more often treated in hospital settings, and older patients were less likely to have their visits adversely affected by financial pressures of the healthcare system. Over 60% of patients in both age-groups received antidepressants, but there was a disproportionately increased use of antipsychotics and antianxiety/benzodiazepine medications among geriatric patients. Being age 65+ was a strong predictor for "improved" clinician rating on general assessment scores, but failed to be a predictor of receiving psychotherapy or pharmacotherapy. CONCLUSION: There were important differences between subject groups. Overall, American psychiatrists treat a complex group of geriatric patients suffering from major mental disorders complicated by medical comorbidity. Additional studies would further enhance our understanding of the delivery of mental health services to elderly patients and improve training of psychiatrists who help care for our aging population.

Adult↗
PubMed2002

Conducting and putting science into practice: the future of oral health research, dental education, and dental practice.

Popular attention has focused on connections between single nucleotide polymorphisms (SNPs) where single genome irregularities are associated with biological deficiencies. The more significant and more difficult work will come through seeking to understand the proteonomics--the way sets of genes are expressed as proteins, and ultimately in larger and more complex entities. Future developments will take place at the interfaces among various disciplines. We are already seeing the introduction of diagnostic tests based on the new genomics in dental offices. New skills will be needed to bring these emerging developments into practice.

Dental Research↗
PubMed2003

Bias in patient assessments of general practice: general practice assessment survey scores in surgery and postal responders.

Patient-based measures of the quality of primary care are increasingly important. However, their effective use requires bias to be minimised. Scores on the General Practice Assessment Survey (GPAS) differ according to whether patients are surveyed in the surgery or by post. It is not clear whether these differences relate to the mode of administration or to the types of patients who complete the scale in postal and surgery samples. Regression indicates that the bias reflects both effects and should be considered when GPAS scores are being interpreted.

Adolescent↗
PubMedDate not supplied

Comparing clinical practice with guideline recommendations for the treatment of depression in geriatric patients: findings from the APA practice research network.

OBJECTIVE: The authors describe treatments provided for depressed geriatric patients (age 65+) treated by psychiatrists in the American Psychiatric Association's (APA) Practice Research Network (PRN) and compare treatments with recommended guidelines for treating late-life depression. METHODS: Detailed demographics, diagnoses, service utilization, and treatment information were collected on relevant patients treated by psychiatrists participating in the APA's PRN during 1997, sample-weighted to produce nationally representative estimates. Treatment data were qualitatively compared with existing depression treatment guidelines from the APA and the Expert Consensus Guideline Series on pharmacotherapy of depressive disorders in older patients. RESULTS: Of patients treated by psychiatrists in the PRN (N=152), just over 41% had a diagnosable depressive disorder, and, of those with depression, nearly 84% had major depression. Over 90% received a psychotropic medication, and over 75% received an antidepressant. Treatment intensity, as measured by visit frequency and duration of treatment, were more intense than typically found in primary care. Most patients received a combination of medication management and psychotherapy. Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressant, although they were less frequently prescribed than in primary care and other national surveys. Just over 11% received a tertiary amine antidepressant, and nearly 43% received benzodiazepines, this frequency being inconsistent with existing guidelines. CONCLUSION: Depressed geriatric patients treated by psychiatrists in APA's PRN receive active treatments largely consistent with existing guidelines, which generally resulted in favorable patient outcomes.

Aged↗
PubMed1992

Is it practical to screen for familial vesicoureteral reflux within a private pediatric practice?

A prospective study was established within a private pediatric practice to identify the incidence and severity of vesicoureteral reflux in the siblings of patients known to have reflux. Twenty-four siblings of 18 children with reflux were studied. Eleven of these siblings were found to have reflux for an incidence of 46%. The risk of reflux in siblings of known children with reflux is thus significant and, at least in this study, compares with the risk of reflux after urinary tract infection. The outcome of the sibling group is discussed, along with our thoughts on the possible modes of inheritance of this disorder.

Age Factors↗
PubMedDate not supplied

Toward a good death: an interpretive investigation of family practice residents' practices with dying patients.

BACKGROUND: Physicians' encounters with dying patients are often problematic. This study was designed to facilitate understanding of what happens when residents encounter dying patients. METHODS: The research involved observing and interviewing 28 family practice residents as they worked with dying patients. The primary research technique was that of a grounded interpretive investigation. RESULTS: We found that working toward a "good death" was a central theme of the residents' everyday actions. At critical points, however, two important forces steered residents away from this central theme: biomedical technology and anxiety. Residents reacted to these forces by distancing, moving back toward a good death, or moving further from a good death. CONCLUSION: Understanding the oscillating course toward a good death will help residents, medical educators, and other physicians deal with dying patients and their families in more meaningful and satisfying ways.

Attitude of Health Personnel↗
PubMed1992

A survey of breast feeding practices in infants seen in general practice.

This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products.

Breast Feeding↗
PubMed2004

From eminence-based practice to evidence-based practice: a paradigm shift.

Evidence-based medicine differs from the traditional approach to health care in that in addition to relying on clinical experience, expert opinion, and knowledge of pathophysiology for clinical decision-making, clinicians identify important knowledge gaps and information needs, formulate answerable questions, identify potentially relevant research, assess the validity of evidence and results, and apply research evidence to individual patients in a way that takes into account the patients' particular experiences, expectations, and values. It is becoming increasingly important that physicians learn the concepts of EBM because many EBM-related concepts have become a part of daily clinical practice. This article uses examples from orthopedics to outline EBM principles and methods and the advantages of EBM over traditional approaches. It also discusses challenges in implementing EBM and suggests EBM-related resources for physicians.

Clinical Competence↗
PubMedDate not supplied

The KDOQI clinical practice guidelines and clinical practice recommendations for treating anemia in patients with chronic kidney disease: implications for nurses.

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recently published revised clinical practice guidelines and recommendations for the treatment of anemia. This article provides an overview of the new guidelines and recommendations, with a focus on the hemoglobin treatment range, iron status, use of erythropoiesis-stimulating agents, and adjuvant therapies.

Anemia↗
PubMedDate not supplied

KDOQI clinical practice guidelines and clinical practice recommendations--2006 updates.

In scanning through the KDOQI guidelines for this article, I applaud the Work Group members as there is an emphasis placed on timely education of the patient, their family members, close friends, and/or primary care providers for both HD and PD. We have all seen in our practice setting, how critical education is for our patients. Studies have shown that timely patient education as CKD advances can both improve outcomes and reduce cost. These guidelines certainly emphasize the importance of advocating for education of patients with CKD. We know that we as nephrology nurses are crucial for educating the patient with CKD, the patient with ESRD, family members, and caregivers and for re-enforcing their education.

Evidence-Based Medicine↗
PubMed1991

A practical application of reliability theory to family practice research.

The practical need for short instruments to assess constructs such as general health results in potentially imprecise measurement. According to reliability theory, a consequence of this imprecision is the inclusion of random error in the observed measurement of any construct. To the extent that measures are unreliable, clinicians may find that large changes in obtained measurements must be seen before one can have confidence that a true change in behavior has occurred. Discussion of the standard error of measurement and its application to functional assessment research is included.

Bias↗