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PubMed1993

Recommended infection-control practices for dentistry, 1993. Centers for Disease Control and Prevention.

This document updates previously published CDC recommendations for infection-control practices in dentistry to reflect new data, materials, technology, and equipment. When implemented, these recommendations should reduce the risk of disease transmission in the dental environment, from patient to dental health-care worker (DHCW), from DHCW to patient, and from patient to patient. Based on principles of infection control, the document delineates specific recommendations related to vaccination of DHCWs; protective attire and barrier techniques; handwashing and care of hands; the use and care of sharp instruments and needles; sterilization or disinfection of instruments; cleaning and disinfection of the dental unit and environmental surfaces; disinfection and the dental laboratory; use and care of handpieces, antiretraction valves, and other intraoral dental devices attached to air and water lines of dental units; single-use disposable instruments; the handling of biopsy specimens; use of extracted teeth in dental educational settings; disposal of waste materials; and implementation of recommendations.

Dental Instruments↗
PubMed2005

Evaluation of risk factors for injury in adolescent soccer: implementation and validation of an injury surveillance system.

BACKGROUND: There are limited data on the epidemiology of adolescent soccer injury across all levels of play. HYPOTHESIS: Through implementation and validation of an injury surveillance system in adolescent soccer, risk factors for injury will be identified. STUDY DESIGN: Descriptive epidemiology study. METHODS: The study population was a random sample of 21 adolescent soccer teams (ages 12-18). A certified athletic therapist completed preseason baseline measurements and did weekly assessments of any identified soccer injury. The injury definition included any injury occurring in soccer that resulted in 1 or more of the following: medical attention, the inability to complete a session, or missing a subsequent session. RESULTS: Based on completeness of data in addition to validity of time loss, this method of surveillance has proven to be effective. The overall injury rate during the regular season was 5.59 injuries per 1,000 player hours (95% confidence interval, 4.42-6.97). Soccer injury resulted in time loss from soccer for 86.9% of the injured players. Ankle and knee injuries were the most common injuries reported. Direct contact was reported to be involved in 46.2% of all injuries. There was an increased risk of injury associated with games versus practices (relative risk = 2.89; 95% confidence interval, 1.69-5.21). The risk of injury in the under 14 age group was greatest in the most elite division. Having had a previous injury in the past 1 year increased the risk of injury (relative risk = 1.74; 95% confidence interval, 1.0-3.1). CONCLUSION: There were significant differences in injury rates found by division, previous injury, and session type (practice vs game). Future research should include the use of such a surveillance system to examine prevention strategies for injury in adolescent soccer.

Adolescent↗
PubMed2006

A tool for measuring physician readiness to manage intimate partner violence.

BACKGROUND: Intimate partner (domestic) violence (IPV) is a common problem in medical practice that is associated with adverse health outcomes. There are widespread calls to improve IPV education for physicians, but there are few valid, reliable, easily available, and comprehensive measures of physician IPV knowledge, attitudes, and practices that can be used to assess training effectiveness. METHODS: In 2002, expert consensus and previous surveys were used to develop a new survey-based IPV self-assessment tool that included more information on current IPV knowledge and practices than previous tools. The draft tool was evaluated using standard psychometric techniques in a group of 166 physicians in 2002, revised, and then retested in a second group of 67 physicians on three occasions in 2003 and 2004. Analyses were conducted in 2005. RESULTS: The draft IPV survey tool demonstrated good internal consistency reliability, with Cronbach's alpha >/=0.65 for ten final scales. The developed scales were closely correlated with theoretical constructs and predictive of self-reported behaviors. On repeat testing, a revised version of the tool was found to have good stability of psychometric properties in a different physician population (Cronbach's alpha>/=0.65, and internal correlations as predicted), good correlation with measured office IPV practices, and stable results in this population over 12 months. CONCLUSIONS: The final version of this instrument, named the PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey) tool, is a 15-minute survey that is a comprehensive and reliable measure of physician preparedness to manage IPV patients. This tool is publicly available and can be used to measure the effectiveness of IPV educational programs.

Attitude of Health Personnel↗
PubMed2006

Does the content of primary care visits differ by the racial composition of physicians' practices?

PURPOSE: The study compared the content of primary care visits between physicians with larger and smaller African American practices. METHODS: We compared the content of primary care adult visits between physicians with larger and smaller African American practices using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey 1997 to 2002. Larger African American practice (>14% of primary care visits by African Americans) was empirically defined to conform with previous studies. RESULTS: Larger African American practices comprised 24% of all practices but accounted for 80% of all visits by African American patients. In adjusted analyses, physicians with larger African American practices were less likely to refer patients to specialists (adjusted odds ratio 0.77; 95% confidence internal 0.61-0.98) and marginally less likely to perform rectal examinations (adjusted odds ratio 0.84; 95% confidence interval 0.56-1.00) but were more likely to schedule a return appointment (adjusted odds ratio 1.25; 95% confidence interval, 1.02-1.52). However, there were no other significant differences in the reported content of the office visits. Results were not altered when different cutoffs for larger African American practices were used or when obstetricians-gynecologists were excluded from the analyses. CONCLUSION: There are few differences in the content of office visits between physicians with larger and smaller African American practices.

Adult↗
PubMed2006

The characteristics of successful family physicians in rural Nebraska: a qualitative study of physician interviews.

CONTEXT: In studying physician shortage issues, few studies have utilized individual interviews, allowing rural physicians to voice their own stories. PURPOSE: To explore rural physicians' unique characteristics affecting their decisions and satisfactions with practice in a rural area. METHODS: A qualitative interview study with 11 Nebraska family physicians practicing in rural (frontier) areas. FINDINGS: Previous experience and preference for a rural lifestyle, desire for autonomy, a wide scope of practice, and close relationships with patients defined those physicians choosing rural practice.

Female↗
PubMed1999

More practice does not necessarily enhance transfer of learning: evidence and interpretations.

The purpose of this study was to investigate what was learned and transferred of a criterion task using a transfer task and a self-paced procedure. Based on the results of two previous studies, five durations of practice were specifically selected to examine what can be transferred to a new task after different amounts of practice (40, 75, 100, 125, and 150 acquisition trials) on a criterion task. The criterion task required subjects to practice finding an 8-in. line with no fixed starting and ending points from left to right. The transfer task was different from the criterion task in two dimensions, distance (10-in. line) and direction (right to left). 50 volunteers were randomly assigned into 5 groups. Appropriate 5 x 2 (groups by blocks of practice) analyses of variance and a priori contrasts were conducted for all dependent variables (absolute error, variable error, movement time, KR-delay, post-KR interval, intertrial interval, interstimulus interval, and KR-delay by post-KR interval ratio) to examine the effects of terminal acquisition of the criterion task on the initial performance of the transfer task. Analysis indicated that, during practice, participants developed a functional interaction between performance characteristics and chronological profile of KR-delivery of the criterion task that was transferable to the transfer task. Also, practice beyond a certain point was detrimental to the ability to transfer what was learned.

Adult↗
PubMed1991

Audit in general practice by a receptionist: a feasibility study.

OBJECTIVE: To examine whether audit can be done cost effectively by a practice's receptionist. DESIGN: The practice set goals for various aspects of care, and forms were devised for the receptionist to collect, analyse, and present data to assess whether these goals had been achieved in the previous year. SETTING: Six doctor practice in south London looking after 11,500 patients. MAIN OUTCOME MEASURES: Ability of receptionist to present data showing the level of attainment of the practice's goals; time spent on audit by receptionist each week. RESULTS: The practice set goals for immunisation; follow up of patients with abnormal cervical smears; frequency of recording of blood pressure and smoking habit; screening of patients over 75; care of diabetic patients and patients with serious mental illness; antenatal care; variations in workload; and availability of appointments. The receptionist was able to audit all these tasks in four hours a week; this increased her job satisfaction and extended her skills. A small amount of regular supervision was necessary--roughly 30 minutes a week in the first year of the study and 30 minutes a fortnight in the second--to ensure accuracy and deal with any difficulties that arose. CONCLUSION: The method developed enabled a receptionist to audit aspects of the practice cost effectively. There is great scope for enlarging the conventional role of the receptionist.

Cost-Benefit Analysis↗
PubMed1995

Concern, continuity, and choice: a health promotion formula for advanced practice nurses.

Promoting health in a newly established nurse practitioner family practice was a major undertaking for one advanced practice nurse (APN) in a semi-rural community in southern California. The alignment of the resources necessary to begin such a practice opened many doors not previously traversed by nurses in this community. Likewise, the development of a formula and model for health promotion came about as a result of overcoming the obstacles to starting this private practice as well as the positive rewards of patient encounters over time. Episodes of concern for patients, continuous care, and choices in health care decisions come together to illustrate this formula. The research data supporting the practice further demonstrate the plausibility of the APN becoming a provider of health promotion in the primary care setting.

Adolescent↗
PubMed1995

Examining patient perceptions of quality care in general practice: comparison of quantitative and qualitative methods.

BACKGROUND: The consultation satisfaction questionnaire and surgery satisfaction questionnaire, and the critical incident technique have been identified as examples of, respectively, quantitative and qualitative (interview) techniques with considerable theoretical merit regarding the measurement of patients' views in a general practice context. AIM: This study set out to assess these techniques in terms of ease of administration and analysis, respondent acceptability, and the extent to which the information provided was useful to the practitioner/practice manager, as well as validity. METHOD: Patients from three practices completed the interview and questionnaires. Data were provided for each practice giving their own results as well as data from the other two practices and the results of previous research. RESULTS: Both methods were, in the main, received positively by general practitioners, managers and patients. Patient responses to the questionnaires in general followed predictable patterns, variations from which suggested practice-specific problems. CONCLUSION: There are caveats regarding the use and interpretation of both methods, of which potential users should be aware. This is particularly the case with the consultation satisfaction questionnaire, scores on which, it is suggested, may be on a downward trend over time. It is possible that results from the consultation satisfaction questionnaire/surgery satisfaction questionnaire could be merely demoralizing for practice staff in some instances. Other research supports this notion of demoralization which, although unproven, would reduce the instrument's potential for comparison between studies, and which is, therefore, a finding which requires further attention. Increasing patient expectations are implicated in this.

Adult↗
PubMedDate not supplied

Student pharmacist perspectives of rural pharmacy practice.

OBJECTIVE: To evaluate the level of interest of upper-level doctor of pharmacy students in rural pharmacy practice, rural pharmacy ownership, and a proposed rural pharmacy practice model. DESIGN: Cross-sectional study. SETTING: Minnesota, North Dakota, and South Dakota in October through December 2003. PARTICIPANTS: Third- and fourth-year professional student pharmacists at the University of Minnesota, North Dakota State University, and South Dakota State University. INTERVENTION: Self-administered questionnaire completed by study participants. MAIN OUTCOME MEASURES: Student interest in rural pharmacy practice and potential future directions for maintaining access to medications and the knowledge of pharmacists in rural communities. RESULTS: Of 177 respondents, 62.7% has given serious consideration to practice in rural communities with populations of 5,000 or fewer residents. Of these 111 students, 81% would be interested in the proposed practice model explained in the survey. Of the 108 total students expressing interest in the proposed rural pharmacy practice model, 63% had not previously given serious consideration to pursuing ownership (full or partnership) of a community pharmacy. CONCLUSION: Students from the schools that have traditionally supplied the majority of Minnesota rural pharmacists indicated an interest in practicing in rural areas as long as opportunities align with their personal and professional interests.

Community Pharmacy Services↗
PubMed1989

A global safety evaluation of etodolac.

Etodolac has previously been reported to have an excellent safety profile. Results of recent clinical trials and of a clinical practice study were compared with the previously reported safety data for etodolac. The total incidence of patient complaints and of laboratory abnormalities continues to be low, with no apparent increase in side effects with increasing patient age. In the clinical practice study, 60% of study events occurred early in therapy (before 10 weeks). These data support an excellent safety profile for etodolac.

Adolescent↗
PubMed2006

Palliative care services in Pennsylvania nursing homes.

BACKGROUND: Palliative care is an interdisciplinary model that focuses on the comprehensive management of physical, psychological, social, and spiritual needs of individuals with lifelimiting illness. Although palliative care is increasingly common in acute care settings, regulatory, financial, and educational barriers often bar nursing home residents from access to palliative care services. OBJECTIVE: The purpose of the Palliative Care Services in Pennsylvania Nursing Homes Survey was to describe existing palliative care services within nursing homes in Pennsylvania, and to classify these services by level of care delivery. METHODS: Ninety-one nursing home administrators throughout the state of Pennsylvania participated in the mailed survey. Multiple logistic regression analysis was used to investigate the association between various organizational characteristics and provision of palliative care services. RESULTS: Results reveal that urban facilities were more likely to provide palliative care services than rural facilities. Urban facilities cited the need for bereavement training most frequently, whereas rural clinical cited the need for training in pain management. Larger facility size was associated with an increased likelihood of pain management practices, even after adjusting for regional differences. CONCLUSIONS: These pilot findings are consistent with and extend previous findings suggesting that palliative care practice in nursing homes is strongly influenced by nonclinical factors and invites further investigation.

Health Care Surveys↗
PubMed2005

Is a computer questionnaire of childhood asthma acceptable in general practice?

OBJECTIVES: To determine whether a previously-validated touch screen computer program of symptoms and management of childhood asthma is acceptable to parents who accompany their children to consult a GP, and to examine whether any parent characteristics are associated with acceptability. METHODS: Conducted in general practice in Newcastle, NSW, Australia. A cross sectional pen and paper survey was given to parents of children consulting a GP after completing the computer questionnaire on childhood asthma in the waiting room. Measurements were frequencies of Likert scale responses to statements concerning the computer questionnaire, compared with demographic and personal characteristics. RESULTS: High levels of acceptability of the asthma computer questionnaire were reported by the 198 respondents, with most being willing to do the same program once or twice a year (87%), or to do similar programs on other topics (91%). Most respondents (81%) agreed that the computer program was enjoyable, and very few (8%) would have preferred to answer the asthma questions by pen and paper rather than by computer. Two or more children accompanying the parent was the characteristic most associated with less positive responses. CONCLUSIONS: Overall the high acceptability of this questionnaire suggests that this computerised format is an appropriate method of screening children for asthma and determining their current management. As a large component of underdiagnosis of asthma is lack of reporting to the doctor, this valid and acceptable diagnostic aid has the potential to improve detection of unreported asthma, and also to identify high-risk individuals.

Adolescent↗
PubMedDate not supplied

Primary care residents and the management of hypercholesterolemia.

A survey of primary care residents' attitudes, beliefs, and knowledge and a medical record audit were used to assess barriers to appropriate detection, identification, and management of hypercholesterolemia. Previous studies have focused on either self-reports or audits alone. This study compares survey results to recorded clinical performance. Family practice and internal medicine residents were compared to determine if previous findings were specialty-specific. The results of the survey indicate that, even prior to the publication of the National Cholesterol Education Program, residents demonstrated positive attitudes and appropriate knowledge of risk levels, in contrast with previous reports on practicing physicians. The medical record audit, however, showed that residents were not providing care that approximated their own recommendations for hypercholesterolemia management. Results of the survey and audit demonstrated little or no difference between specialty groups. The results indicated that training in management skills and reducing practice barriers are important to improve resident physicians' management of patients with hypercholesterolemia. The use of a survey and audit provide a useful needs assessment for designing educational programs.

Attitude of Health Personnel↗
PubMed2005

Classification of low back pain in primary care: using "bothersomeness" to identify the most severe cases.

STUDY DESIGN: Prospective inception cohort. OBJECTIVE: To investigate the validity and use of a single question on the bothersomeness of low back pain (LBP) as a method of classifying the severity of symptoms among patients seen in clinical practice. SUMMARY OF BACKGROUND DATA: There is no widely accepted method for classifying patients with nonspecific LBP in clinical practice. There have been no previous reports of the validity and use of a question on bothersomeness as a method of classifying patients with LBP. METHODS: Consecutive patients (30-59 years old) with LBP consulting at 5 United Kingdom general practices (n = 1464) were mailed a questionnaire after consultation and 6 months later. Construct validity was assessed by comparing baseline responses on the single bothersomeness question with pain, disability, general health, and psychologic health measures. The ability of bothersomeness to predict outcomes at 6 months was assessed against pain, disability, work absence, and health care use. RESULTS: A total of 935 patients (65%) completed baseline questionnaires. There were 776 (83%) patients who consented to enter the follow-up study, and 447 returned the 6-month questionnaire. At baseline, bothersomeness correlated with pain, disability, and other measures (P < 0.001), and had 80% sensitivity (61% specificity) to detect people in the highest category of pain and disability. People with bothersome LBP at baseline evaluation had an increased risk of work absence or health care consultations for LBP 6 months later (relative risks 2.8 and 1.9, respectively). CONCLUSIONS: There is evidence for the validity of a single bothersomeness question as a measure of LBP severity. It has the potential to provide a practical standard scheme for classifying patients with LBP in clinical practice. However, further work is needed to clarify its usefulness in a clinical setting.

Absenteeism↗
PubMed1982

The diagnostic content of family practice: 50 most common diagnoses recorded in the WAMI community practices.

Because there are several methodological deficiencies in previously published studies, a prospective study was carried out of the 50 most common diagnoses of community-based family practices in the Pacific Northwest. Age and sex of patients and reliability of data were controlled. The data reported show reasonable concordance with other published accounts for 10 most common diagnostic categories. For less frequent diagnoses, however, high variability in rank order is the rule, both within this study and by comparison with other studies. This suggests that the diagnostic content of family practice is far from universal and that diagnostic idiosyncrasies of physicians, regional differences in rates of disease, practice style, and as yet other unexplained factors may significantly influence the diagnostic content of family practice.

Adolescent↗
PubMed2004

Switching antipsychotics in inpatient schizophrenia care: predictors and outcomes.

BACKGROUND: Within a pharmacoepidemiologic study, characteristics of patients with schizophrenia switched from first- to second-generation antipsychotics (FGAs and SGAs, respectively) or to antipsychotic polypharmacy were compared with those of patients maintained on treatment with FGAs. The primary aim was to assess factors associated with antipsychotic switching and to compare disease course with regard to mental state and social functioning. METHOD: Adult inpatients with an ICD-10 diagnosis of schizophrenia or schizoaffective disorder were assessed in 7 psychiatric hospitals. Data were collected between 2001 and 2002. For those patients (N = 847) with an antipsychotic prescription at discharge, t tests and covariance and logistic regression analyses were used to evaluate the relationship between demographic and clinical characteristics and antipsychotic switching. RESULTS: Patients switched from FGAs to SGAs had fewer previous psychiatric admissions, a shorter illness duration, fewer substance disorders, and a higher probability of working in a competitive setting but more pronounced symptoms than those maintained on treatment with FGAs. Mental state and social functioning after case-mix adjustment were more favorable in the group switched to SGA monotherapy but not in those patients administered FGAs and SGAs concurrently at discharge. Logistic regression controlling for demographic and clinical variables revealed that a short disease duration (p <.05), fewer previous psychiatric hospitalizations (p <.01), voluntary admission (p <.05), and pronounced thought disorder (p <.05) were significantly associated with switching from FGAs to SGAs. Hospital differences were also observed. CONCLUSION: Remaining on FGAs or switching to SGAs in schizophrenia care depends strongly on institutional practices in addition to the previous disease course and health care utilization.

Adult↗
PubMed2001

Evaluation of nursing care after diagnostic coronary angiography.

BACKGROUND: Restricting inpatients who have undergone a cardiac catheterization to 6 hours of flat bed rest to reduce the potential for bleeding from the femoral arteriotomy site is based on tradition rather than on research and is associated with discomfort for the patients. OBJECTIVES: To (1) determine the prevalence of femoral arteriotomy complications after diagnostic coronary angiography among inpatients after implementation of a guideline that included reduced duration of bed rest, elimination of sandbags at the arteriotomy site, and 30 degrees elevation of the head of the bed; (2) compare complication rates in this study with rates in previous studies; and (3) determine patient- or practice-related characteristics associated with complications. METHODS: Records of 306 inpatients were reviewed retrospectively to determine the prevalence of femoral arteriotomy complications and the presence of patient- or practice-related characteristics potentially associated with complications. Associations between each characteristic and the presence of a complication were evaluated by using the Wilcoxon rank sum test for continuous data and the chi 2 or Fisher exact test for nominal data. RESULTS: Prevalences of complications were hematoma, 8.8%; bleeding, 4.5%; pseudoaneurysm, 1%; arteriovenous fistula, 0%; and thrombosis, 0%. No evidence indicated that the occurrence of a complication was related to any patient- or practice-related characteristic. Complication rates were comparable to those of previous studies. CONCLUSIONS: The findings support continuation of the current guideline for patients' care after diagnostic coronary angiography. However, further prospective studies with larger samples of inpatients are warranted.

Adult↗