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At least 991 records · Page 55Linked to original sources
PubMed1991

Pediatrician's practice choices: differences between part-time and full-time practice.

A national survey was used to study the differences in career and family patterns of pediatricians who work part-time (PT) vs those who work full-time (FT). A questionnaire mailed to 375 members of the American Academy of Pediatrics asked about age, marital status, number of children, type of practice, hours worked in particular duties, and attitudes about their choices. Sixty-five percent (n = 216) of the questionnaires were completed. The mean age of both the PT and FT women was 40 years, and FT men averaged 46 years. Thirty-seven percent of women had worked PT at some point in their careers; 21% were currently working PT. Only 70% of the FT women were married compared with 97% and 95% of PT women and FT men. The FT women had significantly fewer children (mean 1.27, compared with 2.34 for PT women and 2.39 for FT men). Part-time women in academic medicine tended to do little research or administrative work, but they had more teaching responsibilities. Almost all the PT women were happy with their decisions and careers despite the feeling among many that they had made career compromises. Many of the FT pediatricians wanted to work less. It is concluded that many women, particularly those with children, choose PT work in order to combine career and family duties. These choices may lead to different career paths for women pediatricians. By recognizing these different career paths, it may be possible for academic institutions to benefit from the unique contributions that PT women pediatricians can make.

Adult↗
PubMed1990

[Cholesterol measurement in general practice--Norwegian general practitioners' attitudes and estimation of their own practice].

In 1988 a group of Norwegian experts published a programme for treatment of patients with increased cholesterol. The programme recommended dietary counselling when plasma cholesterol exceeded 5 mmol/l. In the autumn 1988 the Norwegian National Health Association started a campaign on cholesterol for health personnel. In order to find out to what extent general practitioners adhered to the recommendations of the programme, a random sample of 100 general practitioners were sent a questionnaire before and after the campaign. The results showed no significant differences in the doctors' attitudes towards diagnosis and treatment of patients with increased plasma cholesterol. Both before and after the campaign the plasma cholesterol levels at which they would initiate follow-up, dietary counselling or drug therapy were 1-2 mmol/l above the levels recommended by the expert group. The attitude of the general practitioners was more conservative than the recommendations of the programme. The interval between the information meeting and the post study was only six months. It is a complicated process to change attitudes and practice routines, and the time required may be longer than six months. Furthermore, the recommendations of the programme were questioned by other doctors, which reduced its impact.

Adult↗
PubMedDate not supplied

Radiology in family practice: a descriptive study of office practice.

This study examined all x-rays from five family practice clinics for the year 1987, recording x-ray type together with the age and sex of the patient x-rayed. A total of 4,024 x-rays was obtained from 71,192 patient visits--an x-ray utilization rate of 5.65 percent. Most office x-rays were of the chest (39.6 percent), upper extremities (21.3 percent) or lower extremities (21.0 percent). These three categories predominated for all age groups of both sexes, for all months of the year, and for all clinics studied. Males utilized x-rays much more frequently than did females (8.86 percent overall rate for males; 3.95 percent overall rate for females) at all ages except for the age group 0-10 (2.19 percent for males, 3.04 percent for females). The gender combined age group with the highest utilization rate was between 51-60 (8.39 percent) whereas the gender combined age group 0-10 had the lowest utilization rate (2.61 percent). Uniformity was demonstrated from clinic to clinic on type of x-rays obtained, frequency of x-rays by gender, and frequency of x-rays per month. A major difference, however, was noted in utilization rates between clinics. There was a two-fold difference in x-ray utilization between the clinic with the highest utilization rate and the one with the lowest. This data is useful for focusing the content of residency training and continuing medical education in radiology, for providing a content base to evaluate family physicians in radiology, and for providing a foundation upon which further investigations into office radiology can be constructed.

Adolescent↗
PubMed1989

[Glucose analysis in general practice. An examination of 4 instruments designed for general practice and self-monitoring].

Several examinations have shown that the analysis of glucose in primary health care is of poor quality. The reason could be the quality of the instruments and/or the way the instruments are operated. We have examined Glucometer II, Glucochek SC, Reflolux II and Hypocount GA. These instruments were studied both in general practice and at Haukeland Hospital. The test results were compared with the routine used in the hospital laboratory. There were no major analytical differences between the instruments. All the instruments were found to have an analytical quality lower than what is recommended by the Norwegian Quality Control. The requested analytical quality for the instrument depends on the clinical needs. We would recommend that these glucose instruments be used to diagnose acute hypo/hyperglucemia and to some extent in control of diabetes. For a certain diagnosis of diabetes, the use of a more precise instrument is to be preferred. The need for a Quality Control program for glucose measurement in primary health care is emphasized.

Blood Glucose↗
PubMed1989

Practice guidelines and practicing medicine. Are they compatible?

Various factors, including increased financial pressures on the health system, the rapidity of the introduction of technology, and data showing high levels of inappropriate care, will coalesce into a movement that will yield practice guidelines. If the guidelines are developed with the aid of the best methods and if they are applied constructively, then the twin goals of increased health of the American public and physician satisfaction can be achieved.

Clinical Protocols↗
PubMed1983

[Diabetes in private practice. Data of the INSERM national survey on private practice (1974-1975)].

Data from a national survey of private medicine in France were used to estimate the frequency of diabetes in primary care and to analyse both patient characteristics and therapeutic management. An approach was made to 2012 physicians who were requested to complete a questionnaire for each patient they saw during the course of a single day; 1103 responded and completed more than 20000 questionnaires. An additional investigation looked into the nature of the non responders. Diabetics represent 2,2% of patients in private medicine. Each year about 5,5 million consultations in private practice in France are for diabetes alone or for diabetes in association with other illnesses. 89% of diabetic patients are over 45 years of age and more than 48% older than 65. In most cases (80%), diabetes is associated with other medical problems, half of them being consequences of diabetes (cardio-vascular diseases, ocular and renal diseases). In 85% of cases, diabetics receive their basic care from a general practitioner. Therapeutic management is based mainly on drugs; diet or advice about life style are mentioned in barely one third of cases. Using linkage with social security data, it was possible to make a crude estimate of the number of diabetics in France. It was estimated at about 1 million for 52,6 million inhabitants.

Adult↗
PubMed1995

[The general practice course catalog--an attempt at quality assurance in graduate general practice education].

Additionally to the training in the hospital and in the practice, the rules for continuing education for general practise, established at the meeting of medical German physicians in 1992 demand the participation in theoretical seminars. The content and duration of these seminars is content and duration of these seminars is laid down in recommendations of the chamber of the physicians of Germany to ensure the quality of the courses. According to this, the first recommendations consists of the Course Book for General Medical Practise regarding a course of 240 hours duration. This is a nation-wide standardized curriculum which was accepted from all German chambers of physicians as the basis of the further education in family medicine. The standardization and the structuring of the content, goals, and methods of teaching and learning as well as the organization of the seminars, the working materials for the teachers, regular training for the presenters and teachers, methods for a nation-wide evaluation of the seminars, and independence from commercial interests are the features to ensure the quality of the courses.

Education, Medical, Continuing↗
PubMed1995

Practice model: collaborative practice.

The concept of collaborative practice is based on the premise that excellent patient care relies on the expertise of several care providers. Collaboration is a complex behavior that requires time, energy, and patience to implement. It demands understanding of its elements and structure, as well as the commitment of clinicians, administrators, insurers, and regulators. The core of the collaborative team is the physician-nurse dyad.

Acute Disease↗
PubMed1994

Practice parameters for the use of stimulants in the treatment of narcolepsy. Standards of Practice Committee of the American Sleep Disorders Association.

Narcolepsy is a disorder of the central nervous system characterized by excessive sleepiness, cataplexy, and other rapid-eye-movement (REM)-sleep phenomena such as sleep paralysis and hypnagogic hallucinations. Although stimulants are the only effective treatment for the sleepiness of narcolepsy, no clinical guidelines on the use of stimulants in the treatment of narcolepsy have been published that address the following factors: appropriate doses; development of tolerance; potential for side effects, adverse reactions and abuse; and use in children and pregnant or breast-feeding women. These practice parameters from the American Sleep Disorders Association provide the first clinical guidelines on the appropriate use of stimulants in the treatment of narcolepsy.

Adolescent↗
PubMed1994

Measuring self-reported comfort with general family practice skills during a required third-year family practice clerkship.

BACKGROUND: To judge the effectiveness of a new required third-year family practice (FP) clerkship, we designed a 20-item FP comfort assessment (FPCA) to measure students' self-reported comfort with a wide range of FP skills. This report examines the behavior and characteristics of the FPCA. METHODS: During the 1990-91 academic year, 179 students who completed the FP clerkship were asked to complete the FPCA on the first and last days of the clerkship. RESULTS: Factor analysis of responses yielded four factors that explained 66.4% of the total variance: relationships and values, history and physical, diagnosis and management, and preventive medicine. After adjustment, internal consistency for each factor ranged from .77 to .89. All postclerkship factor scores were significantly greater than preclerkship factor scores, indicating that the FPCA performed as expected. All postclerkship factor scores and two of the change scores correlated significantly with the students' overall clerkship grade, indicating concurrent validity. CONCLUSION: The FPCA is a reliable and valid measure of student comfort with patient-centered FP skills.

Clinical Clerkship↗
PubMed1993

Family practice clinics. Survey of family practice residents' attitudes.

All residents of McGill University's Department of Family Medicine were surveyed by mail about their family practice clinic experience. Residents were generally satisfied with their training site and their supervision, but noted problems with volume and diversity of patients, learning certain procedures, and knowledge of community resources. They did not want more family medicine clinic time.

Adult↗
PubMed1993

[Anticoagulation therapy in general practice--a practice study from the health region 4].

Organization of anticoagulation therapy in general practice is described on the basis of data from 56 general practitioners interviewed by questionnaire. The average number of patients controlled by each practitioner was 12.0, and 52% of the general practitioners performed the analyses themselves. In municipalities with a local hospital only 13% of the general practitioners performed the analyses themselves, compared with 75% in municipalities without a hospital. The average weekly number of Thrombotests performed by each practitioner was 12.2. When an external laboratory was used 88% were contacted earlier in the case of International Normalized Ratio (INR) > 4.8 while this was uncommon (12%) in the case of International Normalized Ratio < 2.0. We discuss the advantages and possible disadvantages of near testing of patients on oral anticoagulation therapy.

Anticoagulants↗
PubMed1996

Clinical practice by certificate holders in the profession in which they are not certified. Ethical Practice Board.

From time to time, the Ethical Practice Board or the Council on Professional Ethics determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They illustrate the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders engage in self-guided ethical decision-making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical. This Issues in Ethics Statement replaces the previous one of the same title.

American Speech-Language-Hearing Association↗
PubMed1996

Practice guidelines for the clinical assessment and care management of Alzheimer's disease and other dementias among adults with intellectual disability. AAMR-IASSID Workgroup on Practice Guidelines for Care Management of Alzheimer's Disease among Adults with Intellectual Disability.

The AAMR/IASSID practice guidelines, developed by an international workgroup, provide guidance for stage-related care management of Alzheimer's disease, and suggestions for the training and education of carers, peers, clinicians and programme staff. The guidelines suggest a three-step intervention activity process, that includes: (1) recognizing changes; (2) conducting assessments and evaluations; and (3) instituting medical and care management. They also provide guidance for public policies that reflect a commitment for aggressive care of people with Alzheimers's disease and intellectual disability, and avoidance of institutionalization solely because of a diagnosis of dementia.

Activities of Daily Living↗
PubMed1997

Practical issues in neonatal transfusion practice.

Small premature infants frequently require transfusions of blood components, particularly red blood cells (RBCs), during the first weeks of life. Although great efforts have been made during the past few years to optimize the transfusion of blood components to these tiny patients, several questions have not been definitively answered. Accordingly, transfusion practices vary among neonatologists. The purpose of this article was to assess the available data critically. The findings indicated that stored RBCs can be transfused safely into premature infants to diminish donor exposures. It was also found that leukocyte-reduced blood components can be used to prevent the transmission of cytomegalovirus; thus, cellular components do not need to be obtained exclusively from donors negative for antibodies to cytomegalovirus. However, gamma-irradiation of cellular blood components cannot be justified for all neonatal transfusions. Obviously, as new information is reported, these findings may require revision.

Blood Banks↗
PubMed1997

Practice guideline for examination of the placenta: developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists.

The Placental Pathology Practice Guideline Development Task Force, a multidisciplinary group, has prepared this guideline to assist those involved with placental examination. It provides recommendations related to indications and methods for placental examination as well as sample worksheets. An algorithm for the handling of placentas summarizes the recommendations of the guideline. A summary of specific findings of placental examination together with their pathogenesis and clinical associations is also provided. Recommendations related to reporting with sample reporting formats are included. The guideline is intended as an educational tool, and its use should be guided by the individual circumstances and care setting of specific cases.

Humans↗
PubMed1998

Practice parameter for the use of red blood cell transfusions: developed by the Red Blood Cell Administration Practice Guideline Development Task Force of the College of American Pathologists.

A practice parameter has been developed to assist physicians in the therapeutic use of red blood cell transfusions. The developers of this parameter used the best available information from the medical literature, as well as clinical experience and the extensive reality testing required by the College of American Pathologists for approval. In acute anemia, a fall in hemoglobin values below 6 g/dL or a rapid blood volume loss of more than 30% to 40% requires red blood cell transfusions in most patients. However, tissue oxygenation provides a better indication of physiologic need in situations where invasive monitoring provides this information. When these data are not available, heart rate and blood pressure measurements and the nature of bleeding (active, controlled, uncontrolled) supplement the hemoglobin value in guiding the transfusion decision. In sickle cell disease and thalassemias, red blood cells are transfused to prevent acute or chronic complications. Red blood cell transfusions are used in chronic anemias unresponsive to pharmacologic agents based on the patient's symptoms. Guidelines must be altered for neonates who require an increase in hematocrit to above 0.30 to 0.35 when respiratory distress is present. Indications for red blood cell transfusion for the pregnant or postpartum patient are similar to those for the nonpregnant patient. Risks of transfusion, particularly transmissible disease and incompatibility, remain but have been reduced. Thus, red blood cell transfusion continues to be a powerful therapeutic tool when used judiciously and carries less risk than in the recent past.

Adult↗
PubMed1998

[Determining diagnosis and therapy control of hypertension by time-limited loan of blood pressure monitors to patients. A report of experiences with acceptance and practical applications of the procedure in general practice].

Data from an investigation on acceptance and practicability of a temporary self assessment of blood pressure values including 181 patients of a rural practise are presented. Cooperation of the total collective was surprisingly good although particularly those patients with most risk factors revealed deficits in fulfilling the preconceived goals. Compared to 24 hour blood pressure monitoring total drop out rate in the self assessment group was lower (6.6%) although the requirement for involvement and cooperation was increased in this group. On an average about 39 blood pressure measurements have been performed by each patient. In the protocol six measurements per day over a period of 8 days were scheduled, amounting to a total number of single data recorded by experience of other authors to be sufficient for a valid assessment of the real blood pressure situation of each patient. In view of this proof of a satisfying cooperation and the relatively low costs of this method we believe that, according to our personal experience, this method (temporary blood pressure monitoring with rented blood pressure apparatus) may be recommended to every family doctor interested in adequate blood pressure diagnosis. As the investigation demonstrated the efforts caused by this method are low and do not interfere with usual activities in the office of a family doctor. On the other hand the pedagogic effect on the patient may not be underestimated.

Adolescent↗