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PubMed2004

Population genetic evidence for rapid changes in intraspecific diversity and allelic cycling of a specialist defense gene in Zea.

Two patterns of plant defense gene evolution are emerging from molecular population genetic surveys. One is that specialist defenses experience stronger selection than generalist defenses. The second is that specialist defenses are more likely to be subject to balancing selection, i.e., evolve in a manner consistent with balanced-polymorphism or trench-warfare models of host-parasite coevolution. Because most of the data of specialist defenses come from Arabidopsis thaliana, we examined the genetic diversity and evolutionary history of three defense genes in two outcrossing species, the autotetraploid Zea perennis and its most closely related extant relative the diploid Z. diploperennis. Intraspecific diversity at two generalist defenses, the protease inhibitors wip1 and mpi, were consistent with a neutral model. Like previously studied genes in these taxa, wip1 and mpi harbored similar levels of diversity in Z. diploperennis and Z. perennis. In contrast, the specialist defense hm2 showed strong although distinctly different departures from a neutral model in the two species. Z. diploperennis appears to have experienced a strong and recent selective sweep. Using a rejection-sampling coalescent method, we estimate the strength of selection on Z. diploperennis hm2 to be approximately 3.0%, which is approximately equal to the strength of selection on tb1 during maize domestication. Z. perennis hm2 harbors three highly diverged alleles, two of which are found at high frequency. The distinctly different patterns of diversity may be due to differences in the phase of host-parasite coevolutionary cycles, although higher hm2 diversity in Z. perennis may also reflect reduced efficacy of selection in the autotetraploid relative to its diploid relative.

Alleles↗
PubMed2004

Reactions and needs of tristate-area pediatricians after the events of September 11th: implications for children's mental health services.

OBJECTIVE: The terrorist attacks of September 11, 2001, caused mass destruction in Lower Manhattan, the Pentagon, and rural Pennsylvania and resulted in the death of >3000 people. Children were prominent among those affected. Given the wide impact of the attacks, we hypothesized that primary care professionals would see the broad population of affected children but would feel ill-prepared to respond to children's mental health needs. METHODS: One year after the September 11th disaster, a hyperlink to a web-based 42-item survey was sent to all New York, Connecticut, and New Jersey American Academy of Pediatrics members with e-mail addresses (N = 4330), and a paper version of the survey was sent via postal mail to a random sample of those without e-mail (N = 1320). The survey requested demographic data, personal and practice experience of 9/11, perceived knowledge and skills regarding mental health, and perceived barriers to accessing mental health services for their patients. Both groups were contacted a total of 3 times at 2-week intervals, resulting in 1396 completed surveys from providers who were actively seeing patients. RESULTS: Twenty-nine percent of respondents stated that they were seeing affected patients, and 32.6% reported seeing children who were exposed to at least 1 9/11 event. Sixty-four percent of the respondents identified behavioral problems in directly affected children: 41.6% identified acute stress disorder, and 26.3% identified posttraumatic stress disorder (PTSD). However, a majority of these professionals indicated that they either lacked or were uncertain (50.8% PTSD, 51.7% acute stress disorder) of their skills to identify children with mental health problems and that they were "not" or only "somewhat" knowledgeable (76.8% PTSD) in these areas. The majority agreed that child health professionals should be trained to screen for these 2 disorders. Generalists as compared with specialists were more likely to report seeing patients who were affected by 9/11. Gender, race/ethnicity, and geographic location were associated with reported effects of 9/11 on respondents' practice and perceived skills and knowledge related to the psychological effects of community disasters. CONCLUSIONS: Pediatric practitioners in the tristate area reported that children/families sought care for an array of mental health-related concerns. Generalists in the areas affected and those who identified gaps in knowledge or skills in responding to the psychological effects of community disasters should be targeted for additional education.

Child↗
PubMed2006

Spatial and temporal patterns of bird species diversity in the Pantanal of Mato Grosso, Brazil: implications for conservation.

Analysis of a three-year bird survey in the pantanal of Poconé revealed that most of the resident and seasonal birds are habitat generalists, using two or more habitats. In this study, previously sampled habitats were ranked in relation to species richness and stability (as measured by the ratio of seasonal to resident species). In all, nine habitats were grouped into three categories; results are as follows: 1) forests: more species-rich and more stable; 2) cerrado: intermediate levels; and 3) aquatic: less species-rich and less stable. The number of seasonal species remained relatively constant in forests throughout the year, while increasing in the other habitats during the dry season. The abundance of resident species seems to be related to species use of multiple habitats. Although many species were found to be habitat generalists, we discuss possible consequences of habitat loss and other human impacts on efforts to conserve this important bird community.

Animals↗
PubMed2005

Effects of dispersal, predators (Acari: Phytoseiidae), weather, and ground cover treatments on populations of Tetranychus urticae (Acari: Tetranychidae) in apple orchards.

In a 2-yr study of causes of mite outbreaks in apple (Malus spp.) orchards in Nova Scotia, we monitored immigration of Tetranychus urticae Koch from orchard ground cover into trees populated by the generalist phytoseiid predator Typhlodromus pyri Scheuten. In both years, T. urticae-days in the tree canopy increased with number of T. urticae caught in sticky bands on tree trunks. In 2000, T. urticae-days were negatively correlated with T. pyri-days. Lack of correlation in 2001 was attributed to higher rates of immigration, which would mask the effects of predation. Weather also affected mite dynamics. Rainfall in July and August was less in 2001 than in 2000. Heat units were sufficient for six generations of T. urticae in 2001 but only for five in 2000. Consequently, T. urticae-days in the tree canopy and immigration rates were significantly greater in 2001 than in 2000, despite three-fold greater use of miticides. We also tested the effects of herbicides on T. urticae immigration. Application of selective herbicides in laneways reduced coverage of reproductive hosts of T. urticae, but these changes did not reduce immigration. In 2001, application of a miticidal herbicide, glufosinate, in tree rows reduced captures of T. urticae on sticky bands in high immigration orchards but not in low immigration orchards. We conclude that generalist predators and modified herbicide use are insufficient remedies and that effective biological control of T. urticae in the ground cover by a specialist phytoseiid such as Amblyseius fallacis Garman is essential to prevent outbreaks.

Acari↗
PubMed2006

Susceptibility of twolined spittlebug (Hemiptera: Cercopidae) life stages to entomophagous arthropods in turfgrass.

Prosapia bicincta (Say) (Hemiptera: Cercopidae), the twolined spittlebug, is an economic pest of turfgrass in the southeastern United States. No data concerning natural enemies of P. bicincta in turfgrass have been reported previously. We compared predation of spittlebug eggs, nymphs, and adults in the laboratory by potential generalist predators commonly found in turfgrass: bigeyed bugs Geocoris uliginosus Say and Geocoris punctipes Say; red imported fire ant, Solenopsis invicta Buren; wolf spiders (Lycosa sp. Walckenaer); carabid beetles Harpalaus pensylvanicus DeGeer and Calosoma sayi Dejean; and tiger beetles Megacephala carolina carolina L. Eggs were readily consumed by generalist predators. S. invicta consumed 100% of the eggs offered. H. pensylvanicus and C. sayi were also significant predators of P. bicincta eggs. Nymphs live in spittlemasses that protect them from attack by predators, but exposed nymphs were susceptible to attack when mechanically removed from their spittlemasses. S. invicta and M. carolina carolina caused significant mortality of exposed nymphs. P. bicincta adults are aposematic and have the ability to reflex bleed; however, reflex bleeding did not prevent attack by predators. S. invicta and M. carolina carolina killed 100% of the adult spittlebugs offered in laboratory bioassays. Lycosa sp. are less voracious predators of adults. Sound background knowledge about P. bicincta and its potential natural enemy complex is important for the development and implementation of a detailed, site-specific, biologically based pest management program in turfgrass.

Animals↗
PubMed2001

The guest playing host: colonization of the introduced Mediterranean gecko, Hemidactylus turcicus, by helminth parasites in southeastern Louisiana.

Parasite surveys of exotic hosts offer the opportunity to examine parasite colonization on different scales (i.e., host individual, host population, host species, and new geographic locality). Ten helminths (Macracanthorhynchus ingens, Mesocestoides lineatus, Oochoristica javaensis, Haematoloechus varioplexus, Mesocoelium monas, Telorchis corti, Cosmocercoides variabilis, Oswaldocruzia leidyi, Skrjabinoptera sp., and a larval acuariid nematode) were recovered from the exotic Mediterranean gecko Hemidactylus turcicus, in southeastern Louisiana. Only 1 exotic parasite, O. javaensis, colonized a new geographic locality, but 7 local helminths colonized a new host species. Helminth communities of H. turcicus were similar in structure to what has been hypothesized or observed for lizards. Thus, communities were composed of generalists and were depauperate (i.e., colonization of individual geckos or host populations was rare for most of the helminths); however, there was significant variation in community structure among local habitats. Although the gecko's behavioral and physiological attributes predict colonization by monoxenous helminths, only 2, C. variabilis and O. leidyi, were recovered. Eight heteroxenous helminths, 2 of which (the acuariid and O. javaensis) were the most widely distributed and abundant, were the better colonizers. The gecko's generalist diet may have exposed it to a diverse parasite fauna and thus been important in determining the helminths that could colonize.

Animals↗
PubMed2002

Resource tracking in North American Telorchis spp. (Digenea: Plagiorchiformes: Telorchidae).

We examine the evolution of host specificity for species of Telorchis, using the methods developed by researchers studying phytophagous insect-plant systems. Optimization of "generalist" compared with "specialist" onto the phylogeny for Telorchis revealed ambiguous patterns, depending on how the 2 terms were defined. Regardless of that definition, most of the evolutionary diversification of this group has been carried out within eucryptodiran turtles, the ancestral host group. From that plesiomorphic background, there appears to have been 2 episodes of specialization by way of a host switch into caudates (ancestor of T. stunkardi + T. sirenis) and snakes (T. auridistomi), and 1 episode of exuberant expansion producing a true generalist (T. corti). These results, which indicate that most species of Telorchis are tracking widespread plesiomorphic resources, mirror those reported for phytophagous insects and their plants. We believe that establishing a dialogue between the two research groups will be mutually beneficial to both and will strengthen our understanding of the complex factors underlying the evolution of coevolutionary associations.

Animals↗
PubMed2004

Foraging behavior and prey interactions by a guild of predators on various lifestages of Bemisia tabaci.

The sweetpotato whitefly, Bemisia tabaci (Gennadius) is fed on by a wide variety of generalist predators, but there is little information on these predator-prey interactions. A laboratory investigation was conducted to quantify the foraging behavior of the adults of five common whitefly predators presented with a surfeit of whitefly eggs, nymphs, and adults. The beetles, Hippodamia convergens Guerin-Meneville and Collops vittatus (Say) fed mostly on whitefly eggs, but readily and rapidly preyed on all of the whitefly lifestages. The true bugs, Geocoris punctipes (Say) and Orius tristicolor (Say) preyed almost exclusively on adult whiteflies, while Lygus hesperus Knight preyed almost exclusively on nymphs. The true bugs had much longer prey handling times than the beetles and spent much more of their time feeding (35-42%) than the beetles (6-7%). These results indicate that generalist predators vary significantly in their interaction with this host, and that foraging behavior should be considered during development of a predator-based biological control program for B. tabaci.

Animals↗
PubMed2006

Response of predators to loss and fragmentation of prey habitat: a review of theory.

Despite extensive empirical research and previous reviews, no clear patterns regarding the effects of habitat loss and fragmentation on predator-prey interactions have emerged. We suggest that this is because empirical researchers do not design their studies to test specific hypotheses arising from the theoretical literature. In fact, theoretical work is almost completely ignored by empirical researchers, perhaps because it may be inaccessible to them. The purpose of this paper is to review theoretical work on the effects of habitat loss and fragmentation on predator-prey interactions. We provide a summary of clear, testable theoretical predictions for empirical researchers. To test one or more of these predictions, an empiricist will need certain information on the predator and prey species of interest. This includes: (1) whether the predator is a specialist on one prey species or feeds on many kinds of prey (omnivore and generalist); (2) whether the predator is restricted to the same habitat type as the focal prey (specialist), can use a variety of habitats but has higher survival in the prey habitat (omnivore), or lives primarily outside of the focal prey's habitat (generalist); (3) whether prey-only patches have lower prey extinction rates than predator-prey patches; and (4) whether the prey emigrate at higher rates from predator-prey patches than from prey-only patches. Empiricists also need to be clear on whether they are testing a prediction about habitat loss or habitat fragmentation and need to conduct empirical studies at spatial scales appropriate for testing the theoretical prediction(s). We suggest that appropriate use of the theoretical predictions in future empirical research will resolve the apparent inconsistencies in the empirical literature on this topic.

Animals↗
PubMed2006

Spatial scale of the patchiness of plant poisons: a critical influence on foraging efficiency.

Generalist mammalian browsers and folivores feed on a range of chemically different plant species, which may assist them in diluting toxins and diversifying nutrient consumption. The frequency and order in which their diets are mixed are important determinants of intake. As a result, the degree of plant heterogeneity in an environment, and the spatial scale at which this occurs, should directly influence herbivore foraging decisions. We tested whether altering the Spatial scale of plants, and thus plant secondary metabolites (PSMs), affected foraging efficiency of a generalist folivore, the common brushtail possum (Trichosurus vulpecula). First, we demonstrated that possums were able to consume more from a mixed diet of two chemically different species, Eucalyptus globulus and E. tenuiramis, than when either of these species was offered alone. We then tested whether altering the spatial scale between E. globulus and E. tenuiramis, as small- or large-scale plant heterogeneity "patches," affected possum foraging behavior and, ultimately, their foraging efficiency. Possums increased their foraging efficiency when the spatial scale of plant heterogeneity was small rather than large. We argue that the ability to regularly switch diets, when plant spatial distribution is at a small scale, reduces the negative effects of PSM ingestion. We predict that the heterogeneity of plant patches, in relation to PSM distribution, and the scale at which this occurs across a landscape, are critical factors that influence foraging efficiency and, ultimately, fitness of mammalian herbivores. This research provides a fundamental link between plant chemistry, foraging, and habitat heterogeneity.

Animals↗
PubMed2006

Tests of landscape influence: nest predation and brood parasitism in fragmented ecosystems.

The effects of landscape fragmentation on nest predation and brood parasitism, the two primary causes of avian reproductive failure, have been difficult to generalize across landscapes, yet few studies have clearly considered the context and spatial scale of fragmentation. Working in two river systems fragmented by agricultural and rural-housing development, we tracked nesting success and brood parasitism in > 2500 bird nests in 38 patches of deciduous riparian woodland. Patches on both river systems were embedded in one of two local contexts (buffered from agriculture by coniferous forest, or adjacent to agriculture), but the abundance of agriculture and human habitation within 1 km of each patch was highly variable. We examined evidence for three models of landscape effects on nest predation based on (1) the relative importance of generalist agricultural nest predators, (2) predators associated with the natural habitats typically removed by agricultural development, or (3) an additive combination of these two predator communities. We found strong support for an additive predation model in which landscape features affect nest predation differently at different spatial scales. Riparian habitat with forest buffers had higher nest predation rates than sites adjacent to agriculture, but nest predation also increased with increasing agriculture in the larger landscape surrounding each site. These results suggest that predators living in remnant woodland buffers, as well as generalist nest predators associated with agriculture, affect nest predation rates, but they appear to respond at different spatial scales. Brood parasitism, in contrast, was unrelated to agricultural abundance on the landscape, but showed a strong nonlinear relationship with farm and house density, indicating a critical point at which increased human habitat causes increased brood parasitism. Accurate predictions regarding landscape effects on nest predation and brood parasitism will require an increased appreciation of the multiple scales at which landscape components influence predator and parasite behavior.

Agriculture↗
PubMed1993

Radiologists in the United States: demographic, professional, and practice characteristics.

OBJECTIVE: The purpose of this report is to present a statistical portrait of radiologists in the United States based on the 1990 American College of Radiology Manpower Survey. Unlike previous surveys, this survey included radiologists who were not members of the College and was thus more representative of all radiologists. (Approximately three quarters of radiologists are College members.) We examined how the demographic, professional, and practice characteristics of radiologists vary among major groups within the profession. MATERIALS AND METHODS: A stratified random sample of 2804 radiologists and nuclear medicine specialists was drawn from the American Medical Association Physician Masterfile, which is the most complete and extensive single source of information on physicians in the United States. Because the total numbers of female radiologists, nuclear medicine specialists, and radiologists less than 35 years old are relatively small, these groups were deliberately "oversampled" (hence the term stratified random sample) to ensure sufficient numbers of responses in these categories for meaningful analysis. A total of 1845 completed questionnaires were received, which yields a response rate of 68% if the questionnaires sent to invalid addresses are excluded. Responses were weighted to make the data representative of all radiologists, despite differences in sampling rates. RESULTS: Findings for professionally active radiologists who completed their training included the following: 94% were certified by the American Board of Radiology, 13% were women, 47% were less than 45 years old, fees for service were the primary remuneration for 62%, and 72% are in practices owned by physician members of the practice. By major activity in radiology, 69% were diagnostic radiology generalists; 11% were radiation oncologists; 18% were diagnostic radiology subspecialists; and 2% were nuclear medicine specialists. A breakdown by age indicated that the age group of radiologists less than 45 years old included more women, diagnostic subspecialists, and persons who had fellowship training than other age groups did. Percentages of diagnostic radiology generalists and solo practitioners were lower among younger radiologists. Radiation oncologists, compared with all others, were the most likely to practice solo or in small groups of two to four members. The subfields with the highest percentages (60% or more) of diagnostic radiologists reporting expertise or proficiency were CT, mammography, and sonography. Among radiologists who were retired, half had retired by the time they were 65 years old. However, a majority of radiologists 65-69 years old were still working, as were 40% of those 70-74 years old. CONCLUSION: The profession of radiology is changing, with more women, subspecialists, and fellowship-trained radiologists in younger age groups and fewer solo practitioners. Only a small percentage of radiologists are not board certified. Radiologists typically remain professionally active into their late 60s or even beyond.

Adult↗
PubMed2006

Physician and nurse use of psychosocial strategies in diabetes care: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study.

OBJECTIVE: To determine the use of psychosocial strategies by health care providers in treating patients with diabetes and the factors associated with use of these strategies. RESEARCH DESIGN AND METHODS: Cross-sectional survey of national samples of generalist and diabetes specialist physicians (n = 2,705) and nurses (n = 1,122) from the multinational study of Diabetes Attitudes, Wishes and Needs. Respondents were from 13 countries in Asia, Australia, Europe, and North America. Two psychosocial strategies were examined: provider psychosocial care, which provides psychosocial support by diabetes care providers to their own patients, and psychosocial specialist care, which refers diabetic patients to psychosocial specialists. RESULTS: Compared with physicians, nurses perceived significantly higher prevalence and severity of psychosocial problems and used psychosocial strategies significantly more frequently, even though they rated their own psychosocial skills lower. Among both physicians and nurses, diabetes specialists were significantly more likely than generalists to utilize psychosocial strategies. Physicians and nurses used psychosocial strategies significantly more when they believed that more patients have psychosocial problems and that problems interfere more with diabetes control. Referral to psychosocial specialists was significantly more likely when physicians and nurses perceived that professional psychological resources were more available. There were substantial country differences in all factors studied. Compared with other countries, U.S. providers provided more psychosocial care themselves but were less likely to refer to psychosocial specialists. CONCLUSIONS: Psychosocial strategies are important parts of the diabetes care provider repertoire; understanding their determinants may facilitate efforts to increase their use.

Adult↗
PubMed1997

Is the quality of diabetes care better in a diabetes clinic or in a general medicine clinic?

OBJECTIVE: To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center. RESEARCH DESIGN AND METHODS: This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria. A total of 112 patients with diabetes were randomly selected, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were examined: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quality, defined as a blood pressure measurement, a record of type of hypoglycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit. RESULTS: The diabetes clinic performed significantly better than the general medicine clinic on the following criteria: a record of a patient's self-monitoring of blood glucose levels; a foot examination; a comprehensive eye examination; a glycated hemoglobin measurement; and a referral for diabetic education. The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic (73 vs. 52%, P = 0.02). CONCLUSIONS: Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attention needs to be paid to ensure that generalists have the knowledge and system resources necessary to deliver an acceptable quality of diabetes care.

Blood Glucose Self-Monitoring↗
PubMed2026

Cucurbitacins in Plant-Insect Interactions: Biosynthesis, Regulation, Ecological Functions, and Prospects for Crop Protection.

Cucurbitacins are highly oxygenated tetracyclic triterpenoids characterized by intense bitterness, substantial structural diversity, and important consequences for plant-herbivore interactions. Although best known from Cucurbitaceae, cucurbitacins and related cucurbitane-type metabolites also occur in phylogenetically distant herbaceous and woody plants. Genetic and biochemical studies have validated several core biosynthetic steps, including cucurbitadienol formation by oxidosqualene cyclases and subsequent modification by cytochrome P450 monooxygenases, acyltransferases, and glycosyltransferases. Tissue-preferential basic helix-loop-helix transcription factors constitute the best-characterized regulatory layer, whereas the evidence supporting accessory regulators, transporters, and environmental responses varies from functional validation to transcriptomic or genomic prediction. From the plant perspective, cucurbitacins deter feeding or impair performance in many generalist and non-adapted herbivores. By contrast, their use as host-recognition cues and feeding stimulants by specialist diabroticite beetles reflects evolved herbivore adaptations involving perception, tolerance, metabolism, or sequestration rather than a second defensive function of the plant trait. Herbivore-induced cucurbitacin accumulation has been demonstrated in particular systems, although its regulatory mechanisms and ecological generality remain unresolved. Unlike previous reviews centered primarily on cucurbitacin chemistry, pharmacological activity, or individual biosynthetic pathways, this review integrates evidence-graded pathway reconstruction and molecular regulation with taxonomic distribution, insect adaptation, domestication, and agroecological consequences. Mechanistically, this review traces how scaffold formation, oxidative tailoring, conjugation, tissue-specific regulation, and transport give rise to contrasting ecological outcomes through herbivore-specific perception, tolerance, metabolism, and sequestration. We conclude that uniformly increasing or eliminating cucurbitacins is unlikely to provide broadly effective crop resistance because either direction may favor a different herbivore group. Future priorities include functional validation of candidate genes, spatially resolved metabolite analysis, comparative investigation of non-cucurbit lineages, and field evaluation involving generalist and specialist herbivores, crop quality, and non-target organisms. These advances will support context-specific fruit-quality improvement, behavioral pest control, and integrated pest management strategies rather than cucurbitacin manipulation as a stand-alone resistance approach.

agroecology↗
PubMed2004

Social and asocial cues about new food: cue reliability influences intake in rats.

Dietary generalists often treat new foods with caution and may rely on social cues to identify new foods that are safe to eat. However, not all generalists show the same degree of caution, nor do they all rely on social cues to the same extent. The cue reliability approach (CRA) attempts to account for this variation by quantifying the costs and benefits of sampling a new food for the first time. The experiments reported here tested predictions of the CRA, and the results suggested that rats eat more new food when asocial cues predict that new foods will prove more profitable than familiar foods. The experimental results also suggested that rats are more likely to seek out social cues when asocial cues are unreliable.

Adaptation, Psychological↗
PubMedDate not supplied

Meeting the continuing education needs of nurses in rural settings.

Access to continuing education (CE) for rural nurses is hampered by distance, cost factors, and the lack of sufficient personnel to provide coverage when nurses are away from work. Additionally, because rural nurses function as generalists rather than specialists, CE programs should focus on the generalist perspective. The Nevada Area Health Education Center (AHEC) has developed a partnership model for providing CE that addresses these considerations, bringing educational programs to the rural site eliminates travel, cost, and coverage problems for the hospitals. In turn, a close working relationship between AHEC and rural personnel to assess needs and coordinate the planning is critical. Attention to logistical detail is critical. The partnership model described is the foundation of a year-round CE program for nurses working in rural and frontier areas.

Education, Nursing, Continuing↗
PubMed2005

General practitioners with special interests: risk of a good thing becoming bad?

There is a long tradition of some general practitioners developing areas of special interest within their mainstream generalist practice. General practice is now becoming increasingly fragmented, with core components being delivered as separate and standalone services (eg, travel medicine, skin cancer, women's health). Although this fragmentation seems to meet a need for some patients and doctors, potential problems need careful consideration and response. These include loss of generalist skills among GPs, fewer practitioners working in less well-remunerated areas, such as nursing home visits, and issues related to standards of care and training.

Ambulatory Care Facilities↗