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OBJECTIVE: To assess the use of "Best Practice" methods as a means of improving obstetrical care pertaining to labour management and Caesarean birth in a partnership group of 5 hospitals, 4 with birthing rates of 50 to 175 women a year, and the fifth with a birthing rate of approximately 1000 women a year. METHODS: The Labour Management module of the Advances in Labour and Risk Management (ALARM) Best Practice course of the Society of Obstetricians and Gynaecologists of Canada (SOGC) was tested on the 4 Level I rural hospitals and 1 modified Level II hospital in a small city in the Huron Perth Hospitals. The outcomes assessed were the module's effectiveness as a Continuing Medical Education (CME) tool; its effectiveness at promoting common practice guidelines; and its effectiveness at improving communication and co-operation. RESULTS: From the 5 participating partnership hospitals, 3 obstetricians, 28 family physicians, and 5 midwives were eligible to participate. Of these 36 clinicians, 80% completed the Pre-study Phase, which included auditing their practice for Labour Management; 94% attended the workshops; and 67% completed the Post-study Audit. Common practice changes were identified through the workshops and post-study results showed success in their implementation. A Post-study Questionnaire indicated improved co-operation and communication in the partnership hospitals. CONCLUSIONS: The Management of Labour module of the SOGC ALARM Best Practice course was successful in improving obstetrical practice in the partnership group of hospitals tested. This method promoted the use of common practice guidelines at the bedside and also improved communication and co-operation in the hospital partnership.
Partnerships result in many pluses to a dental practice. Interpersonal relationships result in many minuses to the partners' rapport. This is magnified manyfold when the relationship is father and son. This article attempts to resolve some of the problems.
In a primary-care led National Health Service it is imperative for librarians not only to develop user-centred services for health professionals based in the community but also to facilitate information management within Primary Care Groups. In this article recent research in the field is discussed, and challenges intrinsic to delivering information services to primary care are identified. Drawing on the experience of one Practice Librarian in the Aylesbury area, the importance of organizational culture is considered, along with its implications for making successful approaches to partnerships. Five factors that motivated these practices to contract the services of an independent librarian are identified. The information needs of Primary Care Groups are discussed and the essential characteristics of future service provision are noted.
BACKGROUND: Many dentists would like to bring in a future partner but are reluctant to do so for various reasons. The author outlines a three-step process toward achieving a successful partnership: the employment phase, in which an associate is introduced to and integrated into the practice; the at-risk associateship phase, in which the new doctor begins to assume financial responsibility for his or her portion of the practice; and the partnership phase, in which the partners achieve their full function as a team. CONCLUSIONS AND PRACTICE IMPLICATIONS: There will be challenges in any partnership. Regular meetings, division of responsibility and open, nonjudgmental communication will diffuse the problems encountered in day-to-day practice and will ensure that the partners enjoy a rewarding relationship for many years to come.
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A strong partnership between researchers and providers is crucial to advance the science of dissemination and to support dissemination of effective chronic disease prevention programs. We reflect on our experience in three recent studies, (a) COMMIT, (b) a National Survey of School Smoking Prevention Programs, and (c) an ongoing study of Training of Providers of Smoking Prevention Programs to identify specific ways in which research and provider communities might collaborate. We propose that a national working group of researchers and providers be established to support (a) dissemination of programs by creating and continuously updating an inventory of 'tested' methods and protocols for use in key community intervention channels (health care offices, worksites, etc.) and (b) dissemination research by establishing a shared set of research priorities and mechanisms to stimulate researcher-provider partnership during the research process.
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A joint partnership between a University and its local hospitals developed and implemented Practice Learning Teams (PLTs) to enhance student nurse learning experiences. In order to achieve this, PLTs arrived at clear aims and purposes, with educators and nurses working collaboratively and being jointly responsible for the quality of students' placement experience. This study occurred after a year of implementation, and a range of stakeholders were interviewed in order to evaluate perceived effectiveness. Findings of this report suggest the majority of respondents thought PLTs should be retained, recognising that they were new, and thus required development. There was a clear difference between effective and ineffective PLTs. Effective teams were considered to support the students' practice-based learning and mentors, while providing a forum for sharing 'good practice', discussion and problem solving. Less effective teams were characterised by having a low attendance or a membership that lacked enthusiasm and/or willingness to participate.
Further development of a strong research base for general practice is important if the profession is to respond appropriately to its central role in service provision. It can be difficult for general practitioners (GPs) who have not pursued an academic career path to make a significant contribution to research. The development of a service-academic partnership is described, together with an honest account of the difficulties encountered.
OBJECTIVE: To collect baseline data on practice types and services provided by orthodontists in Australia and New Zealand. METHOD: A total of 510 questionnaires was sent and 258 were returned. The response rate was 53 per cent. RESULTS: The average age of respondents was 50 years (SD: 9.8 years) with female orthodontists being younger (Mean: 42.3 years; SD: 6.5). The ratio of responding female to male orthodontists was 1:8.8. Overall, more orthodontists were in solo private practice than associateships or partnerships. New Zealand orthodontists were more likely to be in associateships. Australian orthodontists had twice the number of practices (Mean: 2.4; SD: 1.4) than their New Zealand counterparts (Mean: 1.1; SD: 0.3). Orthodontists estimated they saw a mean of 21.3 (SD: 11.3) patients per day. Older orthodontists saw few patients in a day and spent fewer hours in any practice activity in a week. The mean waiting time for a consultation appointment in the private sector in New Zealand was nearly twice that in Australia. There was a significant association between male orthodontists and referral of patients by general dental practitioners. More than three quarters of respondents incorporated retention fees into the treatment fee. Overall, orthodontists were satisfied with the workload and did not want more orthodontists in their geographical area. CONCLUSION: This study provides a sound basis for consideration of challenges in practice and changes over time.
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Implementation of guidelines offers one of the largest opportunities for quality improvement, utilization review, and cost control for the health-care enterprise. If guidelines could be implemented on a large scale, their adoption could result in $100 billion in annual savings as well as improve the quality of patient care. However, infrastructural barriers impede progress. Collaboration between the Laboratory Medicine Health Services Program at the University of Alabama at Birmingham, Columbia-Presbyterian Medical Center, and the Cerner Corporation, funded by the National Institute of Standards and Technology as part of the Advanced Technology Program involving ¿Information Infrastructure for Healthcare,¿ is focused on developing and delivering: 1) methods for creating operational forms of guidelines; 2) an effective computer-based architecture for implementing guidelines in clinical practice; 3) methods for packaging guidelines for wide distribution; 4) methods for testing the efficacy, safety, and acceptability of guidelines; and 5) a model for collecting, aggregating, and normalizing data from disparate systems. This hypothesis-driven research program is focused on laboratory medicine-based guidelines as a tool for developing, testing, and evaluating methods that can be implemented widely.
The number of women general dental practitioners has increased in the last few years as the number of women graduating from UK dental schools has also increased. The increase in women practitioners from 1975 to 1985 is of the order of 10 per cent, although only 23 per cent of the total owned their own practices either alone or in partnership. The paper describes the author's own experiences in setting up a thriving practice and the problems she encountered as a woman. Also described are the author's observations in striving for greater goals for general dental practitioners in terms of continuing education and vocational training.
OBJECTIVE: To determine the types of values, sources of stress, and methods of coping in a sample of community-based practicing family physicians who were determined as healthy and satisfied with their careers. DESIGN: Qualitative study, combining an interview guide approach with a standardized open-ended interview. SETTING: Offices of practicing physicians in Ohio. PARTICIPANTS: A purposeful sample of 10 central Ohio family physicians, ranging in age from their mid-30s to mid-60s; 8 were married; 2 were African American; 3 practiced in a rural environment; 3 worked in a solo practice, 5 in a partnership, and 2 in a group practice. The sample was identified by a knowledgeable informant, using a criterion of success in coping with occupational stress and satisfaction with the practice of medicine. MAIN OUTCOME MEASURE: Patterns and themes common to the interviews. RESULTS: Primary values presented by the sample included caring, diversity, control, family, and spirituality. Sources of stress involved overload, the nature of today's medical environment, and demanding patients. Coping strategies consisted of problem solving, developing a positive perspective, stress monitoring, support, and "time for self." Stress was often produced when a conflict existed between the person and the work environment. Stress was also created when the manifestation of values was unhealthy and unbalanced. CONCLUSIONS: Research participants described various learned strategies that enabled them to cope more effectively with stress. These were often developed after personal struggle with work or family. Results suggested that assessing the developmental processes in physician stress and coping is important.
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Explore the source record for details and available documents.