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PubMed2003

Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.

BACKGROUND: Female genital mutilation (FGM) or female circumcision is the removal of variable amounts of tissue from the female external genitalia. It is practised all over the world on very young girls. This study was conducted in Sudan where FGM is a criminal offence and not a religious dictate. We assessed the knowledge, attitudes, and perceptions of this practice among Khartoum university students and compared the differences between male and female student responses. METHODS: An anonymised detailed questionnaire was distributed among the university students. In addition to the participant's age, marital status, course studying, details regarding their attitude, knowledge of the practice of FGM, and their own experiences were collected. RESULTS: Of the 500 questionnaires distributed, 414 (82.8%) were returned from 192 (46%) females and 222 (54%) males. 109 (56.8%) of the female respondents were themselves circumcised.18.8% of the male students and 9.4% of the female students thought FGM was recommended by their religion. Only 90 (46.9%) female students compared with 133 (59.9%) male students thought FGM was illegal. Though 16 (8.3%) female respondents thought FGM would increase their chances of marriage, the majority, 166 (74.8%), of the male students would prefer a non-circumcised female. CONCLUSIONS: This study shows that 109 (56.8%) female university students who responded were circumcised. Confusing religious messages and ambiguous laws seem to be responsible for the continuation of this practice. The study highlights the partnership that needs to be established between religious leaders and educationalists to end this medieval practice.

Adult↗
PubMed1997

Physician partnerships: keep the entrepreneurial spirit alive.

With the advent of managed care, physicians who practice on their own and compete against other doctors are becoming a vestige of the past. More and more doctors are learning there is strength in partnering with other physicians and a corporate health care provider to bolster their practices, take advantage of economies of scale, and have more clout when competing for managed care contracts. One corporate provider in the business of establishing such partnerships has learned the key to success in physician partnerships is investing time to build solid relationships with the doctors considering the venture.

Connecticut↗
PubMed2002

Animal care best practices for regulatory testing.

Best practices result from a partnership between law, science, and the people working with the animals on regulated studies. In an ideal setting, people working with animals observe and study animal behavior as influenced by different housing and handling paradigms. These observations are published to create a body of science, and laws are promulgated based on the science. The ideal world does not exist, but there are certain components of best practices common to all species. These components include study design, housing, social contact, diet/feed, enrichment devices, and human interaction. This paper outlines how the forces of law, science, and people work to create best practices for species in regulated studies, specifically mice, rats, rabbits, dogs, and nonhuman primates.

Animal Husbandry↗
PubMed2001

[Network of care for breast cancers: a prospective survey among general practitioners].

OBJECTIVE: To clarify the general practitioner (GP)'s current perception on a network dedicated to mammary cancers in a rural department. METHODS: A survey by questionnaire was carried out from March to September 1999. This questionnaire made of 3 different sheets and 4 parts entitled "your practice in oncology", the "partnership", "GPs and network", "expectations" respectively, was mailed to 233 GPs board certified by the Conseil Départemental de l'Ordre des Médecins. Questionnaire included space for free comments and a specification sheet. There was no letter of reminder following the first mail. RESULTS: The rate of spontaneous answers was 48% (112/233). Representativeness of the sample was considered coherent with age, sex-ratio, mean duration of setting up, practice modalities in the department of Aube. GPs took care, on annual average, over 6 patients with breast cancer. They generally referred their patients to the oncologist team at the Centre hospitalier général. Such a choice was mainly sustained by the quality of patient reception, the psychological support and the fraternal relationship. GPs were mostly concerned (76%) by the management of both chemotherapy side effects and psychological problems occurring in their patients. By popular request, they wished the setting up of a hot line and a systematic historical reminder of the adverse effects joined to the mail. As far as the network was concerned, 83% of the GPs thought it could be helpful, but only 60% would actively participate. Reasons for such a discrepancy are discussed taking free comments into account. CONCLUSIONS: GPs in the Aube department seem eager to practice in a more collective way, which places the patient in the heart of the medical approach. However they demand to play a key role according both to their knowledge of the whole file and to the trust the patients are putting on them.

Adult↗
PubMed1966

Sources of income and principal employers of California physicians, August 1965. A report of the Bureau of Research and Planning, California Medical Association.

As of August 1965, 54.4 per cent of the 31,551 California physicians in active practice indicated that they receive all of their income from fees-for-service, with another 7.9 per cent receiving at least some of their income in this manner. A total of 8,025 M.D.'s, or 25.4 per cent, are on full-time salaries with no other source of professional income, and the remaining 12.2 per cent are members of group practices, whether on an income sharing or a salaried basis. Almost two-thirds of California physicians (66.6 per cent) consider themselves to be primarily self-employed. Of the 21,011 self-employed physicians, 76.3 per cent are in individual practice, 10.5 per cent in partnerships or groups (without income-sharing arrangements) and the remaining 13.2 per cent in group practice (income-sharing). Slightly over one-fifth of all salaried physicians are employed by some Federal agency, primarily in the armed forces. Among the other four-fifths, more than half are hospital employees, with most of the remainder working for other physicians, clinics or educational institutions. General Practice remains the most heavily populated specialty in California, accounting for 26.3 per cent of all physicians; among self-employed physicians only, G.P.'s number more than one out of every three physicians, or 34.6 per cent. Internists, General Surgeons, Psychiatrists and Obstetrician-Gynecologists rank next in order among all physicians; however, the positions of Psychiatrists and OB.'s is reversed among self-employed physicians.

California↗
PubMed2001

"A kiss here and a kiss there": conflict and collaboration in environmental partnerships.

Multistakeholder collaboration in the environmental realm has been increasing steadily over the past decade. This trend is responding to several stimuli, including dissatisfaction with current regulatory regimes, a liberal economic climate emphasizing global competitiveness and short-term returns, and the growing roles of the business and nongovernmental organization sectors in the environmental policy arena. This paper grows out of ethnographic research conducted between 1994 and 1998 with four environmental partnerships in Europe and the United States. The research found all of these partnerships to be marked by practices of conflict minimization and diffusion. Drawing upon illustrative data from one of these case studies, a European Union level initiative aimed at enabling sustainable development in Europe, the paper asks why this was the case, especially given the diverse political and economic interests at stake and the history of contentious relations between the sectors in other venues. Employing a theoretical perspective highlighting the sociohistoric factors involved in these processes, the paper suggests that this proclivity toward nonconfrontational behavior stems in part from two sources: a prominent cultural model that conceptualizes the partnership process as fundamentally nonconflictual in nature, and the promotion of the discourse of ecological modernization over other competing discourses. The paper explores some of the implications of this finding and concludes that environmental partnerships characterized by such nonconfrontational practices risk inadvertently encouraging the delegitimization of conflictual approaches to environmental action and engendering a retreat from radical thinking and innovative environmental solutions.

Conflict of Interest↗
PubMedDate not supplied

Partnerships in mending hearts: nurse and peer intervention for recovering cardiac elders.

As a growing number of older adults recover from cardiac events, volunteer programs have emerged to provide low-cost community support to vulnerable elders. Although an increasing number of studies have described the beneficial relationships between patients and volunteers, little is known about the unique partnership between the advanced practice nurse (APN) and the volunteer peer. The purpose of this article was to explore the interaction between the APN and the peer advisor who provide support for unpartnered elders after myocardial infarction or coronary artery bypass grafting. As part of a larger research study, "Improving Health Outcomes for Unpartnered Cardiac Elders" (R01-NR05205), interactions with peers were recorded by APNs. Essential themes related to working with 20 peer advisors emerged from 30 logs. Findings suggest that establishing the peer support role, acknowledging abilities, and overcoming difficulties are important steps in the relationship. A partnership between healthcare professionals and peer advisors enhances social support for vulnerable elders recovering from myocardial infarction and coronary artery bypass grafting.

Aged↗
PubMedDate not supplied

Specialist physicians providing primary care services in Colorado.

BACKGROUND: There is general consensus that the size of the US physician workforce now exceeds the health care needs of the American public. There is a greater proportion of specialists than primary care physicians, a specialty mix different from that of most other developed countries. METHODS: The Colorado Board of Medical Examiners sent a one-page questionnaire to all physicians licensed to practice in the state. It contained the question: "How many hours in the last week did you provide primary care services, defined as either preventive care, routine physical exams, or treatment of common ailments?" The responses of physicians who reported non-primary-care medical specialties were analyzed with respect to their personal and practice characteristics. RESULTS: Just under half (46.5%) of the 2745 specialist respondents reported having provided primary care services. As a group, however, 27.9% of specialist physicians' direct patient care time was devoted to primary care activities. The amount of primary care services being provided was greater among those not board-certified in their specialties, osteopathic physicians, and specialists spending less time in direct patient care. CONCLUSION: Additional evaluation is needed with a more comprehensive definition of primary care than used in this article, which includes important but difficult-to-measure elements, such as the integration of services, a sustained partnership with patients, and practice in the context of family and community. To the extent possible, this definition should not rely on physician self-definition of which examinations are routine and which ailments are common. However, the contribution of specialists should be considered in future primary care needs assessments, and specialists who experience low demand for their particular specialties may be especially inclined to provide primary care services.

Adult↗
PubMed2003

Lessons learned from implementing multidisciplinary health professions educational models in community settings.

This article addresses sustainability elements for multidisciplinary health professions education in communities. The results are based on a 5 year program involving multiple health professions education institutions in seven states within the USA. We offer observations and suggestions to others who plan and implement multidisciplinary programs for health professions educators. Our findings are based on the outcomes of the Community Partnerships in Health Professions Education (CPHPE) initiative funded by the W. K. Kellogg Foundation. Data sources included pre and post surveys of students and faculty, site visits, published evaluations and site reports, and a 2 year follow-up evaluation after the external funding phase. Elements of the partnership that facilitated the sustainability of the models were: leadership, complementary missions, curriculum that mirrors clinical community practice, change from outside in, partnership boards, and faculty development. Those elements that were barriers to sustaining the efforts were: professional identities and territorial boundaries, structural differences, costs, and unclear goals. The multidisciplinary components of the community partnership initiative were the most challenging. However, in most programs, they did succeed and are currently in place. By paying attention to the elements that enhance and detract from teaming, one can plan for more successful multidisciplinary education.

Allied Health Personnel↗
PubMed1998

Academia as partner in organizational change.

Partnerships are valuable strategies for promoting organizational change. Collaboration between academia and service can provide rapid access to new clinical service delivery mechanisms and real-world laboratories for implementing and testing novel approaches to care delivery. Academic-service partnerships also provide opportunities for work force development. One example of a partnership is described in this article. Details of a Nursing Care Management Institute illustrate principles of good practice for community-campus partnerships.

Appalachian Region↗
PubMed2002

Information within optometric practice: comprehension, preferences and implications.

The partnership approach to health care, in which patients take an active role in decision making, can potentially improve patient satisfaction and adherence to clinician recommendations. However, the process can be impeded by insufficient or poor-quality information provision. This study explored participants' understanding of, and requirements for, optometric information. Information leaflets were obtained from 12 optometry practices and four internet-based resources. Sixty-four patients/ clients participated in focus groups that explored: (1) their understanding of diagrams of visual function, (2) perceptions of good information, (3) information requirements and (4) perceptions of the effects of improved information. A theory-led thematic analysis identified three major themes within each of the four categories. The use of jargon and the inappropriate layout of diagrams and text impeded comprehension of the leaflets. High-quality information was defined as being written concisely with simple explanations and clear diagrams. There was also a preference for information to be relevant and applicable to the patient's own eye care needs. In addition, participants expressed a desire for both written and verbal information regarding eye examination procedures and interpretation of prescriptions. Advice regarding eye care was also requested. To facilitate a partnership approach and improve patient satisfaction, patients should be provided with jargon-free concisely written and clearly presented information. In addition to general information, patients would also benefit from personalised information regarding test results and eyecare regimes.

Humans↗
PubMed1996

Investigation into the attitudes of general practitioners in Staffordshire to medical audit.

OBJECTIVES: To investigate the attitudes of general practitioners to medical audit, and any associations between their attitudes and their personal characteristics. DESIGN: Postal questionnaire survey. SETTING --Staffordshire, United Kingdom. SUBJECTS: 870 Staffordshire general practitioners. MAIN MEASURES: Agreement or disagreement and associations between the attitudes to 16 statements about audit and the doctors' personal or practice characteristics--namely, sex, number of years since qualification, practice list size, number of partners, and the practices' experience of audit. RESULTS: 601 Staffordshire general practitioners (69%) responded. There was most agreement with the statements that audit is time consuming (86%), that ongoing training and education is needed (71%), that there is a compulsion applied on doctors to audit (68%), and that extra resources for audit should be provided by the medical audit advisory group (65%). There was considerable disagreement (53% of general practitioners) with the statement that ¿government policy to expect general practitioners to do audit will enhance the population's health.¿ The median response by the 601 general practitioners was four positive responses out of 14 statements about audit (two of the 16 statements could not be graded positive or negative to audit). Women doctors generally had more positive attitudes towards audit, and so had those working with smaller mean list sizes, those in larger partnerships, and those in practices that had carried out audit for a longer time. CONCLUSIONS: There was a generally negative attitude to medical audit, but it was encouraging that those doctors with the most experience of audit obtained the most job satisfaction from it. IMPLICATIONS: More effort is needed to convince general practitioners of the value of audit. Without this, attempts to involve other members of the primary care team in multidisciplinary clinical audit are unlikely to be effective. Successful audits that are shown to be cost effective as well as leading to improvements in patient care should be publicised and replicated. A higher proportion of resources should be devoted to audit.

Attitude of Health Personnel↗
PubMed2001

Is a partnership or associateship right for you?

Weight your options carefully before bringing another dentist into your practice. This includes careful evaluation of your current situation and what you hope to achieve in the future.

Consultants↗
PubMed1994

The governance team. A firsthand look at leadership practices.

Findings from Phase 1 of the Partnership Study--a national, random sample of board chairmen, chief executive officers and medical staff presidents--paint a detailed picture of national practices of hospital governance teams. In addition, the findings point to a number of inconsistencies regarding the views that board chairmen, CEOs and medical staff presidents have about their leadership roles. Conducted by the American College of Healthcare Executives (ACHE), the American Hospital Association, the American Medical Association and Ernst & Young, Phase 1 Partnership Study findings were reported in the January issue of Trustee (page 16). In Phase 2, of the Partnership Study, in-depth case studies were conducted to address these questions: How do the board chairman, CEO and medical staff president interact one-on-one and as group? How do these three health care leaders perceive one another? What attributes of effective working relationships exist among the three leaders? To answer these questions, confidential site visits were made to six hospitals identified in this article as Metropolitan, North Woods, Midwest, Suncoast, Mountain Valley and Southland (see Study Sites, page 13). Following are some preliminary impressions, based on five completed case-study site visits. The sixth study site visit was in progress at press time.

Chief Executive Officers, Hospital↗
PubMedDate not supplied

Conducting trials in community settings: the provider perspective.

Providers and their treatment programs are the focus of efforts to translate research into practice. In the best of partnerships, they are more than the recipients of research efforts, because they are actively involved in developing and evaluating healthy links between practice and research . This article reports on experiences in a multisite methamphetamine treatment trial funded in October of 1998 by the Center for Substance Abuse Treatment. The goal of the trial is to generate knowledge about how a comprehensive treatment protocol developed by the Matrix Center in Los Angeles can be effectively transferred to the community drug treatment system. The Matrix model provides a three-times-per-week outpatient treatment experience that combines behavioral, educational, and 12-Step counseling techniques. When complete, the study will compare outcomes of the 16-week Matrix program with the usual treatment offered by the programs at the eight participating sites. The UCLA Drug Abuse Research Center and the Matrix Institute on Addictions coordinate the trial. This article describes factors that have fostered or hindered the development of this partnership. These factors can be divided into three temporal phases, although the circumstances presented may occur at any time during the research process. The first set of factors affecting the development of a healthy research-to-practice relationship exists prior to the establishment of that relationship. A second set of circumstances occurs at the initiation of the collaborative enterprise, and the third set of factors is more involved in the development and maintenance of ongoing productive collaboration between researchers and providers.

Central Nervous System Stimulants↗
PubMed1998

[Professional practice by female dentists in the Netherlands].

OBJECTIVE: Obtaining information about differences between male and female dentists in practising dentistry and about changes in practice arrangements. DESIGN: Descriptive analysis, using SPSS (CROSSTABS, ANOVA, HOMALS), based on information on the way(s) dentists practice their profession. SETTING: Department of Research of the Dutch Dental Association (NMT), Nieuwegien, The Netherlands. METHODS: A survey by means of a questionnaire, among a representative sample of 229 female dentists and a representative sample of 483 male dentists. RESULTS: Female dentists have on average fewer patients than male dentists, spend fewer working-hours weekly at their chair and practice more often in some form of partnership. Females have a spouse working in the dental practice less often than males and, while the spouse of males most often works as a dental assistant, the spouse of female dentists is most often also a dentist himself. Compared with male dentists, in 1994 female dentists more often had to arrange cover by a locum while in 1995 they had to take more days of leave due to personal illness or exceptional circumstances. CONCLUSION: In the Netherlands there are substantial differences in the practice of the profession by male and female dentists. This is important for the future policy of the NMT with regard to the required manpower in dentistry.

Absenteeism↗
PubMed1975

Patterns of dental practice in the United States: solo vs group practice.

This overview of selected characteristics of group and solo practices provides baseline information on the dimensions and structures of two general practice types in the United States. It appears that although a dentist spends no more hours or sees no more patients on the average in a group practice, the structure in terms of use of auxiliaries, appointment flexibility, and structured programs provides the dentist in a group practice more opportunity to participate in other professional activities and generate a higher income. Further analysis on the interrelation of these variables will provide a more conclusive comparison of group and solo practices. Also, more conclusive research on variations among different types of group arrangements is needed to appreciate differences in partnerships, groups, and incorporations.

Allied Health Personnel↗
PubMed1991

Strength in numbers. Hospitals that encourage group practice development may have a strategic advantage in the 1990s.

Group practices have become increasingly popular among physicians in recent years. And as competition increases and operating margins become perilously thin, hospitals with significant group practice participation among medical staff appear to be in an enviable position. Before deciding to promote group practices, however, hospital managers should be become familiar with their advantages and disadvantages and determine whether a market exists for group practice development at their facility. The advantages for hospitals include more effective recruiting and a more stable patient base. Among the disadvantages are the fact that groups give physicians a stronger power base from which to request concessions from the hospital and that a preponderance of group-affiliated physicians on staff may discourage referrals from nongroup physicians. A number of considerations are involved in preparing for and coordinating group practice development. In the planning stages open communication with physicians is critical. Physician leaders and a cross section of active staff should participate. Planners should discourage formation of "groups without walls," in which hospitals manage group practices of physicians who remain at different sites. A hospital may, however, choose group-like arrangements (e.g., limited partnerships) without necessarily promoting group practice. Hospitals may also help a group purchase a facility of its own or even create the facility and allow the group to build equity in it.

Evaluation Studies as Topic↗