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PubMed1996

Consensus radiation protection practices for academic research institutions.

Under the auspices of the Howard Hughes Medical Institute, a set of consensus guidelines for Radiation Protection Practices has been developed for biomedical research using radioactive materials. The purposes of the guidelines are (1) to promote good radiation protection practices consistent with the needs of biomedical research, the ALARA principle, and regulatory requirements; (2) to establish common goals and consistent practices within radiation safety programs; and (3) to build a meaningful partnership between radiation safety professionals and the biomedical research community. These practices are intended to enhance radiation protection and the efficiency of the research staff. The consensus guidelines will lessen the variability in radiation safety practices that is evident among many academic research institutions and will encourage better acceptance and regulatory compliance by users of radioactive materials in biomedical research.

Academies and Institutes↗
PubMedDate not supplied

Framing the work: development of a renal nursing professional practice model.

In 1997, a nursing care model task group was formed to develop a framework to guide the development of the nursing care delivery system in a newly merged hospital corporation. A collective group of experienced and motivated nurses in the renal program met to develop an integrated renal nursing professional practice model. In addition it was recognized that a city-wide model involving the two acute care renal centres would be advantageous. The challenge was to clearly articulate the professional roles and relationships of nurses and nurse practitioner/clinical nurse specialists in a constantly changing environment. This process provided the opportunity to identify key trends influencing renal care and possibilities for changing practice. Networking across the corporations was enhanced, partnerships were formed, and a sense of value for the work that was being undertaken developed. The group's endeavours resulted in an integrated nursing professional practice model that emphasizes accountability and continuity and places value on therapeutic relationships. Another strength of the model is the acknowledgement of the collaborative nature of the multidisciplinary team. After two years of development, the model was implemented. A city-wide Renal Nursing Professional Practice Council has been established in order to provide leadership in evaluating the model. This will include assessing the success of implementation, impact on patient/family care, and collaborative rewards experienced by staff. Future planning will address the potential need for a multidisciplinary focus within the practice council.

Attitude of Health Personnel↗
PubMed2006

Collaborative partnerships for nursing faculties and health service providers: what can nursing learn from business literature?

Collaborative partnerships between nursing faculties and health service providers are the cornerstone of successful clinical experience for nursing students. The challenge of providing an optimal learning environment can be enormous given the turbulent and rapidly changing environment in health. The present study uses the business literature to examine what nursing can learn from business about the development of successful collaborative partnerships. The characteristics of sound partnerships are described and a set of best practice guidelines is developed. The guidelines summarize the factors considered to be essential for the effective development of collaborative partnerships. In these times of nursing shortages and high turnover high quality, collaborative partnerships between nursing faculties and the health care sector are seen as a possible solution to optimize clinical learning and therefore graduate preparedness.

Attitude of Health Personnel↗
PubMed2006

The making of an interdisciplinary partnership: the case of the Chicago Food System Collaborative.

Interdisciplinary partnerships foster innovation to address pressing social problems. This paper describes an interdisciplinary partnership called the Chicago Food System Collaborative (CFSC) composed of a team of partners from four academic institutions and three community-based organizations representing a total of eight disciplines that included: community development and community organizing, community psychology, geography, nursing, nutrition, public health, sociology, and urban planning and policy. Partners came together to address the issue of access to healthy foods and nutrition in a working class African American neighborhood. We analyze and discuss the core principles that guided the partnership and its impact across three dimensions: understanding through interdisciplinary action research, building capacity, and facilitating innovations in practices and policies. Despite the challenges of interdisciplinary partnerships, the potential benefits and impact of such efforts reflect their value as a comprehensive approach to addressing complex social problems.

Black or African American↗
PubMed2003

An exploratory metasynthesis of midwifery practice in the United States.

OBJECTIVES: To conduct a metasynthesis of six qualitative studies of midwifery care and process; identify common themes and metaphors among the six studies for further exploration and theory development; and create a framework for further metasynthesis of qualitative studies of midwifery practice in the USA. DESIGN: A qualitative metasynthesis to analyse, synthesise, and interpret six qualitative studies on the process and practice of midwifery care. SAMPLE AND SETTING: Hospital, birth centre, and home birth settings were represented across all of the studies. Participants included nurse- and direct-entry midwives who provided both childbearing and gynaecological care. Recipients of midwifery care also received both childbearing and gynaecological care. FINDINGS: Four overarching themes were identified: the midwife as an 'instrument' of care; the woman as a 'partner' in care; an 'alliance' between the woman and midwife; and the 'environment' of care. These were interpretively and conceptually arrayed into a helix model of midwifery care. KEY CONCLUSIONS: The findings from this exploratory metasynthesis clearly indicate that the practice of midwifery is a dynamic partnership between the midwife and the woman, and reflects an environmental perspective. In a country that has a standard of highly technical childbirth care, perhaps the most outstanding concept of this model is that of the midwife as an 'instrument' of care. The significance of the findings will be determined by their ability to guide further research efforts to support a standard of midwifery care for all women in the USA. IMPLICATIONS FOR PRACTICE: This model offers a benchmark and a structure for considering the dynamic elements of midwifery practice and key roles that the midwife plays in the health care of women and babies.

Anecdotes as Topic↗
PubMed2005

Houston AANCART best practices: from vision to synergy to reality.

The theme for the 2004 AANCART Academy, "Community Partnerships for Cancer Control: From Vision to Synergy to Reality", characterizes Best Practices for the Houston AANCART site. Researchers and community members share a common vision for addressing the cancer and health disparities that exist in our Asian community. They banded together synergistically to bring to reality the programs and projects that are enabling more Asian Americans to understand their risks for cancer, receive screening and education, and access treatment and survivorship support. Along the way, Houston AANCART was also able to conduct meaningful and relevant community-based participatory research and to train young Asian and other investigators in how to reach out to this community in a culturally sensitive and appropriate manner.

Asian↗
PubMed1976

Seeing the same doctor.

It is not known how many general practices are organised so that patients usually see the same doctor (separate list practice) or how many are arranged so that patients are encouraged to see any partner (combined list practice).A survey was carried out in Wiltshire which obtained an 85 per cent response to a questionnaire. This showed that a majority of general practitioners working in partnership in Wiltshire no longer organise their practices so that they care for a defined list of patients.

Continuity of Patient Care↗
PubMedDate not supplied

The Future of Family Medicine: a collaborative project of the family medicine community.

BACKGROUND: Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. METHODS: A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. RESULTS: The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education must continue to include training in maternity care, the care of hospitalized patients, community and population health, and culturally effective and proficient care. A comprehensive lifelong learning program for each family physician will support continuous personal, professional, and clinical practice assessment and improvement. Ultimately, systemwide changes will be needed to ensure high-quality health care for all Americans. Such changes include taking steps to ensure that every American has a personal medical home, promoting the use and reporting of quality measures to improve performance and service, advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, advancing research that supports the clinical decision making of family physicians and other primary care clinicians, and developing reimbursement models to sustain family medicine and primary care practices. CONCLUSIONS: The leadership of US family medicine organizations is committed to a transformative process. In partnership with others, this process has the potential to integrate health care to improve the health of all Americans.

Ambulatory Care Information Systems↗
PubMed1990

Rurally based education: confronting social forces underlying ill health.

Skills needed by physicians to address and prevent our communities' leading causes of premature death--injuries, cancer, cardiovascular disease, homicide, and suicide--are not in the typical roster of medical school learning experiences. And traditional, urban, hospital-based venues of medical education scarcely model for students appealing careers in the community. These twin problems are especially severe in rural America. Yet rural training sites are ideal locations for students to confront the array of social, political, and economic forces underlying ill health in our society. If learning in medical schools is to be suitable for rural practice, students must receive early and sustained exposure to rural communities and to rural physician role models. To facilitate this educational redirection, medical schools must (1) sensitize their existing faculty and residents to community health needs via in-service training on community health topics, (2) encourage faculty and residents to provide service and education outreach to rural communities, and (3) promote rural health research. Finally, to prevent the marginalization of rural health concerns within the academic agenda, efforts should be made to develop university-community partnerships in which model rural training practices and a "field" teaching faculty are established and nourished by the medical center.

Curriculum↗
PubMedDate not supplied

The national post-baccalaureate graduate nurse residency program: a model for excellence in transition to practice.

The Chief Nursing Officers (CNOs) of the University HealthSystems Consortium (UHC) of Academic Hospitals desired to increase the numbers of baccalaureate graduate nurses hired by their facilities and provide a more consistent, uniform transition into practice for these graduate nurses. A partnership between the UHC CNOs and the American Association of Colleges of Nursing (AACN) led to establishing a National Post-Baccalaureate Graduate Nurse Residency Program. The structure, curriculum, and outcomes measures were developed and the program was implemented, with growth from six original pilot sites to 34 academic hospitals. Outcomes from the first year of program operation at these six sites show a high rate of retention, decreased stress by graduate nurses over time, improved organization and prioritization of care, and increased satisfaction in the first year of practice.

Adult↗
PubMed1999

Care for life: a faculty practice with a Lifecare community.

A combined clinical faculty practice model is shown in the partnership that was developed between the University of Maryland, School of Nursing, Baltimore, MD, and Roland Park Place, Baltimore, MD, a continuing care retirement community. This model encourages reciprocal relationships among clinical work, research, and what is taught and learned by the students.

Aged↗
PubMed2003

Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics.

OBJECTIVE: The use of antidepressants (ADs) has escalated and prompted considerable debate. Many depressed patients go unrecognised or under-treated and the area of indication of the new ADs is widening. The aim of this study was to analyse (i). the variation in general practitioners' prescribing of ADs by comparing with prescribing of other drug groups and (ii). whether the general prescribing behaviour, practice activity and demography are associated with the AD prescribing. METHODS: Analysis of AD prescribing patterns among 174 general practices (93.5%) in the County of Funen, Denmark. Age- and sex-standardised 1-year incidences and prevalences of AD prescribing for patients listed were calculated using individual prescription data from Odense University Pharmacoepidemiologic Database. Data about health services and practice demography were obtained from the Health Insurance Register. The variation in AD 1-year prevalence was compared with other drug groups by a variation index (90%/10% percentile). Univariate linear regression analysis was used to examine associations between practice characteristics and prescribing. RESULTS: The 1-year prevalence of AD prescribing varied sixfold, no more than the prevalence of five other drug groups. Practices with high yearly: general prescribing prevalence, mean number of drugs per medicated patient, number of surgery consultations/100 patients and counsellings/100 surgery consultations showed the highest yearly prevalence of AD prescribing. Single-handed practices had higher AD prescribing rates than partnerships. The relative use of selective serotonin re-uptake inhibitors and other new ADs showed only little variation (10% and 90% percentiles as close as 66-86%), but practices with high 1-year prevalence and incidence most often chose the new ADs. CONCLUSION: Analysis of inter-practice variation showed no extraordinary quality problems with regard to AD prescribing, but does not exclude that there might be problems. The general prescribing pattern of the general practitioners seems essential to their attitude to AD prescribing. The relationship between counselling and prescribing was a feature specific to ADs and deserves further investigation. Quality indicators are needed to understand differences in AD prescribing, and studies based on prescription data have to be supplemented with individual clinical data.

Adult↗
PubMed2001

Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study.

OBJECTIVE: To explore reasons for increased risk of hospital admission among south Asian patients with asthma. DESIGN: Qualitative interview study using modified critical incident technique and framework analysis. SETTING: Newham, east London, a deprived area with a large mixed south Asian population. PARTICIPANTS: 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. MAIN OUTCOME MEASURES: Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. RESULTS: South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. CONCLUSIONS: The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated asthma strategies by practices with better access and partnerships with patients may also achieve this.

Adult↗
PubMed1996

Community-oriented primary care.

Community-oriented primary care (COPC) combines elements of clinical medicine and public health to provide an effective strategy in tackling today's health problems. A primary care practice or program that develops a partnership with an identified community to describe and prioritize health concerns and design and monitor the impact of an intervention can make a difference to the health of a community. The key ingredient to a successful COPC venture is a motivated practitioner. Familiarizing health care providers with the COPC model will enable them to form enriching relationships with the communities they serve.

Community Health Services↗
PubMedDate not supplied

HIV/AIDS: Traditional systems of health care in the management of a global epidemic.

Cultural preference and the high cost and unavailability of anti-HIV drugs for people living with HIV/AIDS in the developing world leads many to turn to traditional (indigenous) medicine to manage HIV-related illness. Traditional health practitioners can play an important role in delivering an AIDS prevention message and some may be able to offer treatment for opportunistic infections. In industrialized countries, approximately half or more of those with AIDS use complementary medicines in conjunction with their antiretroviral therapy. A growing body of research highlights the immunomodulatory and antiviral potential of plant-based medicines. There are also concerns about unsafe practices and a growth in claims of traditional cures for AIDS. Partnerships between the modern and traditional/complementary health sectors in research, policy, and practice are essential in building comprehensive HIV/AIDS control strategies.

AIDS-Related Opportunistic Infections↗
PubMed1999

Sources and implications of dissatisfaction among new GPs in the inner-city.

OBJECTIVES: We aimed to examine the factors that were most stressful for new principals in inner-city general practice. In addition, given the concerns about retention of new principals, to ascertain whether high perceived stress translated into regret that they had joined their practice and factors that might protect from regret. METHODS: A questionnaire survey, within an inner-city Health Authority. The subjects were 101 GPs appointed as principals between 1992 and 1995. RESULTS: Eighty-three out of 101 GPs replied. The greatest sources of stress were, in order, patient expectations, fear of complaint, out-of-hours stress and fear of violence. Although these stresses were scored highly, 61% expressed no regret at having joined their practice with just 4% reporting considerable regret. Stress within the partnership and stress arising from patient expectations accounted for 23% of the variation in regret. Holders of the MRCGP were significantly protected against regret; there was no evidence that other factors such as medical positions outside the practice, membership of a young principals support group, fundholding status or training practices offered significant protection against regret. CONCLUSION: Despite reported difficulties in recruiting new young principals to the inner-city-and despite their reported high levels of stress-few have regrets about their decision to join their practice. For those who did regret joining their practice, the three principal associations were partnership stress, patient expectations and not possessing the MRCGP. Each of these factors may be amenable to intervention by policies geared to improve GP retention.

Adult↗
PubMed1986

Group practice in France.

In France, a number of different forms of group practice co-exist. They differ in the number of members and their contractual relationships. 40 per cent of French dentists practise in groups; however, this figure falls to 26 per cent for the true group practices, in only 12 per cent of which are the fees pooled. In most cases groups are established from a solo practice when the number of patients has become too large for the principal to cope alone. The decision to embark on group practice may also stem from a wish for more leisure, the need for ongoing training, and other psychological or social reasons. The association proper is usually preceded by a less formal type of 'collaboration'. A large number of women engage in group practice, either full-time or, more frequently, part-time, but women-only groups are the exception. Eighty per cent of orthodontists practise in a group of some kind. The facility-sharing partnerships (SCMs) (the most frequent form) provide their members with all or part of the requisites for their practice, which itself remains individual, with each member receiving his fees and contributing to the expenses of the group only in proportion to the services received from it. Full partnerships (SCPs), however, embrace not only all the facilities necessary for the practice but also its patients; fees are received in the name of the partnership. Profits are distributed by criteria associated with the practice (time spent, fees received, reputation, etc.); they may also be distributed in equal shares.

Dentists, Women↗
PubMedDate not supplied

Physician executive leadership.

Administrators are joining hands with physician executives to confront the challenges of the changing healthcare environment. Who is this new breed of physician--the physician executive? The author presents a model of physician executive leadership based on in-depth interviews with 45 physician executives in a tertiary care health center. Five physician executive patterns emerge from the research: the practice, profession, self, organization, and syntonic physician executive. The unique qualities of each pattern are discussed, and suggestions are offered for building effective administrator/physician executive partnerships.

Group Practice↗