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PubMedDate not supplied

Translating research on incontinence into practice.

BACKGROUND: Translating research evidence into clinical practice (TRIP) is an important initiative for health services so that care delivered is cost-effective, is efficient, and improves patient outcomes. Most TRIP studies have reported on disseminating and implementing clinical practice guidelines, protocols, or care pathways and have been undertaken in acute rather than community settings. OBJECTIVES: To identify the factors that influence incontinence TRIP and to present key international studies on incontinence TRIP. METHODS: Existing literature on TRIP was analyzed to generate a plan for future research. RESULTS: Several methods to effect incontinence TRIP are described, including clinical practice guidelines and protocols, clinical pathways, partnerships between organizations, a model for incorporating UI research based on generic questions, and implementation strategies that incorporate change theory and consideration of barriers. CONCLUSIONS: Future research is needed on incontinence TRIP in the following areas: barriers, the best theoretical approaches, the effectiveness of empowerment approaches, the value of mentors, effective strategies for nurses and unlicensed personnel, the impact of international collaboration, and regulations across settings.

Critical Pathways↗
PubMed1992

[Evaluation of trainee assistant education].

All of the trainee assistant appointments in general practice in Denmark were assessed by means of a questionnaire investigation during a period of two years. Particular attention was paid to the quality of training and whether there were particular characteristics in the practice which provide the best training. The material consists of 360 questionnaires sent to trainee assistants in general practice one month before conclusion of the appointment. The percentage of replies was 89. The average number of years after graduation was 6.5, which is considerably higher than aimed at in future plans. The investigation reveals that the educational quality and training by the tutor did not appear to be influenced by the number of postgraduate years although there was no doubt that younger trainees required more training and supervision. The quality of training is best in one-man practices and this is followed closely by small partnerships. The investigation reveals that training by the tutor is of decisive significance. It is therefore recommended that trainees in general practice should be more closely associated with one of the practitioners responsible for training. Three fourths of the trainees found that trainee assistant appointment was better than hospital appointments in general. The investigation indicates that following should be standard in every practice: 1) own consultation room, 2) typed records, 3) an introductory leaflet and that training should be arranged with: 1) introduction, 2) half-way assessments, 3) daily conferences about individual patients and 4) weekly conferences about particular subjects related to the practice.

Denmark↗
PubMed1999

The employment status of 1995 graduates from radiation oncology training programs in the United States.

PURPOSE: To quantify the employment status of 1995 graduates of radiation oncology training programs in the United States. METHODS AND MATERIALS: All senior residents (149) and fellows (36) who completed training in 1995 were mailed an employment survey questionnaire by the Association of Residents in Radiation Oncology (ARRO). Telephone follow-up of nonrespondents achieved a 100% response rate. Twenty graduates who chose to continue training and five who returned to their home countries were removed from the study. Of the 160 who attempted to enter the U.S. workforce, 106 were men and 54 were women. Initial job status and job status at 6-8 months following graduation were determined. RESULTS: Unemployment was 6.9% at graduation and 4.4% at 6-8 months. Underemployment (part-time employment) was 10.6% at graduation and 11.9% at 6-8 months postgraduation. Of those working part-time 6-8 months after graduation, 63% (12 of 19) did so involuntarily after unsuccessfully seeking full-time employment. For the 20 graduates who chose to continue training with fellowships, seven (35%) did so solely to avoid unemployment, four (20%) were partially influenced by the job market, and nine (45%) were not influenced by the job market. Adverse employment search outcome was defined as being either unemployed as a radiation oncologist or involuntarily working part-time. Excluding those who chose to work part-time, a total of 19 (11.9%) graduates at 6-8 months following graduation, compared to 22 (13.8%) at graduation, were either unemployed or involuntarily working part-time. In terms of gender, this represented 18.5% (10 of 54) of females and 8.6% (9 of 105) of males. In terms of geographic restrictions in the job search, 56% of males and 70% of females with an adverse employment outcome limited their job search to certain parts of the country. This compares to 62% of all graduates in this study with geographic restrictions in their job search. In terms of perceptions of the workforce and employment opportunities, 95% of all graduates believed there was an oversupply of radiation oncologists and 95.5% believed the job market was worse than what they had anticipated on entering training. Only 42.8% of all graduates were satisfied with the job opportunities available to them. A significant number of private practice positions (41%) did not offer a partnership track, and those that did so had an increased median employment period before partnership (3.25 years) compared to previous years. CONCLUSION: This is the only employment survey for any specialty in which a 100% response rate was achieved. Upon graduation, a significant number of residents and fellows were either unemployed or involuntarily underemployed. The job market absorbed only a fraction of them at 6-8 months. Most graduates, including those employed full-time, were not satisfied with the practice opportunities available to them during their job search. Many private-sector jobs did not offer a partnership track, and those that did required an increased employment period. A higher rate of involuntary part-time employment was seen for female graduates. Geographic restrictions in job search alone could not account for graduates being unemployed or underemployed, and could not account for gender differences. An overwhelming majority of 1995 radiation oncology graduates believed that the job market had deteriorated and that there was an oversupply of radiation oncologists. As one of two major studies tracking the employment status of radiation oncology graduates, we believe this study to be superior in methodology. We also believe this study presents data in a manner useful to medical students, training program directors, and healthcare policymakers.

Employment↗
PubMed1994

New entity for conducting group practice offers new potential.

A new form of entity, the limited liability company (LLC), may be used by physicians to conduct group practices with the tax advantages of a partnership and insulation from liability for copractitioner's acts. The author reviews the New Jersey Limited Liability Company Act.

Group Practice↗
PubMed2004

Lessons from a patient partnership intervention to prevent adverse drug events.

BACKGROUND: Patient safety 'best practices' that call for patient participation to prevent adverse drug events have not been rigorously evaluated. OBJECTIVE: To consider lessons learned from a patient partnership intervention to prevent adverse drug events among medical in-patients. DESIGN: Prospective randomized, controlled pilot trial. SETTING: Boston teaching hospital. Patients. Two hundred and nine adult in-patients on a general medicine unit. INTERVENTION: Intervention patients (n = 107) received drug safety information and their medication list; controls (n = 102) received drug safety information only. Measurements. Adverse drug events and close-call drug errors were identified using chart review and incident reports from nurses, pharmacists, and physicians. Patients and clinicians were surveyed about the intervention. RESULTS: In 1053 patient-days at risk, 11 patients experienced 12 adverse drug events and 16 patients experienced 18 close calls. There was a non-significant difference between intervention patients and controls in survey responses and in the adverse drug event rate (8.4% versus 2.9%, P = 0.12) and close-call rate (7.5% versus 9.8%, P = 0.57). Eleven percent of patients were aware of drug-related mistakes during the hospitalization. Among nurse respondents, 29% indicated that at least one medication error was prevented when a patient or family member identified a problem. CONCLUSION: Partnering with in-patients to prevent adverse drug events is a promising strategy but requires further study to document its efficacy.

Adverse Drug Reaction Reporting Systems↗
PubMed1998

Financial incentives and primary care provision in Britain: do general practitioners maximise their income?

The system of remunerating general practitioners (GPs) in Britain underwent significant changes in April 1990 with the implementation of a new contract between individual GPs and health authorities. The changes were a precursor to a wide-ranging programme of reforms of the British National Health Service. This paper investigates the relationship between financial incentives and the provision of primary health care services in Britain. A comprehensive anonymized data set was used, comprising information on 208 general practices in Scotland which serve just under one million people. An econometric model was tested to identify the determinants of cross-practice variation in the magnitude of the changes in GPs' remuneration levels between the two contracts. A linear programming model was used to examine the GPs' response to the financial incentives built into the new contract. The results of the econometric model indicated that the main beneficiaries of the 1990 contract were the practices which had expanded over the 1989-92 period, re-structured the GPs' partnership and made use of managerial skills by employing a practice manager; those practices also had larger lists in 1992 and relatively more patients attracting deprivation payments. The linear programming model showed that only a small minority of the practices (4.8%) maximised the remuneration from the new contract. Optimal solutions concerning income maximization strategies identified financial disincentives in the fee structure of the remuneration system associated with the provision of selected services and the care of particular groups of patients. The successful adoption of these strategies would involve cream skimming and selective service provision. However, there is no conclusive evidence of British GPs engaging in such activities.

Age Factors↗
PubMed2002

Pursuing community-oriented primary care in a Russian closed nuclear city: the Sarov-Los Alamos community health partnership.

The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a "train the trainers" strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications.

Adolescent↗
PubMed2004

Partnership research with older people - moving towards making the rhetoric a reality.

As nursing develops closer partnerships with older people in delivering care, it also needs to develop partnerships in order to create the knowledge base for practice in a way that challenges professional hegemony and empowers older people. However, the process of developing partnerships in research takes place against a background of academic research traditions and norms, which can present obstacles to collaboration. This paper is a reflection on the issues that have arisen in three projects where older people were involved in research at different levels, from sources of data to independent researchers. It points to some of the areas that need further exploration and development.

Aged↗
PubMed2006

Recommendations for nutrition best practice in the management of gestational diabetes mellitus. Executive summary (1).

Nutrition therapy is an integral part of the management of gestational diabetes mellitus (GDM). Four leading nutrition and diabetes organizations, the Canadian Diabetes Association (CDA), Dietitians of Canada (DC), Diabète Québec (DQ), and the Ordre professionnel des diététistes du Québec (OPDQ), formed a partnership to develop evidence-based nutrition practice guidelines for the management of GDM. It was generally agreed that nutrition requirements during pregnancy are similar for women with or without diabetes. However, evidence supporting current nutrition therapy practice specific to these clients remains limited. Nutrition recommendations for the management of GDM provided here are built on the available evidence and the principles, practices and treatment goals of the Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. They identify areas where additional research is needed to support optimal nutrition therapy.

Adult↗
PubMed1989

Interinstitutional collaboration for nursing excellence: Part 2. Testing the model.

Two unrelated public institutions formed a partnership to foster excellence in professional nursing. The organizational structure was described in Part 1 (February 1989). This second article reports a 15-week pilot study conducted on seven hospital units to determine the degree to which the clinical nurse specialist can merge the multiple functions of professional nursing: practice, education, and research.

Education, Nursing↗
PubMedDate not supplied

Solo versus group practice in the medical profession: the influence of malpractice risk.

While Partnerships are a significant form of business organization in many sectors of the economy, relatively little is known about the incentives which lead to their formation. This paper explores the formation of partnerships among office based physicians when facing some risk of malpractice litigation. Theoretical results indicate that malpractice exposure can increase the incentives to shirk within a partnership, and so exert a significant influence on the decision to form a partnership. Empirical results find that malpractice risk has the expected negative effect on some partnership formation.

Appointments and Schedules↗
PubMed2006

[Study of patients with symptomatic benign prostatic hyperplasia who underwent transurethral resection of the prostate after ineffective alpha-1 blocker treatment by non-urologists].

We evaluated the clinical courses of 60 patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TUR-P) in our hospital after ineffective alpha-1 blocker treatment by non-urologists between January 2001 and September 2004. Overall severity just before TUR-P estimated by the criteria for severity in BPH was mild in 0%, moderate in 37%, and severe in 63%. Urinary retention was noted in 5 patients (8.3%). Nine patients (15.0%), four of whom had received an anti-cholinergic agent, had a residual urine volume over 200 ml. Excellent or good overall efficacy of TUR-P according to the criteria for efficacy of treatment in BPH was 86.7%. According to a questionnaire survey, only 28.9% of non-urologists in the Abashiri district had knowledge of the clinical practice guideline for BPH. We should strengthen the partnership among urologists and non-urologists to appropriately treat patients having BPH by using evidence-based information such as the clinical practice guideline.

Adrenergic alpha-Antagonists↗
PubMed2001

What does it take to collaborate with families affected by brain injury? A preliminary model.

BACKGROUND: Collaboration refers to a process in which family expertise is acknowledged and used to direct selection, implementation, and evaluation of treatment plans. Although the skills required to create collaborative partnerships with families are a mainstay of practice for certain rehabilitation disciplines, others have traditionally worked in client-clinician dyads that emphasize the role of the professional as responsible for client change. In addition, the existing collaborative models for working with families affected by brain injury require intensive resources and supports, making collaborative partnerships difficult to create within today's clinical and educational service delivery environments. RESULT: In this article, we report our efforts to create an accessible set of collaboration procedures for rehabilitation professionals working in clinical and educational settings with individuals with brain injury and their families. A 2-year, qualitative study with eight families led to the development of a preliminary model and prescriptive manual for applying collaborative principles to practice. CONCLUSION: We review the components of the model and implications for practice.

Adolescent↗
PubMed1996

Utility Terrestrial Biodiversity Issues

/ Results from a survey of power utility biologists indicate that terrestrial biodiversity is considered a major issue by only a few utilities; however, a majority believe it may be a future issue. Over half of the respondents indicated that their company is involved in some management for biodiversity, and nearly all feel that it should be a goal for resource management. Only a few utilities are funding biodiversity research, but a majority felt more research was needed. Generally, larger utilities with extensive land holdings had greater opportunities and resources for biodiversity management. Biodiversity will most likely be a concern with transmission rights-of-way construction and maintenance, endangered species issues and general land resource management, including mining reclamation and hydro relicensing commitments. Over half of the companies surveyed have established voluntary partnerships with management groups, and biodiversity is a goal in nearly all the joint projects. Endangered species management and protection, prevention of forest fragmentation, wetland protection, and habitat creation and protection are the most common partnerships involving utility companies. Common management practices and unique approaches are presented, along with details of the survey.KEY WORDS: Biodiversity; Utilities; Rights-of-way; Terrestrial; Management

Journal Article↗
PubMed2006

Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional survey.

OBJECTIVE: To determine the factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis. DESIGN: Cross-sectional survey. SETTING: National survey in the UK. PARTICIPANTS: Participants were recruited through the National Osteoporosis Society and advertisements in the press and on the radio and included 533 women over age 50 with osteoporosis who were currently taking or had taken bisphosphonate therapy within the previous 12 months. MAIN OUTCOME MEASURES: Self-reported factors influencing adherence and persistence to bisphosphonate therapy in osteoporosis: fracture history, pain, practical difficulties taking medication (frequency of dosing, dealing with comedications, impact on daily routine), perceptions of therapy, and concerns about bisphosphonate therapy. RESULTS: Adherence to bisphosphonate therapy was 48% and was associated with previous fracture [odds ratio (OR) 1.62, 95% confidence interval (CI) 1.14-3.02], concerns about medication (OR 1.49, 95% CI 1.01-2.20), and less dissatisfaction with medication (OR 0.65, 95% CI 0.44-0.97). Nonpersistence was associated with dissatisfaction with medication (hazard ratio (HR) 1.83, 95% CI 1.38-2.43), side effects (HR 3.69, 95% CI 2.74-4.97), and concerns about bisphosphonate therapy (HR 2.21, 95% CI 1.48-3.30). For both daily (HR 1.53, 95% CI 1.1-2.33) and weekly bisphosphonates (HR 1.90, 95% CI 1.17-3.07), practical difficulties taking bisphosphonate medication-in particular, too frequent dosing-were associated with nonpersistence. CONCLUSIONS: Self-reported nonadherence to daily and weekly bisphosphonates is independent of the decision to stop taking treatment (nonpersistence). Nonpersistence is associated with side effects and other factors that could be modified in clinical practice through education, information, and concordant partnerships.

Aged↗
PubMed2005

Small school-based effectiveness trials increase vegetable and fruit consumption among youth.

This article profiles a research initiative of state health agency-initiated 5 A Day school-based interventions. Four of the seven projects reviewed had significant results, with an average effect size of 0.4 servings of vegetables and fruit. Results are comparable with the larger-scale, well-controlled, and more costly 5 A Day For Better Health efficacy trials. These comparable findings underscore the value of assessing effectiveness of interventions in real-world settings to potentially enable wide-scale implementation of tested strategies. These small effectiveness trials show that school-based interventions are feasible to implement using current and effective strategies, and may facilitate translation of health promotion research to practice. The projects fostered valuable research/practice partnerships at the community level. Limitations across studies included heterogeneity in research methods, participant attrition, and variability in reporting data. Further research is needed to develop standardized, cost-effective dietary assessment methodology for viable dissemination research in community settings.

Adolescent↗
PubMed2006

Individual patient's preferences for hypertension management: a Q-methodological approach.

OBJECTIVE: To systematically explore and elicit individual patient's preferences in the management of their hypertension using Q-methodology. METHODS: Using Q-methodology, 120 patients ranking 42 statements according to their agreement or disagreement when considering appropriate hypertension management. The statements were derived from an earlier qualitative study. Factor analysis of the data was undertaken using PQMethod software to determine if any patterns were discernible. RESULTS: Ninety-two patients clustered to five factors, which all varied in the degree of involvement patients had, or wished to have, in their hypertension management. The 42 patients who loaded to factor 1 considered that appropriate antihypertensive treatment involved leaving medical decisions to their GPs and trusting their judgement in such matters. The patients (n = 31) who positively loaded to factor 2 suggested that an autonomous relationship with their healthcare professional(s) was an important issue when considering treatment. CONCLUSION: It is concluded that this study has successfully used Q-methodology to systematically investigate people's subjectivity and developed a novel approach to elicit the views of individual patients, as well as explore and differentiate between groups of patients. PRACTICE IMPLICATIONS: The formation of true partnerships between patients and healthcare professionals which will enhance individual patients' ability to self-manage chronic disease.

Adult↗
PubMedDate not supplied

Beyond tradition: synergizing intellectual and material capital to forge the new academic-service partnership.

Academic-service partnerships are being touted as a solution to workforce problems. "Traditional" approaches to these partnerships have been directed primarily at academic and hospital institutions for mutual benefit. An expanded model of partnership possibilities is presented through three detailed exemplars that include population health (with descriptors from an Institute of Medicine study addressing the public's health in the 21st century), public-private ventures (public institution with faith-based and community agencies), and nursing-corporate opportunities (academia and a proprietary information technology corporate supplier). The benefits of these expanded partnerships and the criteria for selecting a partnership sensitive to the scholarship of practice and the mission/purpose/goals of each partnering organization is highlighted.

Community Health Planning↗