SEARCH · PubMed Health

Results for “Previous Practice”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources

PubMedDate not supplied

The use of AAP-recommended disciplinary practice guidelines among African American caregivers of children in Head Start programs.

OBJECTIVE: The American Academy of Pediatrics (AAP) recommends that parents not use harsh disciplinary practices. Previous studies have characterized the disciplinary practices of African American parents as harsh, with reliance on more aggressive techniques not currently recommended by the AAP. However, recent research has indicated more disciplinary practice diversity among African Americans. This study describes factors associated with the use of AAP-recommended disciplinary practices among lower-income African American caregivers of children in Head Start. METHODS: Subjects were caregivers of children at three Head Start sites. Participants were eligible for inclusion if the biological mother, biological father, or target child was identified as African American. Using consensus methods, responses to the Parental Discipline Methods Interview (PDMI) were described as consistent or inconsistent with AAP guidelines regarding use of negative disciplinary practices (e.g., spanking, yelling). Caregivers avoiding any of these inconsistent methods were referred to as "adherent." RESULTS: "Adherent" caregivers were older (32.5 years vs. 30.4 years) and had more education (86.0% vs. 75.4% high school graduates). They were also less likely to report that their child had behavioral problems (12.9% vs. 25.2%) or deficient social skills (1.7% vs. 8.0%). CONCLUSIONS: Lower-income African American caregivers were more likely to use disciplinary practices consistent with AAP guidelines if they had higher levels of education and were living in an urban setting. Caregivers describing their child as having fewer behavior problems, better social skills, or themselves as less stressed were also more likely to be "adherent."

Adult↗

PubMed2005

Adaptation to visuomotor rotations remaps movement vectors, not final positions.

When exposed to novel visuomotor rotations, subjects readily adapt reaching movements, such that the virtual display of the hand is brought to the target. Whereas this clearly reflects remapping of the relationship between hand movements and the visual display, the nature of this remapping is not well understood. We now examine whether such adaptation results in remapping of the position of the visually displayed target and the final limb position or between the target vector and the movement vector. The latter is defined relative to a starting position, whereas the former should be independent of the starting position. Subjects first adapted to a 30 degrees rotation during reaching movements made from a single starting location to four different target locations. After adaptation, generalization trials were introduced, during which reaching movements were made under the same visual rotation condition but started from one of two locations outside the practiced workspace. These trials were directed to either the previously practiced targets or new targets that reflected the direction and distance of the practiced trials. Generalization was greatest for movements made in similar directions, regardless of changes in spatial location. Most significantly, when reaching to the previously adapted targets, subjects did not reach to the previously learned limb positions but rather to positions that reflected a near 30 degrees rotation of the new target vector. These results indicate that learned visuomotor rotations remap the representations of movement vectors and not final positions of the limb in the workspace.

Acclimatization↗

PubMedDate not supplied

Establishing a rural family practice research network.

One approach to addressing the deficit in the primary care knowledge base is to answer clinical questions using a consortium of collaborating practices. Previous reports have described networks that collect descriptive data from many practices, but there are difficulties in establishing and managing large networks. Accordingly, smaller networks may be more valuable in some settings and for some clinical questions. At the University of Missouri, we have developed a research network composed of four rural family practices and a group of study coordinators. Research topics have been chosen, study methods devised, funding obtained, and valuable data collected. Although logistical problems with any diverse network are formidable, a structured approach with careful communication can overcome these difficulties. The lessons from this experience combined with those of larger primary care networks should assist others in implementing research consortiums. Collaborative research by family physicians is practical, feasible, personally and professionally rewarding, and likely to contribute important primary care knowledge.

Family Practice↗

PubMed2005

Learning to detect error in movement timing using physical and observational practice.

Three experiments assessed the possibility that a physical practice participant's ability to render appropriate movement timing estimates may be hindered compared to those who merely observed. Results from these experiments revealed that observers and physical practice participants executed and estimated the overall durations of movement sequences similarly and more accurately than those who were not privy to any previous practice. This was true for a case in which (a) the execution demands for the physical practice participant were relatively high when multiple movement sequences were practiced with a consistent relative time structure but different overall durations (Experiment 1) and (b) the execution demands were relatively modest when only a single sequential motor task was learned (Experiment 2). Moreover, this general set of findings remained true for individuals who had previous experience with physical or observational practice, even when timing estimations were made during tests with no execution demands (Experiment 3). Thus, executing a movement sequence does not appear to interfere with the development of a learner's subjective evaluation of overall timing performance. Specifically, these data provided evidence that recognizing error in movement timing can be accomplished via observation, and, more generally, they add to the growing evidence supporting the claim that observational practice is a legitimate method facilitating the acquisition of sequential movement behaviors.

Humans↗

PubMed2006

High latent drug administration error rates associated with the introduction of the international colour coding syringe labelling system.

BACKGROUND AND OBJECTIVES: The potential for increased drug administration errors during the transition to the International Colour Coding syringe labelling system has been highlighted. The purpose of this study was to assess the potential effects before their introduction into our department. METHODS: Thirty-one anaesthetists, 19 with no previous practical experience of the new labelling system (Group 1), and 12 with previous experience (Group 2), volunteered to induce general anaesthesia for a standardized simulated patient in a designated theatre. They were presented with a scenario designed to suggest the need for a rapid sequence induction and provided with drug syringes labelled with the International Colour Coding system. All drug administrations were recorded. Active error was defined as the injection of the wrong drug. Latent error was defined as the selection of a syringe in error but stopping short of administering the drug. RESULTS: In Group 1 a total of 107 drug injections were recorded of which 1 (0.9%) was an active error and 16 (15%) involved latent errors. Eleven anaesthetists (58%) performed at least one latent error. Group 2 had an error rate of 3%, a 6.9 (1.3-26.7) fold reduction in the rate of error (P = 0.023). CONCLUSIONS: Although only one drug was given in active error, latent errors occurred in 15% of drug administrations. The only factor conferring protection against error was prior experience of the new labelling system. The period of transition to the International Colour Coding syringe labelling system represents a time of increased risk of drug administration error.

Adult↗

PubMed2001

Pre-registration house officer rotations incorporating general practice: does the order of rotation matter?

CONTEXT: In relation to pre-registration house officer (PRHO) rotations incorporating general practice, previous research has recommended that where possible, no PRHO should undertake general practice as the first placement, because of the difficulties encountered. It was recognized that logistically, this could make such schemes almost unworkable. Within the context of a larger qualitative evaluation comparing how 24 PRHOs learned in hospital and general practice settings, the issue of rotation order was explored. METHODS: In-depth semistructured interviews were conducted with the 12 PRHOs who were involved in general practice rotations. They were interviewed at the beginning and end of the PRHO year, and following their return to hospital work after the general practice placement. RESULTS: Each rotation order had both advantages and disadvantages, with no particular rotation order being obviously better or worse for the PRHOs involved. CONCLUSIONS: This small qualitative evaluation has highlighted a number of advantages and disadvantages specific to each rotation order, and makes some practical recommendations to help alleviate the problems encountered. It is important that future evaluations of similar schemes consider this issue, as there are conflicting reports about the significance of the rotation order.

Attitude of Health Personnel↗

PubMed2003

A cohort study of family practice residency graduates in a predominantly rural state: initial practice site selection and trajectories of practice movement.

Limited information is available on long-term patterns of practice location choice among family physicians, although these patterns will significantly affect the quantity, quality, and continuity of health care provided in rural areas. From 1992 through 2000, five biennial surveys were administered to graduates of three family practice residency programs. Graduates were asked the location of their current and previous practice site locations, specific practice information, and global satisfaction with family practice. Identifiable practice sites were assigned a U.S. Department of Agriculture rural-urban continuum code based on the county in which the practice was located. The use of rural-urban continuum codes as a measure of rurality was believed to be particularly applicable to the small rural and frontier counties typical of the Great Plains region. For purposes of this study, practice locations were considered rural if they were in rural-urban continuum codes 7, 8, or 9. Of 593 graduates, 514 (87%) returned at least one questionnaire. Overall, about one-third of graduates had chosen their first practice sites in counties with rural-urban continuum codes of 7, 8, or 9. While most graduates remained in their initial practice site, almost half moved at least once. Those who left nonmetropolitan practices tended to move to less rural locations, though a few moved against this gradient. Moves away from the initial practice site occurred after a median of 3 years, and the likelihood of a first move decreased rapidly 5 to 6 years after graduation. Much remains to be learned about decisions to enter or leave practice in rural-urban continuum code 7, 8, and 9 counties.

Career Mobility↗

PubMed1997

The completeness and accuracy of patient record transfer between practices.

OBJECTIVES: In addition to the paper record, most general practitioners now use a parallel electronic record system on their practice computer. When a patient changes practice at present, the written records are transferred from the patient's previous practice to the next. An up to date computer generated summary or print out should also be sent. Our aim was determine the completeness and accuracy of this process of patient record transfer. DESIGN: A survey of an opportunistic sample of one hundred patient records in transit between general practices during a single week. Accuracy of information transferred was assessed by examining the records. Further analysis of discrepancies was conducted by one of the authors (FS) to assess their clinical significance. SETTING: September 1995, primary care department of Lanarkshire Health Board. RESULTS: Only 46% of practices transfer the complete record compared to the 85% of practices with computers which would have been expected to do so. Even in those which transferred a paper copy of the electronic record, a total of 51% showed discrepancies between the computer and manual format in recording of some or all of the following: diagnoses, prescribing data and the results of investigations. CONCLUSION: Practices should ensure all relevant data is transferred when a patient moves from one practice to another. The current arrangements do not ensure that this occurs.

Continuity of Patient Care↗

PubMed1998

Survey of research activity, training needs, departmental support, and career intentions of junior academic general practitioners.

BACKGROUND: Recent changes in the organization of the National Health Service have created new roles and responsibilities for academic general practice. Previous work on the constraints and opportunities of a career in academic general practice is largely anecdotal and is often based on the views of more senior members of the profession. AIM: To survey the research activity, perceived level of training, support needs, and career intentions of junior academic general practitioners (GPs). METHOD: A postal, validated, semistructured questionnaire was sent to the 121 eligible junior academic GPs in the academic departments of general practice in the United Kingdom and Dublin. Main outcome measures were 'research activity score', as measured by publications in peer-reviewed journals and involvement in research projects, 'training score' devised from 13 skills required for both research and teaching, and perceived level of departmental support assessed by six different support mechanisms. RESULTS: Response rate was 89% (n = 108). Forty-six responders (43%) had no publications. Twenty-five responders (23%) had no principal project. Thirty-nine responders (37%) had a mentor. Research activity appeared to be dependent on sex, having a predominantly research role rather than a full-time teaching role, and a positive perception of academic training (P < 0.05). Increasing departmental 'support scores' and length of time in the department were both significantly associated with more positive perceptions of academic training (P < 0.05). Only 29 (27%) responders wanted to progress to senior positions within academic general practice. CONCLUSION: Training and departmental support and guidance available to junior academics in primary care are perceived as variable and often inadequate. If academic general practice is to thrive, improved academic training is required, such as taught Master's degrees, supervised personal projects or 'apprenticeship' as a co-investigator, and improved methods of departmental support.

Career Choice↗

PubMed2006

Learning of similar complex movement sequences: proactive and retroactive effects on learning.

The authors used an interference paradigm to determine the extent to which the learning of 2 similar movement sequences influences the learning of each other. Participants (N=30) produced the sequences by moving a lever with their right arm and hand to sequentially presented target locations. They practiced 2 similar 16-element movement sequences (S1 and S2), 1 sequence on each of 2 consecutive days of practice. Control groups received only 1 day of practice on 1 of the sequences. Early in S2 practice, the experimental group demonstrated a relatively strong level of proactive facilitation arising from previous practice with S1. The advantage was not evident at the end of S2 practice or on the S2 retention test. No advantage of practicing the 1st sequence on the learning of the 2nd sequence (proactive effect) was found in the analysis of element duration in the retention and transfer tests, even though 14 of the 16 elements were common to both sequences. A strong retroactive interference on the switched elements was detected, however. Thus, the memories underpinning S1 seemed to be "overwritten" or adapted in response to the learning of S2.

Humans↗

PubMed1977

Profile of full-time family practice educators.

This paper presents the first study of characteristics of full-time family practice educators in the United States. The majority of family practice educators entered the teaching field within the 1972 to 1975 time period, having done so after a period of ten to 20 years in the private practice of family medicine. Group practice (124) marginally outnumbered solo practice (102) with internal medicine and pediatrics representing the greatest percentage of patient care in all previous practice settings. A large majority of family practice educators have had two years of graduate training and are diplomates of the American Board of Family Practice. The respondents expressed a high degree of personal and professional satisfaction in their present positions, but many desired continuation of personal patient contact.

Adult↗

PubMed2005

Audio computer assisted interviewing to measure HIV risk behaviours in a clinic population.

OBJECTIVES: To examine whether audio computer assisted survey interviewing (ACASI) influenced responses to sensitive HIV risk behaviour questions, relative to interviewer administration of those questions (IAQ), among patients attending a sexually transmitted infection (STI) clinic and whether the impact of interview mode on reporting of risk behaviours was homogeneous across subgroups of patients (defined by age, sex, and previous STI clinic experience). METHODS: 1350 clinic patients were assigned to complete a detailed behavioural survey on sexual risk practices, previous STIs and symptoms, condom use, and drug and alcohol use using either ACASI or IAQ. RESULTS: Respondents assigned to ACASI were more likely to report recent risk behaviours such as sex without a condom in the past 24 hours (adjusted OR = 1.9), anal sex (adjusted OR = 2.0), and one or more new partners in the past 6 months (adjusted OR = 1.5) compared to those interviewed by IAQ. The impact of ACASI varied by sex but, contrary to expectations, not by whether the patient had previously visited an STI clinic. Mode of survey administration made little difference within this population in reports of STI knowledge, previous STIs, STI symptoms, or illicit drug use. CONCLUSION: ACASI provides a useful tool for improving the quality of behavioural data in clinical environments.

Adolescent↗

PubMedDate not supplied

The effects of maternal diabetes on the fetus and neonate.

The outlook for the fetus and infant of the diabetic mother has changed remarkably over the past 70 years. Following the discovery of insulin in 1922, young diabetic women who were previously practically infertile, were introduced to the option of conceiving and bearing children. Pregnancy-related maternal mortality, which had previously been extremely high in this group of patients, fell dramatically after the advent of exogenous insulin. Nevertheless, perinatal morbidity and mortality remained unacceptably high. Over the past 20 years, there has been growing understanding of the pathophysiology of the diabetic pregnancy, development of specialized health care centers for pregnant diabetic women, and remarkable improvements in neonatal care. All these have conjointly resulted in a markedly improved prognosis for the infant of the diabetic mother. Despite these optimistic undertones, it is prudent to bear in mind that these unborn infants developing in the sweet maternal environment are set out for a bitter struggle against some rather unfavorable odds.

Female↗

PubMedDate not supplied

Self-care practices in women with diastolic heart failure.

BACKGROUND: For many patients with heart failure (HF), performing self-care is complicated by the complex medication regimen, symptom monitoring, and required decision-making. Women with HF are typically older and more physically debilitated, have more comorbidities, and may be at higher risk for poor self-care practices. Previous studies have largely excluded patients with diastolic heart failure (DHF), however, so little is known about their self-care practices. OBJECTIVES: The purposes of the study were to describe the (a) performance of self-care behaviors and (b) demographic and clinical characteristics that affected self-care practices in women with DHF. METHODS: Thirty-two women who were 50 years of age or older and diagnosed with DHF were recruited through cardiologist referral from an outpatient HF clinic in an academic health care setting. Data were collected using a semistructured interview guide. Descriptive statistics were used to analyze participant demographic and clinical characteristics. The responses were tabulated in order of frequency and then coded into categories. RESULTS: The mean age of the women was 68 +/- 11 years; 81% had annual incomes at or below the poverty level, 41% lived alone, and the majority had three or more comorbidities. Although most perceived their HF knowledge to be fair to good, and 62% had received HF educational information, only six (19%) weighed daily, few followed the recommended sodium restrictions, and 91% were sedentary at the time of the interview. The only self-care behavior that was consistently practiced (72%) was taking prescribed medications. Exertional intolerance often interfered with household chores and was cited most often as the reason for poorer quality of life. Decision-making about self-care activities such as taking diuretics was typically based on daily plans and social outings. Medical attention was sought only when acute or life-threatening symptoms occurred. Few women actively participated in ongoing symptom monitoring, and confusion over symptom recognition was a recurrent problem. CONCLUSIONS: Lower socioeconomic status and advancing age increase vulnerability for poor self-care and negative clinical outcomes in women with DHF. Recommendations to improve self-care practices among economically disadvantaged women with HF such as prescribing routine activities as exercise, screening for depression, and home visits to increase socialization are discussed along with areas for future research.

Aged↗

PubMed1999

New methods of seafarer's training: an internet "refresher course on first-aid and medical care on board".

Our objective is to facilitate seamen's health education, according to the recommendations of international organisations like IMO (STCW 1995) and EC (Directive 92/29): They recommend a refresher course on first-aid at least every 5 years for persons in charge of medical care on board. In Spain the transposition of this Directive was published (RD 258/99). So, we thought that in order to help seafarers and officers in their training in prevention and in solving health problems derived from their occupational risks on board, continuing education could be implemented using an innovative and adaptable tool. No first-aid course can be useful without practical exercises. The term "refresher" (in this paper) is a way of reminding what people have learnt and practised in a previous practical course. In 1998, the Spanish Society of Maritime Medicine promoted a pilot internet refresher course for seafarers in its web, URL: "http://www.semm.org/curso/pauxm.html++ +". There are 10 didactic units (resources for medical assistance on board, radio-medical advice, environmental problems, travel medicine, cardio-respiratory resuscitation, prevention of problems in diving, death on board, occupational risk prevention ... etc.). Hypertext linked keywords help the student to revise the subject, a teacher can counsel him by e-mail and a multiple choice test, and clinical cases are included to check the comprehension of the didactic units. A CD and an English version of the course is being prepared.

First Aid↗

PubMed2003

Evaluation of cultural competence and antiracism training in child health services.

AIMS: To evaluate the acceptability and effectiveness of cultural competence and antiracism training to professionals providing services to ill or disabled children. METHODS: Immediate post-training and retrospective questionnaire survey of trainees. Main outcome measures were acceptability; perceived relevance to practice; previous training in this area; perceived impact on professionals' confidence in providing care to diverse communities; and reported changes in behaviour and practice. RESULTS: Cultural competence and antiracism training has been neglected in the health sector but is well received by professionals. It is a positive experience for trainees and perceived to be relevant to their practice. Appropriate and non-threatening training in cultural competence changes attitudes, behaviours, and practice, including promoting good practice in communication across linguistic and cultural differences. CONCLUSIONS: Appropriate cultural competence and antiracism training is both effective and acceptable in child health services.

Attitude of Health Personnel↗

PubMedDate not supplied

The current status of psychotherapy.

Psychotherapy has a long history but its practice has always been strewn with controversy. In this review, the current status of psychotherapy is examined by setting its development in historical perspective. While previous practice was often based on the pronouncements of "masters", current approaches are almost always embedded in both rigorous theoretical formulations and frequently also in empirically derived data on efficacy. A fundamental understanding about the mechanisms of action of psychotherapy is a promising new development that is emanating from modern techniques of neurosciences and neuroimaging. Whether such understanding will lead to a renaissance in the clinical utility of psychotherapy is still early to say. However, there is little doubt that the provision of a holistic care for patients with psychological and mental disorders in particular, and most physical conditions in general, should be informed by an appreciation of the bi-directional nature of the relationship between the mind and the body and should therefore include the provision of appropriate psychotherapeutic interventions.

Empiricism↗

PubMed2004

Practices of vitamin D recommendation in Las Vegas, Nevada.

Reports of vitamin D deficiency rickets, although rare in the United States, have increased over the past few years, including in children living in climates with abundant sunshine. The purpose of this study was to describe vitamin D recommendation practices among pediatric health care providers in Las Vegas, Nevada. Of the 155 providers surveyed, 52.3% did not recommend vitamin D for exclusively breastfed babies. Providers who were more likely to recommend supplementation were doctors of medicine, were female, specialized in pediatrics, were of Hispanic ethnicity, had previously practiced and trained in states less sunny than Nevada, had graduated from training 21 or more years previously, had taken histories of infants' sun exposure, and had clinical experience with cases of rickets. Providers demonstrated a knowledge deficitforquestions that dealt with preventive measures.

Clinical Competence↗