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At least 415 records · Page 23Linked to original sources

PubMed2005

The vascular surgeon's role in risk factor modification: results of a survey.

PURPOSE: Comprehensive care of vascular patients includes attention to atherosclerotic risk factor management. We surveyed members of the Midwestern Vascular Surgical Society (MVSS) with the following objectives: (1) to determine the usual practice pattern with respect to risk factor inquiry, screening, and intervention, (2) to determine which risk factors vascular surgeons believe are important for patients with peripheral arterial disease, and (3) to determine the vascular surgeon's confidence for management of each risk factor. METHODS: A survey was mailed to all MVSS members and two additional notifications were sent for initial nonresponders. Data regarding practice environment and local resources available to each surgeon were recorded. Questions were designed to determine the prevalence of risk factor inquiry and screening, grading of the importance of each risk factor, and the vascular surgeon's confidence in the management of each risk factor. RESULTS: The survey was completed by 219 (56%) of 391 of MVSS members. The average age of the responders was 53.1 +/- 9.3 years, and 94.1% were men. Seventy-four percent of the surgeons dedicate 90% to 100% of their time to vascular surgery, and 89% dedicate more than 50%. Seventy-seven percent of responders work in a private institution and 23% in a public hospital. The surgeon's practice had a full- or part-time affiliation with a medical school in 62% and was entirely community-based in 38%. A high proportion of surgeons inquire about each risk factor, but only a minority performs the actual screening of the risk factors, with the exception of hypertension. Diabetes mellitus and smoking were believed to be very important risk factors, hypertension and lipids of moderate importance, and exercise and activity, nutrition, and homocysteine level of low importance. The surgeons' confidence in risk factor management was low to moderate for most risk factors, but high for smoking and exercise. Despite these responses, only 10% of vascular surgeons thought that they should be primarily responsible for risk factor management. CONCLUSIONS: Vascular surgeons must provide a comprehensive approach to risk factor management for their patients. This can be conducted through the establishment of multidisciplinary risk factor programs or by the surgeon in certain cases when outside resources are not available. Risk factor management must be emphasized in vascular continuing medical education programs to enable surgeons to be confident with management.

Arteriosclerosis↗

PubMed2006

Fellowship training in family medicine at Brown: adding depth to breadth.

The Brown Family Medicine fellowship programs share a common goal of nurturing the future leaders of our specialty. In a complex and demanding practice environment our fellowships have contributed to the development and propagation of an adept Family Medicine specialist. These fellowships endorse our specialty's broad approach to healthcare through addressing primary care and prevention, but also enhance the future of our field through melding the breadth of our discipline with the depth of expertise and the stewardship of responsible leadership.

Academic Medical Centers↗

PubMed1997

Collecting data on potentially harmful events: a method for monitoring incidents in general practice.

OBJECTIVE: The prediction and subsequent prevention of errors, which are an integral element of human behaviour, require an understanding of their cause. The incident monitoring technique was developed in the study of aviation errors in the Second World War and has been applied more recently in the field of anaesthetics. This pilot study represents one of the first attempts to apply the incident monitoring technique in the general practice environment. METHOD: A total of 297 GPs across Australia anonymously reported details of unintended events which harmed or could have harmed the patient. Reports were contemporaneously recorded on prepared forms which allowed a free text description of the incident, and structured responses for contributing and mitigating factors, immediate and long-term out-comes, additional costs etc. RESULTS AND DISCUSSION: The first 500 reports were analysed using both of qualitative and quantitative methods and a brief overview of results is presented. The methodological issues arising in the application of this technique to such a large, widely spread profession, in which episodes of care are not necessarily confined to a single consultation, are discussed. This study demonstrated that the incident monitoring technique can be successfully applied in general practice and that the resulting information can facilitate the identification of common factors contributing to such events and allow the development of preventive interventions.

Australia↗

PubMed1997

Constraints to advanced psychiatric-mental health nursing practice.

Constraints and barriers to advanced practice psychiatric nursing were reported by respondents of the Primary Mental Health and Advanced Practice Psychiatric Nursing survey of certified psychiatric clinical nurse specialists. Primary data (N = 507) were the qualitative responses to a survey item about constraints and secondary data were the literature and theoretical memos. Methodology was based on principles of qualitative data analysis and procedures for manifest and latent content analysis. Findings resulted in eight themes that explained both constraints and barriers to advanced practice: (1) reimbursement, (2) prescriptive authority, (3) admitting privileges, (4) bureaucracy, (5) practice environment, (6) colleagues, (7) image, and (8) personal. Themes were interpreted within the context of regulatory, market-based, and inter/intraprofessional constraints and barriers that led to suggestions for organizational and individual strategies for action. The survey was funded by the Society for Education and Research in Psychiatric-Mental Health Nursing with technical support from the Center for Mental Health Services.

Attitude to Health↗

PubMed2006

A practice-based evaluation of the handling of a new self-adhesive universal resin luting material.

OBJECTIVE: Ease of handling of materials may be considered helpful to achieving good results. The handling properties of a new self-adhesive universal resin luting material were tested in clinical use. METHOD AND MATERIAL: Thirteen practitioners were selected at random from the Product Research and Evaluation by Practitioners (PREP) Panel, a United Kingdom-based group of dental practitioners prepared to complete evaluations of new materials and techniques in the practice environment. Explanatory letters, questionnaires and packs of the luting material were sent to the evaluators. The practitioners were asked to use the material and return the questionnaire. RESULTS: 144 restorations were placed using the new self-adhesive resin luting material, which was rated higher by the evaluators for ease of use (4.7 on a visual analogue scale where 5 represented easy to use and 1 represented difficult to use) than both the pre-trial resin-based and 'conventional' luting materials (rated 3.7 and 4.4 respectively on the same scale). The presentation, instructions, convenience of dispensing and handling and viscosity also received high ratings. CONCLUSION: The new material achieved ratings for ease of use superior to the pre-study resin-based and conventional luting materials in the dental practices of 13 UK dental practitioners.

Adhesives↗

PubMed2006

Knowledge translation in developing countries.

There is increasing evidence that the application of knowledge in developing countries is failing. One reason is the woeful shortage of health workers, but as this is redressed, it is also crucial that we have an evidence base of what works to minimize the "know-do gap." The World Health Organization and other international organizations are actively building momentum to promote research to determine effective strategies for knowledge translation (KT). At this time, the evidence base for the effectiveness of those strategies is not definitive in developed countries and is relatively sparse in developing countries. It appears, however, that the effectiveness of these strategies is highly variable and dependent on the setting, and success hinges on whether the strategies have been tailored. A useful framework to provide direction for tailoring interventions is the Ottawa Model of Research Use (OMRU). Underlying OMRU is the principle that success rests with tailoring KT strategies to the salient barriers and supports found within the setting. The model recommends that barriers and supports found in the practice environment or as characteristics of potential adopters and the evidence-based innovation or research evidence be assessed and then the KT strategy tailored and executed. The model also recommends that whether the research has been applied and has resulted in improved health outcomes should be measured. Studies in developing countries, although few, illustrate that the OMRU approach may be a valid method of tackling the challenges of KT strategies to improve health care in developing countries.

Developing Countries↗

PubMed2006

Professional liability issues and practice patterns of obstetric providers in Washington State.

OBJECTIVE: To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives). METHODS: All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes. RESULTS: Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers' most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period. CONCLUSION: Liability insurance premiums rose dramatically from 2002 to 2004 for Washington's obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study's results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics. LEVEL OF EVIDENCE: III.

Adult↗

PubMed1996

Effects of market reforms on doctors and their patients.

The outcome of the competitive revolution in health care will depend critically on how it affects physicians' behavior and their interaction with patients. From the standpoint of physicians, competition often seems mediated by three influences affecting their day-to-day practice environment: the organizational phenomenon, the customer phenomenon, and the commodification phenomenon. A careful examination of these three phenomena offers reasons to believe that both the supporters and detractors of competition may be partially correct. Competitive markets may work extraordinarily well for some consumers and very poorly for others. The competitive restructuring of our health care system will accentuate the divisions and inequalities that existed in our society before the transition to a market-based health care system.

Case Management↗

PubMedDate not supplied

Health care trends, Part I. The promise and perils of evidence-based medicine ... panel discussion.

Numerous studies have demonstrated that there are wide variations in the way physicians manage similar patients. This suggests that an evidence-based approach could lead to better outcomes with less cost. But practicing evidence-based medicine requires new skills, such as using computerized databases and applying the rules of evidence to primary and integrative studies in the medical literature. The progress of evidence-based medicine will depend in large measure on how quickly these new skills can be developed and integrated into the practice environment. Here's how six experts see the promise and the perils of evidence-based medicine, now and in the new millennium. Part 2 of the panel discussion will explore the new provider team, which includes nurses and, more recently, pharmacists, who are collaborating with physicians to provide disease management and drugs therapy management services.

Cooperative Behavior↗

PubMed2004

CT in your clinical practice.

This report presents the results of a survey of 500 U.S.-based radiologists on critical issues associated with the use of CT. The survey represents a collaboration between the American Roentgen Ray Society (ARRS) and Philips Medical Systems. An outside firm, ICR/International Communications Research, conducted the survey. Survey questions were designed to elicit opinions about the past, present and future of CT, especially MDCT imaging, in various practice environments. Most radiologists (69%) indicated that CT has had a major influence on their specialty, more than any other medical advance, and that they expected this influence to increase. The idea that MDCT radically improves diagnostic quality was not universal, and opinions were mixed about the expansion of CT into new applications such as cardiac imaging. A number of concerns were attributed to the advent of MDCT and expansion in the number of slices-a phenomenon commonly referred to as a "slice war." These concerns revolved around managing the data explosion, excessive patient irradiation, bottlenecks in patient throughput, the ability of CT staffs to keep up with the rapidly evolving technology and the costs of keeping up with these changes. Nevertheless, most radiologists (78%) who were surveyed indicated that they used MDCT and that MDCT has had a positive effect on their practices in the past five years (90%); most (77%) expected that the number of slices would increase by two to 10 times the current level. Fifty-six percent said that they would be adding one to two scanners to their practices in the next five years.

Attitude of Health Personnel↗

PubMed2005

Does litigation influence medical practice? The influence of community radiologists' medical malpractice perceptions and experience on screening mammography.

PURPOSE: To assess the relationship between radiologists' perception of and experience with medical malpractice and their patient-recall rates in actual community-based clinical settings. MATERIALS AND METHODS: All study activities were approved by the institutional review boards of the involved institutions, and patient and radiologist informed consent was obtained where necessary. This study was performed in three regions of the United States (Washington, Colorado, and New Hampshire). Radiologists who routinely interpret mammograms completed a mailed survey that included questions on demographic data, practice environment, and medical malpractice. Survey responses were linked to interpretive performance for all screening mammography examinations performed between January 1, 1996, and December 31, 2001. The odds of recall were modeled by using logistic regression analysis based on generalized estimating equations that adjust for study region. RESULTS: Of 181 eligible radiologists, 139 (76.8%) returned the survey with full consent. The analysis included 124 radiologists who had interpreted a total of 557 143 screening mammograms. Approximately half (64 of 122 [52.4%]) of the radiologists reported a prior malpractice claim, with 18 (14.8%) reporting mammography-related claims. The majority (n = 51 [81.0%]) of the 63 radiologists who responded to a question regarding the degree of stress caused by a medical malpractice claim described the experience as very or extremely stressful. More than three of every four radiologists (ie, 94 [76.4%] of 123) expressed concern about the impact medical malpractice has on mammography practice, with over half (72 [58.5%] of 123) indicating that their concern moderately to greatly increased the number of their recommendations for breast biopsies. Radiologists' estimates of their future malpractice risk were substantially higher than the actual historical risk. Almost one of every three radiologists (43 of 122 [35.3%]) had considered withdrawing from mammogram interpretation because of malpractice concerns. No significant association was found between recall rates and radiologists' experiences or perceptions of medical malpractice. CONCLUSION: U.S. radiologists are extremely concerned about medical malpractice and report that this concern affects their recall rates and biopsy recommendations. However, medical malpractice experience and concerns were not associated with recall or false-positive rates. Heightened concern of almost all radiologists may be a key reason that recall rates are higher in the United States than in other countries, but this hypothesis requires further study.

Adult↗

PubMedDate not supplied

The Health Promotion-Disease Prevention Project: effect on medical students' attitudes toward practice in medically underserved areas.

BACKGROUND AND OBJECTIVES: Increasing the supply of primary care physicians who will practice in medically underserved areas is a national concern. This study examined the impact of carefully structured, preclinical, and service-oriented learning experiences in underserved areas on medical student participants' attitudes toward practice in such areas. METHODS: Pre- and post-placement assessments were conducted using a Likert-type scale to measure attitude. Data were obtained from 169 students. A descriptive/interpretational qualitative analysis of participants' final reports of their experiences was conducted to amplify statistical findings. RESULTS: Results indicated an improvement in attitude from pre-placement to post-placement. Also observed were improved perceptions of the competence of physicians, quality of care, and practice environment in underserved areas, along with an improvement in the students' levels of comfort working with underserved patients. CONCLUSIONS: The study findings provide some evidence that supports recommendations for reform of undergraduate medical education to promote primary care specialties and to improve access to health care services for the underserved. These recommendations include early exposure to primary care, opportunities to identify primary care role models, service to the community, introduction to community-oriented primary care skills, and community-based experience.

Attitude of Health Personnel↗

PubMed2007

The Family Medicine Curriculum Resource Project: implications for faculty development.

Faculty development implications related to implementing the Family Medicine Curriculum Resource (FMCR) Project provide an opportunity to look at the recommendations of the Society of Teachers of Family Medicine's federally funded Faculty Futures Initiative (FFI) and the recent Future of Family Medicine (FFM) project. Implications for faculty development include the importance of the clerkship setting, originally defined in 1991, with new features added in today's practice environment as outlined by the FFM and the changing assumptions in approaching faculty development. Previously, faculty development focused on teaching learners to master current knowledge. Now, faculty must teach learners how to master new competencies throughout their lives; learners need to learn how they and others learn now. Teaching must focus on how to learn in the future as well as what to learn for the present. Competence ("what individuals know or are able to do in terms of knowledge, skills, and attitudes") has become the focus of curriculum development efforts over the last few years and most appropriately serves as the focus of curriculum development in the FMCR Project. Implications for developing teachers and preceptors focus on the skills and circumstances required to teach and evaluate all types (cognitive, metacognitive, and affective) of competence. In the new culture, novel teaching methods will serve as the focus of faculty development in teaching and of educational ("best practices") research.

Clinical Clerkship↗

PubMed2006

Nurse intention to remain employed: understanding and strengthening determinants.

AIM: This paper reports a study testing a hypothesized model of the determinants of nurse intention to remain employed in current hospitals of employment. BACKGROUND: Previous research has shown that stronger nurse intention to remain employed is associated with higher job satisfaction, higher organizational commitment, higher perceived manager support, lower burnout, higher work group cohesion, being older, having more years of nursing experience and having lower levels of education. METHODS: A descriptive survey design was adopted. Over 13,000 Ontario, Canada nurses were invited to complete a mailed survey between February and May 2003. The Ontario Nurse Survey includes instruments and items measuring job satisfaction, burnout, professional nursing practice environment, demographic characteristics of nurse respondents and items about intention to remain employed. Two multiple regression models, one including all variables and the other using a stepwise method, were used to test the proposed model. RESULTS: Regression models explained 34% of variance in nurse intention to remain employed. The strongest predictors were nurse age, overall nurse job satisfaction and years of employment in the current hospital. Although the proposed model hypothesized six categories of predictors of intention to remain employed, only four of these were statistically significant determinants of nurse intention to remain: job satisfaction, personal characteristics of nurses, work group cohesion and collaboration, and organizational commitment of nurses. The other two categories of predictors, nurse burnout and nurse manager ability and support, may be predictors of job satisfaction and have indirect effects on intention to remain employed that are mediated through job satisfaction. CONCLUSION: Possible strategies to strengthen predictors of intention to remain employed include employment practices that reflect moral integrity, incorporate clear communication systems, maximize employee involvement in decision-making, promote praise and recognition, and establish a shared vision and goals.

Adult↗

PubMed1997

The globalization of behavioral science evidence about battered women: a theory of production and diffusion.

A theoretical framework is proposed for understanding how the innovative use of behavioral science evidence is both produced and diffused among members of the global legal community. Using case law analyses and interviews with key individuals involved in selected cases, we examine how battered woman syndrome (BWS) is produced and diffused between and among Australia, Canada, England, and the United States. The following diffusion mechanisms are proposed: (1) The availability and accessibility of credible dissemination sources; (2) characteristics of the overall practice environment operating in each legal culture; (3) the attitudes and knowledge of attorneys and judges about the use of scientific evidence; (4) political and social support for the use of the evidence in the legal culture; and (5) the level of structural equivalence, communication, and "neighbor effects" between and among legal cultures. Each mechanism is discussed and supplemented with information from interviews with individuals involved in key cases involving BWS evidence.

Australia↗

PubMed2005

Antineoplastic agent workplace contamination study: the Alberta Cancer Board Pharmacy perspective.

STUDY OBJECTIVE: To investigate the feasibility of routine monitoring for workplace antineoplastic agent contamination in the Alberta Cancer Board (ACB) pharmacy practice environment. SETTING: The ACB in the Canadian province of Alberta, which includes two public tertiary centres and 17 associated community satellite sites based around the province in existing hospitals. METHODS: Obtained organizational support and input prior to launching the feasibility study (Phase I). Samples were analysed for a common cytotoxic agent - cyclophosphamide. Surfaces chosen were within the biological safety cabinets, workplace counter tops and on external surfaces of vials provided by manufacturers. Blank samples and known contaminated controls were included in Phase I to reconfirm the methodology in a previously published study. Feasibility aspects of logistics and financial expenses were examined. A second phase (Phase II) was completed to test other areas of the pharmacy and vials, with blank samples included to reconfirm previously mentioned methodology. RESULTS: The results determined that the samples tested were below acceptable detection limits with the exception of the known contaminated sample (Phase I) and exterior surfaces of vials (Phase II). CONCLUSION: This project has increased staff awareness of the sources for antineoplastic agent workplace contamination. Some practice changes were instituted during the project itself. Logistics and expenses were realistic for routine monitoring to be adopted.

Alberta↗

PubMed2005

Accurate dosimetry: an essential step towards good clinical practice in nuclear medicine.

In nuclear medicine, an increasing number of radiolabelled agents are under investigation for future use in diagnostic imaging and for applications in radionuclide therapy. All these studies require large amounts of human data to allow for statistical comparisons with existing and well established diagnostic or therapeutic methodologies. In the framework of a good clinical practice environment, clinical trials should be carried out according to international guidelines and regulations as described in the Declaration of Helsinki. Studies involving ionizing radiation, as is the case in nuclear medicine, require special consideration to comply with the ALARA (as low as reasonably achievable) principle. Special publications of the International Commission of Radiological Protection and the World Health Organization deal with this topic in medical research. From the legislation point of view, the 97/43/EURATOM Directive represents the reference to clinical research using ionizing radiation within the European Union. In order to keep the radiation dose of (healthy) volunteers as low as possible, predictive dosimetry studies based on in-vivo animal biokinetics are essential. On the other hand, patients included in dose-escalation radionuclide therapy trials should be monitored individually with respect to dosimetry of the tumour and the critical organs. In this paper the importance and methodology of contemporary patient dosimetry in diagnostic and therapeutic nuclear medicine research are reviewed. It is concluded that reliable dosimetry is essential in performing scientific clinical studies according to the principle of good clinical practice.

Biomedical Research↗

PubMed1986

'There's a lot of it about': clinical strategies in family practice.

Is there a difference in the way family physicians and specialists deal with clinical problems? Family physicians, in contrast to specialists, work in a practice environment in which there is a high prevalence of symptomatic discomfort, but a low prevalence of frank disease. These circumstances result in clinical strategies that are very different to those used in secondary and tertiary levels of care, and which run counter to what are usually accepted as medical norms. The primary care physician must often diagnose what things are not, rather than what they are, must make management decisions prior to, or instead of, diagnostic decisions and must resist the temptation to be ;thorough' These imperatives are reflected in the language family physicians sometimes use in their conversations with patients. Clinical reasoning in primary care involves important but poorly understood intellectual processes which may be of significance to all levels of medicine.

Family Practice↗