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PubMed1977

Nutrition analysis of prosthodontic patients.

A program of nutrition training has been included in the undergraduate curriculum of the University of Washington School of Dentistry. Data obtained indicated that involved patients were receptive and that many showed improvement in dietary habits. Nutritional analysis and counseling can be introduced into a private-practice environment with very little increase in the dentist's work time. Procedures have been suggested that are efficient and effective. It is recommended that nutritional analysis and counseling be used routinely on all prosthodontic patients. This training should be included in the dental school curriculum so that students can become competent and comfortable in its use. To meet this objective, in-service training programs for faculty members are required. Careful attention to systemic factors such as nutrition will allow dentists to provide an enhanced level of care for patients. Concern for the general health of patients must continue to be a necessary part of prosthodontic care.

Cooperative Behavior↗

PubMed2000

A conceptual model for the development of professional behaviours in occupational therapists.

The ever-changing, dynamic practice environment coupled with increased consumer needs and awareness create an atmosphere that requires optimal professionalism from occupational therapists. Professionalism requires specific knowledge, attitudes, and values--all manifested by professional behaviours. The authors assume that professional behaviours mature through a natural developmental process; a process that requires careful nurturing on the part of educators and clinical supervisors. Based on this assumption, the authors propose this conceptual model based on Erikson's life cycle stages. The model implies that occupational therapy professional behaviours develop sequentially through stages that begin during the educational process of occupational therapists, and progress throughout their career. The purpose of this model is to provide a framework for educators and supervisors to nurture professional behaviours in students and novice clinicians, and to continue their own professional growth.

Career Mobility↗

PubMed1994

Time parameters for glaucoma procedures.

Changes in physician reimbursement and the practice environment have emphasized the importance of determining physician time for procedures and services. Forty-five percent of the members of the American Glaucoma Society responded to a mail survey of estimates of the length of time and number of visits for the preoperative, operative, and 90-day postoperative care for six common glaucoma procedures. Results suggest a significant underestimation of time for trabeculectomies exists in the original and new resource-based relative value scale work values. Further, 47% to 53% of surgeons hospitalize patients on at least the first postoperative day. There were no apparent time efficiencies between "high-" and "low-volume" respondents. Thus, careful attention should be paid to the accuracy of certain time estimates and the resulting work values in the resource-based relative value scale. Additional work in this and other areas may prove illuminating.

Glaucoma↗

PubMed2002

Trends in dental specialty education and practice, 1990-99.

Policy issues related to dental specialty education and practice have been the responsibility of the American Dental Association's Council on Dental Education and Licensure. In 2001, the council concluded a comprehensive study of the ADA-recognized dental specialties that included a review of specialty practice and the practice environment, membership in specialty organizations, requirements and trends in board certification, advances in research and technology related to each specialty, and trends in advanced specialty education. This paper provides an overview of the results of this study and the council's analysis of data and information provided by the dental specialty organizations and the ADA Survey Center with an emphasis on dental specialty education. The council concluded that none of the dental specialties should be considered for rerecognition, but identified concerns regarding the shortage of qualified faculty and educational program directors. As a result of the council's study, recommendations have been made to the dental specialty organizations and ADA-recognized dental specialty certifying boards that they continue to monitor the number of board-certified specialists and identify ways to increase the number of board-certified specialists.

American Dental Association↗

PubMed2006

A faculty's experience in changing instructional methods in a professional physical therapist education program.

BACKGROUND AND PURPOSE: In response to the demands of a changing practice environment, many physical therapist educators have incorporated problem-based learning methods into their teaching. The purpose of this study was to describe a physical therapist program faculty's experience in transitioning from traditional instruction to problem-based instructional methods. SUBJECTS AND METHODS: Face-to-face, semistructured interviews followed by a focus group were conducted with 7 faculty members, guided by questions about factors that influenced instructors' experience of changing instructional methods. RESULTS: Nine themes described the faculty's experience: perception of need for teaching change, personal knowledge of problem-based learning, decision-making process, peer support, partial adoption, values related to teaching and learning, significant response from the community, administrative support, and perceived barriers to incorporation of problem-based methods. DISCUSSION AND CONCLUSION: The findings are consistent with literature describing change: change is a process, the process of change must accommodate individual change, a network of peer support is necessary, and the change process requires leadership and support from administrators within and outside of the group.

Adaptation, Psychological↗

PubMed2005

Surgeon and community factors affecting breast cancer sentinel lymph node biopsy.

BACKGROUND: We sought to determine whether the results of sentinel lymph node (SLN) biopsy are related to practice and community factors. METHODS: This prospective study included more than 300 surgeons from a variety of practice environments. Most surgeons had minimal experience with SLN biopsy prior to this study. Patients underwent attempted SLN biopsy, followed by completion axillary dissection. Univariate and multivariate analyses were performed to assess factors related to the SLN identification rate and the false negative rate. RESULTS: A total of 4131 patients were enrolled. SLN identification rate was 93%; the false negative (FN) rate was 7.9%. The only factor that was significantly associated with improved SLN identification rate (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.12 to 2.36, P = .0126) and FN rate (OR 2.39, 95% CI 1.32 to 4.79, P = .0073) was surgeon experience (>20 SLN cases). CONCLUSIONS: Surgeon experience is the major factor that contributes to improved SLN biopsy results. SLN biopsy can be performed equally well by community and academic surgeons.

Adult↗

PubMed2003

Inpatient surgery in California: 1990-2000.

BACKGROUND: The practice environment for surgery is changing. However, little is known regarding the trends or current status of inpatient surgery at a population level. HYPOTHESIS: Inpatient surgical care has changed significantly over the last 10 years. DESIGN: Longitudinal analysis of California inpatient discharge data (January 1, 1990, through December 31, 2000). SETTING: All 503 nonfederal acute care hospitals in California. PATIENTS: All inpatients undergoing general, vascular, and cardiothoracic surgery in California from January 1, 1990, through December 31, 2000, were obtained. MAIN OUTCOME MEASURES: Volume, mean age, comorbidity profile, length of hospital stay, and in-hospital mortality were obtained for inpatient general, vascular, and cardiothoracic surgical procedures performed during the period 1990 to 2000. Rates of change and trends were evaluated for the 10-year period. RESULTS: Between January 1, 1990, and December 31, 2000, 1.64 million surgical procedures were performed. The number of surgical procedures increased 20.4%, from 135,795 in 1990 to 163,468 in 2000. Overall, patients were older and had more comorbid disease in 2000 compared with 1990. Both crude and adjusted (by type of operation) in-hospital mortality decreased from 3.9% in 1990 to 2.75% (P<.001) and 2.58% (P<.001), respectively, in 2000. Length of hospital stay decreased over the period for all operations analyzed. CONCLUSIONS: The total number of inpatient general, vascular, and cardiothoracic surgical procedures has increased over the past decade. Furthermore, our findings indicate that the outcomes of care (eg, in-hospital mortality and length of hospital stay) for patients who undergo general, vascular, and cardiothoracic surgical procedures have improved. However, continued evaluations at the population level are needed.

California↗

PubMed2006

Assessment of residents' loss of interest in academic careers and identification of correctable factors.

OBJECTIVE: To quantify interest in an academic career at the dermatology resident and residency applicant level. DESIGN: Cross-sectional survey. PARTICIPANTS: Dermatology residents attending a basic science course and residency applicants applying to a single residency program. MAIN OUTCOME MEASURES: Self-reported level of interest in an academic dermatology career, reasons for losing interest in academics, and area of desired primary academic contribution. RESULTS: One hundred nine of 230 dermatology applicants and 130 of 190 dermatology residents completed the survey. Seventy-nine applicants (72.5%) and 48 residents (36.9%) were interested in an academic career. Thirty-three of 47 residents (70.2%) and 63 of 79 applicants (79.8%) interested in an academic career hoped to make their primary academic contribution as teacher-clinicians, while only 7 residents (14.9%) and 15 applicants (19.0%) planned to primarily contribute through basic or clinical research. Thirty-eight resident respondents (29.2%) reported losing interest in academics for the following primary reasons: bureaucracy, 24 (63.2%); salary differential/financial issues, 20 (52.6%); lack of effective mentorship, role model, or professional guidance, 19 (50.0%); and location or practice environment, 10 (26.3%). CONCLUSIONS: Many residents report losing interest in pursuing a career in academic dermatology. Many reasons for this are not easy to correct. However, half of those residents primarily lose interest because of a lack of mentors, role models, and career guidance. Methods to improve this perception and experience should be sought. Strategies should also be developed to cultivate future teacher-clinicians, where most of the interest lies.

Academic Medical Centers↗

PubMed1995

Practicing with the urban underserved. A qualitative analysis of motivations, incentives, and disincentives.

OBJECTIVE: To investigate the personal characteristics and professional experiences of medical providers working with medically underserved urban populations. DESIGN: Focus groups of primary care providers. SETTING: Public and private clinics in Salt Lake City, Utah, in which the providers had ongoing relationships with medically underserved patients. PARTICIPANTS: Twenty-four providers (11 men and 13 women), including 12 physicians (three family physicians, seven pediatricians, and two psychiatrists), one dentist, three physician assistants, and eight nurse practitioners participated in three focus groups. MAIN OUTCOME MEASURE: Interpretative analysis of verbatim quotations regarding personal beliefs, feelings, and practice experiences. RESULTS: Participants revealed a strong sense of service to humanity and pride in making a difference. They thrive on the challenge of creatively dealing with their patients' complex human needs with limited health care resources. Factors critical to survival in an urban underserved setting include a hardy personality style, flexible but controllable work schedule, and multidisciplinary practice team. The camaraderie and synergy of teams generate personal support and opportunities for continuing professional development. CONCLUSIONS: Increasing the numbers of health care professionals wanting to work with the medically underserved may be facilitated through refining admissions criteria to schools for health care professionals to include values and personality characteristics, emphasizing within curricula the important skills and practice styles necessary to work with underserved patients, and ensuring that underserved practice environments provide support through multidisciplinary teams and structured work hours. These potentially effective approaches could increase success in recruiting and retaining health care professionals to work with medically underserved patients.

Adult↗

PubMedDate not supplied

Cancer early-detection services in community health centers for the underserved. A randomized controlled trial.

BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.

Aged↗

PubMed2000

The impact of clinical pathways on the practice of head and neck oncologic surgery: the University of Texas M. D. Anderson Cancer Center Experience.

OBJECTIVE: To assess the impact of clinical pathways on the practice of head and neck oncologic surgery in an academic center. DESIGN: Cross-sectional study. SETTING: Cancer treatment center. PATIENTS: The study population consisted of 3 groups of patients who underwent unilateral neck dissection and were treated in the Department of Head and Neck Surgery of the University of Texas M. D. Anderson Cancer Center, Houston. Additional procedures which may have been performed were direct laryngoscopy, rigid esophagoscopy, and/or dental extractions. Ninety-six patients treated during 1993-1994 prior to the implementation of the clinical pathway (historical control group) were compared with 94 patients treated during 1996-1998, 64 who were not (contemporaneous nonpathway group) and 30 who were managed on the clinical pathway (pathway group). Patients from 1995 were excluded since the pathway was in the planning stages then. MAIN OUTCOME MEASURES: Median length of stay; median total costs of care. RESULTS: The median length of hospital stay of the historical control, contemporaneous nonpathway, and pathway groups decreased from 4.0 to 2.0 days (P<.001). The total median costs of care were less in the pathway group as compared with the historical control group ($6,227 and $8,459, respectively, P<.001) and also less in the contemporaneous nonpathway group compared with the historical control group (S6885 and $8,459, respectively, P<.001). Mean and median length of hospital stay and costs were lower in the pathway group as compared with the nonpathway group but not significantly (P = .11 and P = .07, respectively) The contemporaneous nonpathway and pathway groups did not differ in complications or readmissions. CONCLUSIONS: Development and implementation of this clinical pathway played a statistically significant role in decreasing length of hospital stay and total costs of care associated with neck dissection between nonpathway and pathway patients. Thus, a more cost-effective practice environment has resulted for all of our patients.

Academic Medical Centers↗

PubMed1990

The intensive care unit--who's in charge? The private practice view.

In the past 10 years, a number of authors have expressed concern that surgeons are abdicating their traditional role of providing preoperative and postoperative care in surgical intensive care units. To study today's private practice environment, we took a survey. Questionnaires were sent to the chiefs of surgery and the nurse managers of the surgical intensive care units at 188 non-university-affiliated hospitals throughout the United States. Results show that surgeons do not have the principal managing role in the intensive care unit for surgical patients in 70% to 75% of the hospitals. Results also indicated that surgeons are relinquishing their responsibilities in the direct care of the preoperative and postoperative critically ill patients. Three main reasons are given for this: (1) an ever-increasing body of critical care knowledge plus complex technology, (2) a lack of economic incentive, and (3) professional liability. To reverse this trend, these three areas must be addressed.

Critical Care↗

PubMed1989

Dynamics of the marketplace: key issues, new linkages, and successful organizational models in academic CME.

Following an initial description of the marketplace for CME, the article identifies and explores six key issues for the future of academic CME: evolution of the academic health center; practice changes and reimbursement; impact of technology; regulatory influences; proliferation of CME providers; and medical school leadership. The author then turns to a discussion of new ways to link CME with practitioners--through academic health centers, within various practice environments, through technology, in the regulatory arena, and by developing relationships with competing groups and organizations. Finally, the article suggests several organizational models with potential for expanding these linkages.

Academic Medical Centers↗

PubMedDate not supplied

Job characteristics related to job satisfaction in rehabilitation nursing.

While much research is available on the job satisfaction of nurses in general, little is known about the job satisfaction of rehabilitation nurses. The purpose of this quantitative descriptive study was to identify job characteristics that are related to job satisfaction in rehabilitation nursing. The target population was rehabilitation nurses throughout the United States. The McCloskey-Muller Satisfaction Scale was used to measure three dimensions of job satisfaction: safety rewards (potential against dangerous threats), social rewards (the need to belong), and psychological rewards (autonomy, responsibility, recognition, and appreciation). Respondents rated their satisfaction with aspects of their current job by selecting a response from a 5-point Likert scale for 31 items in these three dimensions. The results suggest that rehabilitation nurses are satisfied with scheduling, extrinsic rewards, coworkers, social interactions, professional opportunities, delivery of care, praise, recognition, and responsibility. They are, however, less satisfied with child care facilities, balance between family and work, opportunities to participate in organizational decision making, control in the work setting, and career advancement. Opportunities to participate in nursing research or to write and publish neither satisfied nor dissatisfied the majority of respondents. Nursing administrators need to examine the factors that provide job satisfaction to rehabilitation nurses so as to retain capable nurses in the practice environment.

Adult↗

PubMed2004

Achieving competency in psychological assessment: directions for education and training.

This article provides an overview of issues related to the development and evaluation of competency in psychological assessment. Specifically, we delineate the goals, ideas, and directions identified by the psychological assessment work group in the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist. The psychological assessment group was charged with the tasks of: (a). identifying the core components of psychological assessment competency; (b). determining the central educational and training experiences that will aid competency development; (c). explicating strategies for evaluating competence; and (d). establishing future directions for furthering the identification, training, and evaluation of competence in psychological assessment. We present a set of eight core competencies that we deemed important for achieving psychological assessment competency and discuss four guidelines for training in the domain of psychological assessment. A variety of methods for evaluating competencies in this domain are suggested, with emphasis on using a collaborative model of evaluation. Recommendations for future directions include strengthening the academic prerequisites for graduate school training; increasing training in culturally sensitive measures; incorporating innovative assessment-related technologies into training; and addressing discontinuities between academic training, internship, and practice environments.

Competency-Based Education↗

PubMed1997

Delivering clinical preventive services is a systems problem.

A steadily increasing number of research trials and prevention advocates are identifying the practice environment as the main source of both problems and solutions to the improved delivery of clinical preventive services. Although these sources are correctly focusing on office systems as solutions, there is a tendency to focus on only parts of a system and to relate this to just one or a few related preventive services. However, the effort required to set up and maintain an office system makes it difficult to justify doing so for a single clinical activity. The process and system thinking of Continuous Quality Improvement (CQI) theory suggests that there may be both efficiency and effectiveness advantages to the concept of all clinical preventive services being served by a single system with many interrelated component processes. Such a system should be usable for all age groups. This system and its literature base are described. The feasibility of applying this concept is being tested in a randomized controlled trial in 44 primary care clinics in Minnesota and Wisconsin.

Delivery of Health Care↗

PubMed2000

New aspects of image distribution and workflow in radiology.

The progressive use of digital image-generating devices and digital communication technology in clinical and practice environments implies changes in radiological workflow and asks for adequate quality assurance in the whole process of radiology report preparation. This improvement potential has to be rigorously reinvestigated with regard to up-to-date procedures and the full exploitation of supporting technologies like linguistic analysis, help desk and trouble ticket systems, competitive allocation algorithms, time-and-event monitoring, and intelligent agents. These approaches are to be evaluated in combination with business process analysis and shall help to reduce turnaround times for radiology reports while maintaining or even increasing quality-assurance levels.

Germany↗

PubMed1981

Serum cholesterol and the aging process.

With advancing age, the average serum cholesterol level rises. Thus, older persons generally have higher cholesterol scores than do younger individuals. Quite apart, it is a generally agreed fact that older persons die more readily than younger people. Finally, there is general agreement that older persons with higher cholesterol levels die more readily, though not necessarily of cardiovascular disease, than older people without hypercholesterolemia. It then follows that, all other factors being equal, lowering hypercholesterolemia is, in fact, an expression of "making people younger". Two hundred and twenty-one routine private practice patients were studied before and after approximately two months of routine therapy including EDTA treatment and general supportive care including multivitamin-trace mineral supplementation. The evidence indicates, within the limits of this kind of study conducted in a private practice environment, that favorable changes occurred in serum cholesterol levels suggesting a possible reversal of the aging process.

Adult↗