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PubMed2001

Nutritional practices of male and female endurance cyclists.

The nutritional requirements of the training and competition programmes of elite endurance cyclists are challenging. Notwithstanding the limitations of dietary survey techniques, studies of high-level male road cyclists provide important information about nutrient intake and food practices during training and major stage races. Typically, male cyclists undertaking intensive training programmes report a high energy intake (> or = 250 kJ/kg/day) and carbohydrate (CHO) intakes of 8 to 11 g/kg/day. Intakes of protein and micronutrients are likely to meet Recommended Dietary Intake levels, because of high energy intakes. Data on female cyclists are scarce. Stage racing poses an increased requirement for energy and CHO, with daily energy expenditure often exceeding 25 MJ. This must be achieved in the face of practical constraints on the time available for eating, and the suppression of appetite after exhausting exercise. However, studies show that male cyclists riding for professional teams appear to meet these challenges, with the assistance of their medical/scientific support crews. Current dietary practices during cycle tours appear to favour greater reliance on pre-stage intake and post-stage recovery meals to achieve nutritional goals. Recent reports suggest that current riding tactics interfere with previous practices of consuming substantial amounts of fluid and CHO while cycling. Further study is needed to confirm these practices, and to investigate whether these or other dietary strategies produce optimal cycling performance. Other issues that should receive attention include dietary practices of female cyclists, beliefs and practices regarding bodyweight control among cyclists, and the use of supplements and sports foods.

Bicycling↗

PubMed1998

Why doctors would stay in rural practice in the New England health area of New South Wales.

Retention of rural doctors is a critical factor in effectively addressing the well-documented maldistribution of the medical workforce. The present study explores the reasons why rural doctors working in north-western New South Wales left their previous practice, moved to their current practice and have considered moving to another practice. In addition, these doctors were also asked as to the most effective strategies in retaining rural doctors and which organisations could make a valuable contribution in making rural general practice more attractive. As the doctor's choices concerning their practice locations involve judgements relating to a complex array of factors, there are a great number of priority actions involving many stakeholders that can impact positively on the retention of rural doctors. In addition to strictly professional issues, such as access to hospitals, a reasonable work load and a good level of procedural work, other issues, such as the availability of good social and cultural facilities, work opportunities for one's partner and good educational facilities for one's children, have a great bearing on the doctor's decision where to practise. Put differently, while the professional environment needs to be conducive to good rural practice, rural doctors are also human beings, requiring appropriate facilities to meet their 'quality of life' needs.

Attitude of Health Personnel↗

PubMed1995

Conception, commitment, and health behavior practices in medically high-risk pregnant women.

Based on cognitive dissonance and related theories of commitment, this study tested hypotheses that planning pregnancy and number of months spent trying to conceive would be associated with better prenatal health behaviors and that commitment to pregnancy and motherhood would mediate these associations. Participants (N = 96) were pregnant women at high medical risk for an adverse birth outcome. As predicted, planning pregnancy predicted better prenatal health care practices, and this effect was mediated by commitment level. Among women who planned their pregnancy, longer time to conceive predicted higher commitment but did not influence prenatal health behaviors directly. Women who had given birth previously practiced fewer prenatal health behaviors. Commitment, however, remained the strongest predictor of prenatal health care practices. Results are consistent with theories of commitment and with prominent approaches to the study of health behavior.

Adult↗

PubMed2004

Implementing intensive insulin therapy: development and audit of the Bath insulin protocol.

Intensive insulin therapy to control blood glucose has been found to reduce mortality among critically ill patients in a surgical intensive care unit, though a simple prescriptive insulin infusion protocol to achieve this has not been published previously. This study documents the development and routine use of a simple prescriptive intravenous insulin infusion protocol for critically ill patients and compares the results with previous practice. During development the protocol was optimized and practical issues of implementation addressed. The optimized protocol was then used for all ICU admissions, and a prospectively defined retrospective chart audit performed for the first month of use. Results were compared with a similar time period the previous year. In September 2002, 27 admissions were started on the protocol. Blood glucose for the time on the protocol had a median value of 6.2 (IQR 5.9-7.1) mmol/l compared with 9.2 (IQR 8.1-10.2) mmol/l for those on insulin in 2001. Blood glucose for the whole ICU stay for those on the protocol in 2002 had a median value of 6.6 (IQR 6.0-7.4) mmol/l compared with 8.6 (IQR 8.0-9.4) mmol/l in 2001. Blood glucose for all ICU patients in 2002 had a median value of 6.5 (IQR 6.0-7.3) mmol/l compared with 7.2 (IQR 6.3-8.3) mmol/l in 2001. Three blood glucose recordings were less than 2.2 mmol/l in September 2002. This study provides initial effectiveness and safety data for the Bath Insulin Protocol Further audits in a larger patient population are now needed.

Blood Glucose↗

PubMed2004

Can practice overcome age-related differences in the psychological refractory period effect?

Can dual-task practice remove age-related differences in the psychological refractory period (PRP) effect? To answer this question, younger and older individuals practiced 7 blocks of a PRP design, in which Task 1 (T1) required a vocal response to an auditory stimulus and Task 2 (T2) required a manual response to a visual stimulus (Experiment 1). The results showed that practice did not reduce, but rather increased, age-related differences in PRP interference. Using the trained individuals, the introduction of a less complex new T1 (Experiment 2) or a less complex new T2 (Experiment 3) with the task previously practiced reduced the PRP interference but only in older adults. The authors propose that older adults suffer from a large task-switch cost that is more sensitive to task complexity than to the amount of practice.

Adolescent↗

PubMed2002

Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study.

OBJECTIVES: The goal of this study was to develop a psychometric instrument that classified physiciansamprsquo response styles to new information as seekers, receptives, traditionalists, or pragmatists. This classification was based on specific combinations of 3 scales: (a) belief in evidence vs experience as the basis of knowledge, (b) willingness to diverge from common or previous practice, and (c) sensitivity to pragmatic concerns of practice. The instrument will help focus efforts to change practice more accurately. STUDY DESIGN: This was a cross-sectional study of physician responses to a psychometric instrument. Paper-and-pencil survey forms were distributed to 3 waves of physicians, with revision for improved internal consistency at each iteration. POPULATION: Participants were 1393 primary care physicians at continuing education events in the Midwest or at primary care clinic sites in the Veteransamprsquo Health Administration system. OUTCOMES MEASURED: Internal consistency was measured by factor analysis with orthogonal rotation and Cronbachamprsquos alpha. RESULTS: A total of 1287 usable instruments were returned (106, 1120, and 61 in the 3 iterations, respectively), representing approximately three fourths of distributed forms. Final scale internal consistencies were a = 0.79, b = 0.74, and c = 0.68. The patterns of scores on the 3 scales were consistent with the predictions of the theoretical scheme of physician types. The "seeker" type was the rarest, at fewer than 3%. CONCLUSIONS: It is possible to reliably classify physicians into categories that a theoretical framework predicts will respond differently to different interventions for implementing guidelines and translating research findings into practice. The next step is to demonstrate that the classification predicts physician practice behavior.

Adult↗

PubMed2006

[Healthy elderly drivers are more likely to commit errors or lapses than violations. Survey of 904 volunteers].

OBJECTIVES: Driving is an important part of everyday life for the elderly today. Older drivers are suspected to be involved in more automobile accidents than younger adults. Although healthcare professionals are aware of specific diseases and impairments that increase accident risks, they cannot distinguish safe from unsafe drivers among the healthy elderly population in general practice. Previous English studies of younger populations differentiate three main types of bad driving that are associated with accident involvement: violations, errors, and lapses. The aim of this study was to assess the driving behavior associated with car crashes in a healthy elderly population. METHOD: This prospective survey of healthy drivers aged 65 years or older living in the community asked subjects about their habitual driving and accident history in the past three years. Subjects also completed the French version of the Manchester Aging Driver Questionnaire, which contains 24 items, scored from 0 (never) to 5 (nearly all the time) and yields three sub-scales: errors, violations, and lapses. Simple logistic regression, adjusted for age and sex, was used to analyze associations between the questionnaire results and driving history. RESULTS: These elderly drivers (mean age: 69 years) reported primarily lapses (mean: 5.42) but also violations (mean: 3.76) and errors (mean: 2.12). In all, 237 drivers (27%) reported accidents: 29.4% of the men compared with 20.2% of the women (p<0.01). After adjustment for age and gender, the logistic regression showed four specific errors and one lapse to be associated with accidents: "Queuing to turn left onto main road, you pay such close attention to the main stream that you nearly hit the car in front" (OR: 1.71; 95% CI: 1.05-2.08); "On turning left, nearly hit a cyclist who has come up on your side" (OR: 1.58; 95% CI: 1.01-2.45); "Underestimate the speed of an oncoming vehicle when overtaking" (OR: 1.48; 95% CI: 1.09-2.02); "Brake too quickly on a slippery road, or steer the wrong way into a skid" (OR: 1.60; 95% CI: 1.15-2.29); and "Hit something when reversing that you had not previously seen" (OR: 1.73; 95% CI: 1.19-2.50). CONCLUSION: As previously reported, errors and lapses are more common than violations among healthy elderly drivers. Five specific actions were associated with accident risk. The ADQ is a short, simple survey questionnaire that is useful for screening bad driving behavior in elderly drivers and for promoting safe driving practice among them.

Accidents, Traffic↗

PubMedDate not supplied

Implementing practice guidelines for depression: applying a new framework to an old problem.

We discuss the challenges of implementing clinical practice guidelines for depression in the primary care setting. Multiple potential barriers can limit physician guideline adherence and translation of research into improved patient outcomes. Six primary barriers relate to providers (lack of awareness, lack of familiarity, lack of agreement, lack of self efficacy, lack of outcome expectancy, and inertia of previous practice). In addition, factors related to patient, guideline, and practice environment factors encompass external barriers to adherence. By delineating the underlying barriers to adherence, different interventions that are tailored to improve physician adherence to guidelines can be utilized. We review examples of these barriers, as well as interventions to improve guideline adherence. We also review characteristics of successful interventions to improve physician adherence to guidelines for depression. Since different physicians and practice settings may encounter a variety of barriers, multifaceted interventions that are not focused exclusively on the physician tend to be most effective.

Depressive Disorder↗

PubMed1999

Research-based practice: reducing bedrest following cardiac catheterization.

Patient discomfort with prolonged bedrest following femoral arterial puncture for cardiac catheterization is a significant nursing problem. Safely reducing the time required for supine bedrest could improve patient comfort and reduce nursing care needs. Reducing bedrest also has the potential to improve organizational resource utilization. A review of the literature was conducted and a decision was made to implement 2 hours of bedrest, a significant decrease from the previous practice of 6 hours. Vascular complications were closely monitored in the first 50 patients, as a means of implementing the research-based change in practice. No significant vascular complications occurred and the practice change has expanded to all inpatient and outpatient areas caring for patients undergoing cardiac catheterization. This experience with utilizing research to change practice has created a positive environment for future research-based initiatives.

Back Pain↗

PubMed1976

Time utilization of a population of general surgeons in a prepaid group practice.

Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surgeons also devoted a mean of 6.7 evening hours per week to professional activities for a mean net professional week of 57.4 hours. Comparisons with a population of previously studied community surgeons revealed that the prepaid group surgeons were able to produce a surgical output more than double that of the community surgeons while devoting only one and a half as much time to professional activities. Economies in the utilization of surgical manpower in the prepaid group appear to stem from: 1) restriction of practice setting to a single geographic location, 2) restriction of patients to surgical patients, 3) reduced surgeon waiting time in the office, and 4) the utilization of paraprofessional personnel for selected operative assisting. These economies were achieved while the prepaid group surgeons were observed to average more time per patient visit both on rounds and in the office than the community surgeons.

Adult↗

PubMed1997

Risk factors for adult paternity in births to adolescents.

OBJECTIVE: To examine the risk factors for adult (aged 20 years and older) paternity in births to teenagers (14-17 years of age). METHODS: This was a population-based, retrospective cohort analysis of 27,215 adolescent mothers residing in California who had a live singleton birth during 1993. Adjusted risks for adult paternity by paternal and maternal characteristics were derived from comparisons of adult-teen and teen-teen couples. RESULTS: Adult fathers, who were responsible for 49.2% of births to teenage mothers, were a mean of 6.4 years older than the mother. The most important risk factors for adult paternity were as follows: father's (odds ratio [OR] 5.19; 95% confidence interval [CI] 4.43, 6.08) or mother's (OR 1.33; 95% CI 1.14, 1.55) educational attainment of at least 3 years lower than expected for their age, two or more previous live births (OR 3.34; 95% CI 2.48, 4.53), mother's birthplace outside the United States (OR 2.33; 95% CI 2.11, 2.58), father's (OR 2.16; 95% CI 1.98, 2.36) or mother's (OR 1.28; 95% CI 1.15, 1.42) educational attainment 1-2 years lower than expected for their age, one previous live birth (OR 1.92; 95% CI 1.75, 2.12), and Asian (OR 1.29; 95% CI 1.04, 1.62) or African American race (OR 1.25; 95% CI 1.06, 1.46) of the father. CONCLUSIONS: Teenage pregnancy prevention programs must address adult paternity, which contributed to almost half of the births in our study. These programs should consider education adequacy, cultural beliefs and practices, previous live births, and race and ethnicity when designing programs to decrease the number of adults involved in teenage births.

Adolescent↗

PubMed1992

The UK indicative prescribing scheme: background and operation.

The cost of drugs in the UK has increased at a rate of 4% above inflation over the last ten years. Prescribing in general practice accounts for 80% of the total drugs bill. Within general practice, there is considerable variation in individual prescribing frequency and costs, reflecting demographic, morbidity and professional influences. Recognition that much prescribing is unnecessary and wasteful of resources which may be better used elsewhere in the NHS is a major force behind recent radical changes to the organisation of British general practice. This paper describes the background, implementation and first year of the Indicative Prescribing Scheme (IPS). The IPS is an initiative of the Department of Health in the United Kingdom that aims to introduce greater accountability for, and control over, the costs of prescribing in general practice. Previous attempts to control the costs of drugs to the NHS included efforts to control price, demand, availability; encouraging generic prescribing; and educational initiatives. The IPS was introduced to place downward pressure on expenditure on drugs by improving the quality of prescribing and by eliminating wasteful prescribing. The scheme hinges around the setting of 'indicative prescribing amounts' for each general practice. Practitioners are expected to operate within these guidelines and are provided with regular financial summaries to help them gauge their progress. Additionally, Family Health Service Authorities (the new administrative and managerial body with responsibility for the day-to-day running of primary care services) have engaged medical and pharmaceutical advisers to provide support and information to assist general practitioners with their prescribing. The first year of the scheme has been one of establishment and consolidation. It is too early to judge whether it will be a success. After initial resistance, many doctors are adopting the principles of the scheme and are critically reviewing their prescribing. Greater awareness of the content and influences on prescribing in primary care and of the resource implications for the rest of the NHS of rational prescribing has encouraged dialogue between hospital clinicians, managers and general practitioners.

Budgets↗

PubMed2001

Therapists' beliefs about research and the scientist-practitioner model in an evidence-based health care climate: a qualitative study.

The growing emphasis on achieving therapeutic practice that is informed by research evidence or 'evidence-based' has been well documented. However, if therapists are to operate effectively within evidence-based services, it is necessary to develop a better understanding of factors that influence their attitudes towards research in routine clinical work. Within this context, there is a need to re-examine the scientist-practitioner model as potentially complementing or competing with evidence-based practice. This study explores the beliefs about research and the scientist-practitioner model amongst a diverse group of therapists whose work is contextualized by evidence-based practice. In-depth, qualitative interviews were used to elicit significant themes that related to current practices, previous training and contact with other professionals. The findings suggest that the therapists' beliefs were shaped by different levels of influence that range from personal values to organizational and political issues. The results also highlighted how the therapists had constructed more idiosyncratic definitions of the scientist-practitioner model that related to perceptions of its value. Implications for further research, training and practice are discussed.

Attitude↗

PubMed2001

Therapists' beliefs about research and the scientist-practitioner model in an evidence-based health care climate: A qualitative study.

Journal Article↗

PubMedDate not supplied

Creating and validating practical measures for assessing public health practices in local communities.

Efforts to develop a surveillance system to measure local public health performance were initiated in 1991. The organizing framework for the proposed system consisted of three core functions formulated by the Institute of Medicine and linked with 10 practices previously defined. A surveillance protocol was developed using local public health jurisdictions rather than specific agencies within the jurisdictions, as the units of study. Selection of 84 indicators was assisted by follow-up study of a group of departments analyzed in 1979 and by review of recent public health literature. Each of the 84 performance indicators was linked to one of the 10 practices. Responses to the survey were obtained from local health department directors. Results yielded scores for the surveyed jurisdiction with regard to adequacy of performance for each practice, the proportional contribution to performance by the local health department, and the identification of other providers contributing to the coverage of each practice within the jurisdiction. A shortened version of the protocol (26 indicators) was tested in all local jurisdictions in six states and shown to correlate reliably with scores obtained from the longer protocol for overall public health performance, as well as for performance of each of the three core functions and for some of the 10 practices. A subset of four indicators was shown to predict reliably the overall score. The findings support the proposition that public health practice can be defined, measured, and monitored and that current widely accepted definitions of core functions and practices have utility. Measurement and surveillance tools for these functions and practices are available and tested.

Community Health Services↗

PubMed1998

Empirically generated attributes of experience in nursing.

Researchers examining clinical decision-making often explored the role of the nurse's experience. In these studies, experience was conceptualized as either the time spent in nursing or the knowledge which came from practice. This paper reports on the conceptualization of the nurse's experience emerging from a grounded theory study describing one decision-making process: 'knowing the patient'. Data included in-depth interview text, participant observation fieldnotes, and documents. Data were analysed using the constant comparative method and open, axial and selective coding techniques. In the analysis, the nurse's experience was conceptually defined as 'the application of that learned from previous practice situations'. Three attributes of the nurse's experience emerged. These included a focus on the patient, confidence in practice, and knowledge of antecedents and consequences of similar patient situations. Each aspect enhanced the individualization of nursing interventions. The findings are related to other investigations in nursing and insights for practice are offered.

Clinical Competence↗

PubMed2002

Age, religious beliefs, and sexual attitudes.

Age effects on sexual attitudes were examined using the Hendrick and Hendrick (1987a) Sexual Attitude Scale. The study was cross-sectional, including people from various age groups, from young adults to older adults. The religious beliefs variable, which covaries substantially both with age and sexual attitudes, was controlled. Three main questions guided the study: (a) Is the four-factor structure (Permissiveness, Instrumentality, Communion, and Sexual Practices) previously identified in a sample of young students able to accurately account for data gathered over a full range of adult ages, (b) are older adults much less permissive and less instrumentalist than young people, and (c) to what extent are believers less permissive and instrumentalist than young people when age is taken into account? Factor analyses showed that at least five correlated factors were needed to account for the data; the fourth factor, Sexual Practices, divided itself into two distinct factors: Pleasure and Responsibility. Older adults and believers were shown to be less permissive than young people and nonbelievers, and this result held regardless of the participants educational level. As regards to instrumentality, however, the pattern of differences was extremely complex.

Adolescent↗

PubMed1985

Satisfaction with children's medical care in six different ambulatory settings.

This article compares mothers' satisfaction with children's medical care in six widely varying settings: fee-for-service solo and group practices, prepaid group practice, public clinics, hospital outpatient departments, and emergency rooms. Data are from a household survey representing 700 children in Washington, D.C. Satisfaction with the physician's friendliness, competence, and personal care, as well as waiting time, atmosphere, and cost were examined, comparing how satisfaction levels varied in relation to patient attributes and also among medical settings. Findings revealed significant differences across settings, even controlling statistically for multiple patient characteristics. Satisfaction with interpersonal items was highest in fee-for-service settings, especially solo practice, whereas satisfaction with cost was highest in the public clinics, followed by the prepaid group practice. Previously published comparisons of utilization and health outcomes in the same settings revealed entirely different rankings. Together, these findings illustrate the multifaceted and paradoxical nature of health system performance.

Age Factors↗