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Results for “generalization”

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PubMed1998

Variations in use of cardiac services in England: perceptions of general practitioners, general physicians and cardiologists.

OBJECTIVE: To explain why those who live some distance from tertiary cardiac centres make less use of coronary angiography and revascularisation than those who live close by, and why people living in particular wards within certain districts make less use of services than might be expected from their level of need. METHOD: Semi-structured interviews with 24 general practitioners (GPs) in two English health districts (Morecambe Bay and East Lancashire), five general physicians working in district general hospitals, and four interventional cardiologists working in tertiary centres. Transcripts of audiotape recordings were analysed using the constant comparative method. RESULTS: Those living far from tertiary centres are usually referred to general physicians before they are referred for angiography. The general physicians tend to be more conservative in their approach to treatment than interventional cardiologists. GPs working near tertiary centres are able to refer directly to interventional cardiologists. There are also logistical and economic reasons for inequitable use of services. Some GPs perceived that patients of South Asian descent undergo fewer investigations than might be expected because of communication or other difficulties. CONCLUSION: Use of cardiac services would be more equitable if there were interventional cardiologists based in district general hospitals who could perform angiograms for their own patients in the tertiary centres. Patients might also benefit in angiograms could be conducted in selected district general hospitals. Further qualitative research, involving both doctors and patients, is needed to explore other reasons for relatively low rates of investigation and revascularisation in certain groups of patients.

Attitude of Health Personnel↗

PubMed1997

Of science, meta-science, and clinical practice: the generalization of a generalization to a particular.

Although science is the most powerful method for advancing knowledge and scientific and statistical formalisms are generally much sounder than impressionistic judgment, advanced methodological training (as it is presently comprised) is often of little direct use to practicing clinicians. Practitioners should be able to identify grossly deficient knowledge claims and clear scientific winners, but beyond this, the trick usually is to determine which scientific authority or authorities on whom to depend, a decision task that is ultimately to be tackled through the type of meta-scientific studies that Faust and Meehl have proposed. In applying scientific knowledge, the clinician usually must choose between the generalization of a scientific generalization to a particular versus the application of a clinical generalization to a particular. Determining the relative power of scientific generalizations developed outside, versus clinical generalizations developed within the setting of application, can be very difficult, and there are few established guides. A more advanced science of generalization, another meta-scientific problem, would allow sounder predictions about application to new domains and could greatly aid the practitioner.

Journal Article↗

PubMed2002

[General medicine and general practitioner. The viewpoint of the teachers at the Department of Medicine of Tunis].

The general medicine remains a same survey subject in countries where the debate began since several years. We have led an investigation by questionnaire close to 50 chosen hospitalo-academic physicians by pull to the fate on the list of teachers of the faculty of medicine of Tunis. The majority of our investigated (90%) consider that the physician general practitioner is the physician of the individual in its totality, the counselor and the family's confidant. The formation that receives the future general practitioner currently doesn't prepare it to assure his role. To form the future physician better general practitioner, we think that it's necessary to define the general practitioner role, to adapt the formation to the role of the general practitioner and the specificity of the general medicine.

Adult↗

PubMed2000

Effect of general practitioner hospitals on district general hospital bed use in the Highlands of Scotland.

OBJECTIVE: To examine hospital bed use by General Practices with and without access to General Practitioner beds. DESIGN: Information from the Contract Management System for General Medicine and Surgery, and from SMR returns for Geriatric Medicine and GP beds was used to compare hospital bed use in District General Hospitals (DGHs) and in General Practitioner beds for practices with and without access to GP beds. Age adjusted rates were calculated for overall use of each specialty. SETTING: All General Practices in the Highland Health Board area for December 1995-April 1997. RESULTS: Compared to practices with no access to GP beds, practices with access used 39.4% fewer bed days per 1000 patients for medical specialties; 18% fewer bed days for surgical specialties; 34.5% fewer bed days for geriatric medicine, and 4.9% fewer bed days for other DGH specialties. Taking into account GP bed day use, practices with access to GP beds used 6.1% more hospital bed days per 1000 patients than did practices with no access. CONCLUSION: These findings largely replicate work in England that found substantial decreases in General Medical and Geriatric Medicine bed use in Practices with access to GP beds, combined with an overall increase in occupied bed day use of 6-8% per 1000 patients. The lower use of surgical beds was unexpected, and may reflect more flexible use of GP beds in the Highlands for observation or rehabilitation, possibly related to the far greater distances involved than in the English studies.

Adolescent↗

PubMed2004

New Zealand Rural General Practitioners 1999 Survey--Part 3: rural general practitioners speak out.

AIMS: To describe themes about rural general practice from the written responses in the 'New Zealand Rural GPs 1999 Survey'. METHODS: A postal questionnaire surveyed all rural general practitioners (GPs) in New Zealand (NZ), who were asked for comments or suggestions about rural general practice. These responses were explored for themes about rural practice. RESULTS: Of 338 completed questionnaires (response rate--75%), 138 contained written responses. The positive themes of rural general practice included: forming strong relationships with patients and the community, and practising the full spectrum of general practice, including emergency medicine. The negative themes included: heavy workloads, frequent on-call, inability to get time off, and feeling undervalued and underpaid by funders. Retention solutions included: better pay to adequately reflect the skills and workload, more salaried positions with guaranteed working conditions, and better rural continuing education. Recruitment solutions included: reducing barriers for foreign doctors to enter NZ, establishing a rural GP career pathway, and increasing the number of rural registrars. CONCLUSIONS: This study highlights both the positive and negative features of NZ rural general practice, and makes it clear that further concerted and sustained action is required to improve retention and recruitment. The GPs' written comments provide detail on the challenges facing rural general practice, as well as informed comment about potential solutions.

Attitude of Health Personnel↗

PubMed2005

Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain.

BACKGROUND AND PURPOSE: The purpose of this randomized controlled trial was to examine the usefulness of the addition of specific stabilization exercises to a general back and abdominal muscle exercise approach for patients with subacute or chronic nonspecific back pain by comparing a specific muscle stabilization-enhanced general exercise approach with a general exercise-only approach. SUBJECTS: Fifty-five patients with recurrent, nonspecific back pain (stabilization-enhanced exercise group: n=29, general exercise-only group: n=26) and no clinical signs suggesting spinal instability were recruited. METHODS: Both groups received an 8-week exercise intervention and written advice (The Back Book). Outcome was based on self-reported pain (Short-Form McGill Pain Questionnaire), disability (Roland-Morris Disability Questionnaire), and cognitive status (Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, Pain Locus of Control Scale) measured immediately before and after intervention and 3 months after the end of the intervention period. RESULTS: Outcome measures for both groups improved. Furthermore, self-reported disability improved more in the general exercise-only group immediately after intervention but not at the 3-month follow-up. There were generally no differences between the 2 exercise approaches for any of the other outcomes. DISCUSSION AND CONCLUSION: A general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific low back pain. Stabilization exercises do not appear to provide additional benefit to patients with subacute or chronic low back pain who have no clinical signs suggesting the presence of spinal instability.

Abdominal Muscles↗

PubMed1994

[Did the distribution of trauma treatment by general practitioners and emergency departments in the county of Ringkøbing change after the introduction of the on-call coverage for general practitioners?].

The aim of the study was to investigate the changes in minor trauma treatment structure after a reduction in the number of general practitioners on call in a county, where minor trauma treatment is supposed to be carried out by general practitioners and only major trauma is supposed to be treated at the hospital Accident and Emergency Department. The design was a cross-sectional analysis of trauma treatment in Ringkøbing County before and after the reduction in the number of general practitioners on call. Over a four week period before and after the reduction in the number of general practitioners on call all trauma treatment at the Accident and Emergency Departments was registered together with trauma treatment by general practitioners. Furthermore a questionnaire was given before and after the reduction to a sample of the population regarding the population's behaviour and attitude towards minor trauma. Analysis showed that there was a minor reduction in the total number of trauma treatments after the reduction in the number of general practitioners on call was made. The percentage of patients that were treated at the Accident and Emergency Departments at hospital directly without being referred from general practitioners was reduced from 30% to 21%. The population's behaviour and attitude towards minor trauma was unchanged.

Cross-Sectional Studies↗

PubMed1993

[Smoking habits in France among general practitioners and the general male population over a twenty-five year period (1966-1991)].

Epidemiological surveys are presented regarding smoking habits among two populations: the general practitioners in France since 1966 to 1991 and the general population of adult men in the same period of time. We add some European and foreign surveys in the same groups of population. These data show a regular and rather slow reduction of percentage of smokers during the last 25 years. We can see, in general, the behaviour of the general practitioners are in advance comparing with the general population of ten to twenty years. If we compare the French data with the foreign one we can see that France is not in a very good situation regarding the decreasing tendency of smoking among the general practitioners and in the general population. This study justify the strengthening of the fight against smoking among adults and doctors. We remind that the very roots of the tabagism are in the youth: specific studies might take in account this core problem.

Adult↗

PubMed1996

The computer research network of the Royal New Zealand College of General Practitioners: an approach to general practice research in New Zealand.

Computers are now in widespread use by general practitioners (GPs) in many countries. In New Zealand this development has advanced general practice research by enabling collaboration among a small population of doctors practising in geographically diverse locations. This paper reviews the establishment of the Computer Research Network of the Royal New Zealand College of General Practitioners (RNZCGP) and its development between 1990 and 1995. The Network consists of 181 general practices (approximately 450 GPs) from throughout urban and rural New Zealand. All participants use computers in their practices to record consultation notes and to generate prescriptions, investigations and referral forms. Computer programs developed in the RNZCGP Research Unit are run on commercial software in doctors' surgeries to provide anonymous, individual data. In addition to the routine analysis of utilization for feedback to participants, 13 research projects have been completed. These include investigations of access to general practice care, use of health services by individuals and families, surveillance of immunization uptake, epidemiology of common conditions, and the use of pharmaceuticals in general practice. The RNZCGP Computer Research Network is an example of a computerized general practice research network that has been productive without receiving significant financial resources or having a formal management structure.

Confidentiality↗

PubMed1993

General surgery, the general surgical subspecialties, and prerequisite training.

Currently, several specialties (cardiothoracic, pediatric, and colorectal) require a full general surgery residency before specialty training. Plastic surgery has, in essence, a de facto requirement since most residents have had at least 5 years of general surgery training before initiation of a plastic surgery residency. Forces within both general surgery and plastic surgery will dictate that such a de facto requirement will not persist in the future. The pressures that compel plastic surgery to modify the traditional role of general surgery as preparatory training for requisite or specialty residency training can be extended by analogy to the other specialties as well. This article will hypothesize that the premises and the conclusions about the relationship between plastic surgery and general surgery apply equally well to the other specialties. If the traditional and historical role of full general surgery residency as prerequisite training for a specialty residency is discarded, careful thought must be given to any substitute system to graduate surgical education. In particular, attention must be directed to the three components of clinical skills to be acquired and to an expectation of operative or technical experience.

Certification↗

PubMed2002

Ward reduction without general anaesthesia versus reduction and repair under general anaesthesia for gastroschisis in newborn infants.

BACKGROUND: Gastroschisis is a congenital anterior abdominal wall defect with the abdominal contents protruding through the defect. Reduction of the abdominal contents is required within hours after birth as the infant is at risk not only of water and heat loss from the exposed bowel but also of compromised gut circulation with ischaemia and infarction. To avoid the complications of general anaesthetic and mechanical ventilation it has been proposed that the reduction of abdominal contents can be achieved without endotracheal intubation or anaesthesia. OBJECTIVES: To determine which approach to the immediate surgical treatment of gastroschisis has the better outcomes: ward reduction without general anaesthetic or reduction and repair of the abdominal wall defect under general anaesthesia. SEARCH STRATEGY: Searches were made of MEDLINE from 1966 to March 2002, CINAHL from 1982 to March 2002, and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002). Previous reviews including cross references, abstracts, and conference and symposia proceedings published in Pediatric Research (from 1990 to 1994) were also searched, especially for any unpublished data. SELECTION CRITERIA: Randomised, controlled trials (RCT) comparing ward reduction with reduction under general anaesthesia, for neonates with gastroschisis. Outcomes considered were: mortality, duration of total parenteral nutrition, time to full enteral feeds, need for a silo, infection, gastro-intestinal tract perforation, length of bowel lost/resected, need for a general anaesthesia, need for and duration of mechanical ventilation and respiratory support, duration of oxygen therapy, need for further operative procedure after initial reduction, duration of hospital stay, cosmetic outcome, nutritional status, and neurodevelopmental outcome. DATA COLLECTION AND ANALYSIS: No studies were found meeting the criteria for inclusion in this review. MAIN RESULTS: No studies were found meeting the criteria for inclusion in this review. REVIEWER'S CONCLUSIONS: There is no evidence from RCTs to support or refute the practice of ward reduction for the immediate management of gastroschisis. There is an urgent need for RCTs to compare ward reduction versus reduction under general anaesthesia in infants with gastroschisis. Initial trials would best be limited to those infants with uncomplicated gastroschisis (using pre-defined selection criteria excluding infants that are unstable, have gut perforation, necrosis or atresia, have other organs requiring reduction besides bowel, or are considered to need a silo prior to any reduction. Trials should use adequate pain relief and specify a pre-defined time period after which manual reduction is abandoned.

Anesthesia, General↗

PubMed1986

Response variation and the generalization of a dressing skill: comparison of single instance and general case instruction.

Two, identical multiple-baseline-across-subjects designs were used to compare the effects of single instance and general case instruction on the generalized dressing of youth and adults with severe mental retardation. Performance across eight nontrained, probe shirts was used to assess generalization of the skill "putting on pullover shirts." Following training with a single shirt, subjects exhibited limited success with the eight nontrained shirts. Only after training with a set of shirts that sampled the range of stimulus and response variation for "putting on pullover shirts" was successful generalization observed. Results suggest that the response variations taught during general case instruction played a major role in improved performance across the nontrained shirts. Implications of the results are discussed for instruction in applied settings, and for research methodology in the analysis of generalization.

Activities of Daily Living↗

PubMed2003

General dental practitioners' knowledge of and attitudes towards the employment of dental therapists in general practice.

OBJECTIVE: To investigate general dental practitioners' knowledge of and attitudes towards dental therapists, to ascertain the likelihood of their employment in general dental practice, what client groups they would be likely to treat, and to identify the main perceived barriers to their employment in general dental practice. METHOD: Postal questionnaire. SETTING: General dental practitioners in the county of West Sussex. SAMPLING: All dentists holding a contract to provide general dental services in West Sussex were contacted. Final sample size was 200. KEY FINDINGS: Thirty eight per cent of dentists said they would employ a therapist if legislation allowed. Main perceived barriers were cost, lack of knowledge and dentists' acceptance. CONCLUSIONS: In general dentists had a favourable attitude towards dental therapists, although there was a real lack of knowledge about their permitted duties. Most dentists felt therapists should treat children and people with special needs.

Adult↗

PubMed2006

General health promotion in general dental practice--the involvement of the dental team Part 2: A qualitative and quantitative investigation of the views of practice principals in South Yorkshire.

AIM: To investigate the factors that might influence the provision of general health promotion through seven different health interventions by dental teams in general dental practice. METHOD: A mixed-method was used comprising cross-sectional qualitative research using semi-structured interviews of a purposive sample of 10 practice principals, and a cross sectional survey of a practice principal from every dental practice in South Yorkshire, using a self-complete questionnaire. RESULTS: Two core categories emerged from the qualitative data: seeing health or disease and practitioners' views of the structure of dental practice. The former refers to the participants' general outlook and cut across many dimensions constituting the structure of dental practice. Health-orientated dentists were more likely to be involved in prevention and were more open-minded to expanding the dental team's role into general health promotion. However participants perceived that barriers existed to involvement such as time and financial factors, current workload and lack of personal skills. The response rate of useable questionnaires in the cross sectional survey was 84%. Reported levels of involvement in general health promotion were low. Most frequently reported barriers were 'insufficient funding' and 'poor use of time'. 'Poor use of time' and 'lack of training/knowledge' were reported less frequently for professionals complementary to dentistry (PCDs) than dentists (p<0.05). Most dentists agreed that PCDs could be trained to deliver health interventions and would be happy for PCDs to do so in their practice if reported barriers were removed. CONCLUSIONS: Although dental teams' involvement in general health promotion is low, there is willingness to increase involvement, particularly among health-orientated dentists. Some reported barriers to involvement might be removed by impending changes to the GDS in England. Other important factors include a lack of education and workforce shortages of dentists and PCDs. Respondents indicated a high regard for PCDs and there was broad agreement that they were suitable to be involved in this work.

Attitude of Health Personnel↗

PubMed1999

Malignancy load on general surgeons: the need to change the general surgical training curriculum.

AIMS: With the advent of newer diagnostic modalities more and more cancer patients are being diagnosed each year. The rising detection rate and greater public awareness have immensely increased the load on already overburdened and increasingly fewer surgical oncology units. As a result a large number of these cases are being dealt with by general surgeons. METHODS: We have used a retrospective case count from a single surgical unit, based at the University Hospital, Varanasi, and data from the Hospital Based Cancer Registry (HBCR), Regional Cancer Centre (RCC), Trivandrum, from 1990 to 1994, to define the malignancy load on general surgical units and to define the number and sites of malignancies commonly encountered by general surgeons. RESULTS: A total of 28,136 patients were registered at the RCC, the commonest malignancy being oral cavity (16.35%), followed by lung (12.7%) and breast (23.8%) among men and women, respectively. On the other hand, in the 2123 patients with malignancy who were treated at the Medical College (MCH) in Trivandrum, the commonest sites encountered were stomach (11.68%), thyroid (10.31%) and colorectal (9.5%). This was quite similar to the frequencies observed at Varanasi, where colorectal cancer constituted 10.26% and stomach 6.98%. Only 13.6% of the patients reporting to RCC were treated by surgery alone or in combination, while this figure was 48. 1% for MCH. Similarly 2056 (7.3%) patients presenting to RCC had completed treatment prior to being referred to RCC; almost all of these patients were treated by surgery at referral institutions by general surgeons. CONCLUSIONS: The results clearly indicate an increased demand on the surgical oncology units, or alternatively an urgent need to redefine the postgraduate curriculum for the better training of general surgeons in understanding malignant disease, especially in the developing countries. We recommend a minimum of 6 months training in surgical oncology for each general surgery postgraduate.

Cancer Care Facilities↗

PubMed2000

Generalized seizures induced by an epileptic focus in the mesencephalic reticular formation: impact on the understanding of the generalizing mechanism.

The mode of seizure propagation was studied using a generalized seizure model induced by microinjection of kainic acid (KA) into a unilateral mesencephalic reticular formation (MRF) in cats and rats. Stereotactic surgery was performed under pentobarbital anesthesia; an injection cannula was placed into a unilateral MRF, and bipolar electrodes were implanted into the MRF and the thalamus. Microinjection of KA induced generalized seizures. Focal electrical seizures were elicited in the injected site of the MRF starting 30 min after the injection. The initial clinical change during each seizure was behavioral arrest. These seizures immediately developed to generalized seizures, which were characterized by generalized tonic convulsions with short-term clonic convulsions. On EEG, each generalized seizure started at the same time in all the sites of the brain recorded. Autoradiographic study using a rat model demonstrated high glucose utilization in the MRF, bilateral thalamus, forebrain and bilateral cerebral cortices. The results demonstrated an active participation of MRF in the mechanism of generalized seizures.

Animals↗

PubMed2001

General case quasi-pyramidal staff training to promote generalization of teaching skills in supervisory and direct-care staff.

The authors employed staff training strategies designed to enhance generalization of teaching skills in staff working with persons with developmental disabilities. Staff training consultants initially employed a general case training approach involving the use of specially selected client program exemplars to provide three supervisory staff with generalized teaching skills. Subsequently, supervisory staff used the general case approach to train teaching skills to direct-care staff, with staff training support from the consultants (quasi-pyramidal training). Supervisors showed improvement in teaching skills after supervisory staff training, but only one of the three supervisors exceeded 70% correct skill use. After participating in the training of their own staff, however, supervisors demonstrated further improvements in skill use. All direct-care staff showed improvement after quasi-pyramidal training, with seven of the nine staff exceeding 70% correct skill use. General case quasi-pyramidal training appears to have potential as a strategy for promoting generalization of staff teaching skills in both trainees and trainers.

Activities of Daily Living↗

PubMed1984

The effects of single instance, multiple instance, and general case training on generalized vending machine use by moderately and severely handicapped students.

This report provides an experimental analysis of generalized vending machine use by six moderately or severely retarded high school students. Dependent variables were training trials to criterion and performance on 10 nontrained "generalization" vending machines. A multiple-baseline design across subjects was used to compare three strategies for teaching generalized vending machine use. Training occurred with (a) a single vending machine, (b) three similar machines, or (c) three machines that sampled the range of stimulus and response variation in a defined class of vending machines. Results indicated that the third approach was the most effective method of obtaining generalized responding. Methodological implications for the experimental analysis of generalization and programmatic implications for teaching generalized behaviors are discussed.

Adolescent↗