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At least 937 records · Page 52Linked to original sources
PubMed2005

Reducing the amount of blood transfused: a systematic review of behavioral interventions to change physicians' transfusion practices.

BACKGROUND: Transfusion services have used various techniques to reduce blood product utilization. Given the potential adverse effects of transfusions and the resources consumed in implementing strategies to reduce transfusions, there is a need to understand their effectiveness. Therefore, we performed a systematic review of the literature to examine the effectiveness of behavioral interventions to reduce blood product utilization. METHODS: We identified all relevant articles through the use of electronic searches of MEDLINE and EMBASE, as well as hand searches of review articles and personal files. The electronic searches included articles published between January 1966 and May 2003. The searches included the terms blood transfusion, plasma exchange, guidelines, education, practice patterns, and professional practice. The outcomes of interest were the number of units transfused and the proportion of patients who received transfusions. RESULTS: Nineteen studies examining the effectiveness of single (guidelines, prospective audits, retrospective audits, and reminders) or multifaceted interventions in reducing red blood cell, platelet, plasma, cryoprecipitate, and albumin transfusions met the inclusion criteria. Eighteen studies demonstrated a relative reduction in the number of units given (range, 9%-77%) or the proportion of patients receiving transfusions (range, 17%-79%). The reported reductions were qualitatively similar for the different blood products studied. No particular intervention or combination of interventions appeared more effective in reducing utilization. CONCLUSIONS: Behavioral interventions, including simple interventions, appear to be effective in changing physician transfusion practices and reducing blood utilization. Appropriately designed clinical trials are still needed to determine the relative effectiveness of different interventions to change practices.

Behavior↗
PubMed2005

Radiation oncology practice accreditation: the American College of Radiation Oncology, Practice Accreditation Program, guidelines and standards.

The American College of Radiation Oncology Practice Accreditation Program (ACRO PAP) is a process by which a medical practice is evaluated through an in depth external review to ascertain whether or not key components of the practice comply with existing regulations, rules, laws, practice guidelines and professional practice standards. In radiation oncology, like other fields, it is driven by the need or desire to demonstrate an identified level of patient care. The accreditation process adopted by the American College of Radiation Oncology (ACRO) is based on the parameters of quality care assessment outlined by the National Academy of Science's Institute of Medicine. Those practices that meet these criteria are eligible for recognition and accreditation by ACRO.

Accreditation↗
PubMed2005

Introduction of diabetes passports involving both patients and professionals to improve hospital outpatient diabetes care.

AIM: To investigate whether a comprehensive strategy involving both patients and professionals, with the introduction of a diabetes passport as a key component, improves diabetes care. METHODS: The first 150 consecutive patients who visited their internist for a diabetes check up at the internal medicine outpatient departments at each of nine Dutch general hospitals were included in this 1 year clustered, randomised, controlled trial. Health care professionals attended an educational meeting about the use and dissemination of the diabetes passport which is a patient held record. They also received aggregated feedback on baseline data and personal feedback. Educational meetings were also organised for patients. Patient files were used in conjunction with questionnaires to determine adherence rates. Data were analysed using multilevel regression analysis. RESULTS: Small but significant changes were found in mean HbA1c levels. In the intervention group, positive health changes for patients were found (-0.3%) when compared to those in the control group (+0.2%). Diastolic blood pressure improved slightly, but no changes were found in systolic blood pressure or cholesterol. Improvements were found with regard to levels of examination of patients' feet and in patient education. CONCLUSIONS: Efforts to improve professional practice involving both professionals and patients led to small improvements in HbA1c and diastolic blood pressure levels. Further study is needed to establish whether a better structured health care delivery, operating in a more supportive environment can enhance these effects.

Ambulatory Care↗
PubMed1991

Responsibility and autonomous nursing practice.

In this paper, the consequences were there greater autonomy in nursing practice, are considered. Autonomous practice implies accountability which entails both personal and professional responsibility: a personal responsibility to endorse ethical conduct consistent with professional practice; and a professional responsibility to exercise discretionary powers to the ultimate benefit of the patient. In this context, discretionary responsibility implies: recognizing a patient's wants may not be consistent with a patient's needs; abstaining from collusion with noncompliant patients; supporting the patient's right to refuse treatment only after full psychological exploration; understanding the psychological ramifications of informed consent from a practitioner and recipient point of view; maintaining appropriate personal and professional boundaries; and fostering collegiate relationships with the medical fraternity grounded on egalitarian principles. The author provides a philosophical and psychological analysis of responsibility in an effort to achieve a deeper understanding of the relationship this has with the concepts of 'freedom' and 'accountability'.

Choice Behavior↗
PubMed2006

Experiential learning in women's health: medical student reflections.

CONTEXT: Reflection on clinical experience is used by medical students to enhance the development of clinical practice skills and professional behaviours in the area of obstetrics and gynaecology. It is applied through small-group reflective tutorials, writing reflective summaries and one-to-one discussion of reflections with staff. OBJECTIVE: To identify the levels of critical reflection achieved and explore the emergent themes in students' written reflections. METHODS: Thematic analysis was undertaken to document the recurring emergent themes on which students chose to reflect and the depth of reflection students achieved. RESULTS: Most students reflected on clinical, communication and reasoning skills, lack of medical knowledge, and the development of their own and others' professional practice. The 4 levels of reflection students demonstrated were: listing, where students only state the clinical experience; describing, where students describe the clinical experience, including what they did well and what they did not; applying, where students discuss what they need to change and how to develop, and integrating, where students apply reflection to future clinical practice. Few respondents demonstrated the ability to reflect to the level of integration except with facilitated discussion. DISCUSSION: The range of experiences on which students reflected was appropriate. The information obtained from the emergent themes has been useful for programme development. At the end of the process students were still not reflecting at the level of integration. This affirms that reflectivity is a skill that develops throughout life. Evaluating the level of reflection achieved and discussing this explicitly with the student may be instrumental in helping the student develop his or her reflective capacity further.

Attitude of Health Personnel↗
PubMed2006

From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations.

BACKGROUND: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. The selected recommendations were prioritisation systems for patients on waiting lists for two surgical procedures: hip and knee replacement and cataract surgery. METHODS: Determinants of physician intention to use HTA recommendations for patient prioritisation were assessed by a questionnaire based upon the Theory of Interpersonal Behaviour. A total of 96 physicians from two medical specialties (ophthalmology and orthopaedic surgery) responded to the questionnaire (response rate 44.2%). A multiple analysis of variance (MANOVA) was performed to assess differences between medical specialties on the set of theoretical variables. Given the main effect difference between specialties, two regression models were tested separately to assess the psychosocial determinants of physician intention to use HTA recommendations for the prioritisation of patients on waiting lists for surgical procedures. RESULTS: Factors influencing physician intention to use HTA recommendations differ between groups of specialists. Intention to use the prioritisation system for patients on waiting lists for cataract surgery among ophthalmologists was related to attitude towards the behaviour, social norms, as well as personal normative beliefs. Intention to use HTA recommendations for patient prioritisation for hip and knee replacement among orthopaedic surgeons was explained by: perception of conditions that facilitated the realisation of the behaviour, personal normative beliefs, and habit of using HTA recommendations in clinical work. CONCLUSION: This study offers a model to assess factors influencing the intention to adopt recommendations from health technology assessment into professional practice. Results identify determinant factors that should be considered in the elaboration of strategies to support the implementation of evidence-based practice, with respect to emerging health technologies and modalities of practice. However, it is important to emphasise that behavioural determinants of evidence-based practice vary according to the specific technology considered. Evidence-based implementation of HTA recommendations, as well as other evidence-based practices, should build on a theoretical understanding of the complex forces that shape the practice of healthcare professionals.

Journal Article↗
PubMed2003

[Clinical practice guidelines: a reader's guide].

INTRODUCTION: This article is devoted to the critical appraisal of clinical guidelines. METHODS: The example chosen is the update of the guideline "Clinical management of chronic obstructive pulmonary disease: diagnosis, follow-up, and acute exacerbations". The full and abbreviated versions of the text published by the "Société de Pneumologie de la Langue Française" were analysed by a guide for the critical evaluation of clinical guidelines. BACKGROUND: The evaluation guide "AGREE" allows assessment of six areas included in the development of a guideline: scope and objectives, involvement of the groups concerned, rigour of development, clarity and presentation, applicability and editorial independence. CONCLUSION: Clinical guidelines are going to play an important part in medical practice. Evaluation of professional practice will be based on their contents. A critical appraisal of their validity and applicability in this way allows an accurate decision on their subsequent application.

Humans↗
PubMed1991

Quality assurance and quality improvement: a PACU focus.

In the last decade, government and other regulatory agencies have made a dramatic impact on patient care delivery systems. These changes have resulted in the redesign of quality assurance (QA) and quality improvement (QI) programs. The Joint Commission on Accreditation of Healthcare Organization's Agenda for Change and their 10-step method of implementation provide a format for QA and QI activities. In addition, the Peer Review Organization's guidelines and various professional practice standards play an increasingly significant role in defining the continuous improvement of professional practice and patient care. It is important to note that QA is not the same as QI; yet, the two are not mutually exclusive. QA is a methodology whereas QI is a process and a structure that can facilitate the methodology of QA.

Humans↗
PubMed2005

A systematic review of practice standards and research ethics in technology-based home health care intervention programs for older adults.

OBJECTIVE: The purpose of the review is to assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home health care programs. METHODS: Key databases were searched to yield 2,866 abstracts that were independently rated by two reviewers using inclusion-exclusion criteria, resulting in 107 articles that were then reviewed for reports of practice standards and research ethics. RESULTS: Issues related to professional practice standards and research ethics were not well reported. When reported, adherence to practice standards included preintervention training, use of intervention protocols, supervision, and mechanisms for risk management. Research ethics most commonly reported were informed consent, REB/IRB approval, and protection of privacy. DISCUSSION: The results raise questions as to whether practice standards and research ethics are addressed sufficiently when health service delivery occurs in technology-based environments. Guidelines for professional accountability in e-health service delivery are needed.

Aged↗
PubMedDate not supplied

The junior doctor handover: current practices and future expectations.

Restructuring junior doctors' patterns of work has led to several changes, including the increasing implementation of shift and partial-shift rotas. These changes heighten the necessity for good communication between the doctors responsible at different times for the patients. We sent a questionnaire to all junior doctors in two district general hospitals; the results showed that existing handover systems are frequently not as good as doctors would wish. In our opinion, the lack of advice and guidance on the structure of handover has impeded good practice, and a standard of professional practice needs to be set. Opportunities exist within the NHS to utilise information systems to obtain the necessary information and to improve the format of the handover.

Continuity of Patient Care↗
PubMed2004

A professional ethics learning module for use in co-operative education.

The Professional Practice Program, also known as the co-operative education (co-op) program, at the University of Cincinnati (UC) is designed to provide eligible students with the most comprehensive and professional preparation available. Beginning with the Class of 2006, students in UC's Centennial Co-op Class will be following a new co-op curriculum centered around a set of learning outcomes Regardless of their particular discipline, students will pursue common learning outcomes by participating in the Professional Practice Program, which will cover issues of organizational culture, technology, professional ethics, and the integration of theory and practice. During their third co-op work term, students will complete a learning module on Professional Ethics. To complete the learning module students must familiarize themselves with the code of ethics for their profession, create a hypothetical scenario portraying an ethical dilemma that involves issues covered by the code, resolve the dilemma, and explain why their resolution is the best course of action based upon the code of ethics. A three-party assessment process including students, employers and faculty complete the module.

Cooperative Behavior↗
PubMed2000

The three faces of Occupational Medicine: printed paper, problems in practice, and professional purpose.

The 50-year run of the journal Occupational Medicine and its forbears demonstrates the ways in which UK occupational medical practice has developed and changed since 1950. This has been in response to changes in society, technology and medicine. The journal has played an important part in education and professional development. It has also been the voice for the aspirations and concerns of its readers. Two aspects stand out: the development of occupational medicine as a specialty, and the way in which a medical model for occupational health service provision has been championed. A distinguished line of journal editors has been central to the crystallization of ideas within occupational medicine and their editorials map out professional successes and challenges over the years.

Chronology as Topic↗
PubMed1976

General practice and professional coordination.

In a satellite city in South Australia, 17 miles from Adelaide, a controlled experiment in which a social worker from a local community agency has been placed in a four-man practice is demonstrating one way in which new forms of professional coordination can evolve out of already existing services. Through daily face-to-face contact, doctors, and social worker, as well as other surgery staff members, are learning ways of cooperating in unravelling the many mixed medical and psychosocial problems that present in a general practice setting. There are indications that community response to the innovation is positive because the doctors develop an assurance in making referrals, and people see the service as an extension of a known service in an already familiar setting.

Attitude of Health Personnel↗
PubMed2006

Supporting disaster healthcare professionals: a practical and virtual approach.

In this paper, we report on a questionnaire undertaken to evaluate an innovative programme of education for healthcare professionals in the field of aid and disaster healthcare that has been delivered by a partnership of three Higher Education Institutions (HEIs) across Europe since 1999. The development of this programme was a direct response to the stated needs of Non Government Organisations (NGOs) and military healthcare professionals as well as those aspiring to enter this complex area of healthcare. The aim of the project was to evaluate whether the programme was meeting the needs of students and to elicit what improvements could be made to the programme in order to enhance the learning experience. A questionnaire was developed to gather data across seven areas. It was subsequently analysed using the report and statistics features available within WebCT's Quiz/Questionnaire tool, in addition to the spreadsheet software MS Excel. The results of the questionnaire confirm that the programme, while successful in many ways, needs to be modified on a regular basis to reflect relevant worldwide changes and would benefit greatly from increased interaction between faculty and students.

Adult↗