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PubMed1988

Practice-based research: opportunities and obstacles.

Renewed interest in practice-based research reflects growing realization of the limitations of research from a hospital perspective. Practice-based pediatric research promises to broaden the range and severity of conditions commonly studied, to enhance the study of the natural history of disease and of normal development, to provide normal controls and standards, and to facilitate recruitment of adequate sample sizes. Cohort, incidence, and health services research will be promoted by the development of patients registries. The Chicago area Pediatric Practice Research Group is a research consortium of 81 practitioners in 27 office practices. Formed in 1984, it receives logistic and financial support from Children's Memorial Hospital, with which it is affiliated. The Pediatric Practice Research Group has undertaken six studies, most with outside funding. During these studies, some unifying characteristics of practice-based research have emerged. These include the need to tailor study protocols to individual practice characteristics and routines and the critical role of office staff in the conduct of research. Features can be identified that make specific studies more or less intrusive into office functioning. It has proved feasible to obtain data of high quality and reproducibility despite geographically scattered data collection sites. This review of Pediatric Practice Research Group activities and experience is intended to open an exchange of ideas with others interested in practice-based research.

Humans↗
PubMed1988

[Obstacle to left ventricle ejection after mitral valvular replacement with a Carpentier-Edwards bioprosthesis. Apropos of 2 cases].

Impairment of the left ventricular ejection induced by a mitral prosthesis remains an infrequent complication, perhaps because it often is unrecognized. This complication would mainly be seen with ball prostheses or standard bioprosthesis used in mitral valve replacements with a small ventricle. Two cases have been recently reported during mitral valve replacement. The two patients were successfully re-operated upon, one after five weeks and the second immediately after the first procedure. A review of the literature enable to specify the etiology and diagnostic criteria with the assistance of Doppler-sonocardiography. Early re-operation may prevent death, often due to a post-operative myocardial dysfunction.

Bioprosthesis↗
PubMed1988

Is population mobility an obstacle to continuity of care? Attrition rates over five years in 17 Ontario practices.

The University of Western Ontario Hypertension Study provided an opportunity to study attrition rates over a five-year period in the population of 17 family practices in southwestern Ontario. The baseline population consisted of all patients between the ages of 20 and 65 years who were active in the practices in 1978. During the five years of the study, a medical assistant in each practice recorded data on morbidity, mortality, and patients leaving the practice. The follow-up of nonresponders to a demographic questionnaire provided additional data on patient moves. The overall five-year move rate was 13.2 percent for men and 16.6 percent for women. Those in the 20- to 29-year age group had the highest rates, and those in the 30- to 39-year age group had the next highest. The rates for men stabilized after the age of 40 years to between 8 and 10 percent, and for women after 40 years to between 11 and 13 percent. The move rates were higher in urban than in rural practices. Ninety percent of hypertensive patients received continuous care over the five-year period. In southwestern Ontario, population mobility does not appear to be a major barrier to continuing care.

Adult↗