WorldWideScience

Sample records for general practice implications

  1. Miscommunication between patients and general practitioners: implications for clinical practice

    Directory of Open Access Journals (Sweden)

    Morgan S

    2013-06-01

    Full Text Available INTRODUCTION: Effective communication is integral to the general practice consultation, yet it is acknowledged that problems commonly occur. Previous research has shown that misunderstandings with potentially significant consequences occur frequently, but does not provide a clear picture of how and why miscommunication occurs, or how such problems can be prevented or resolved. This study explored the occurrence and management of specific examples of miscommunication in two routine general practice consultations. METHODS: A multi-method case study approach was used. The primary data collected for each case included a video-recorded consultation and post-consultation interviews with each general practitioner (GP and patient. Instances of communication mismatch were examined using in-depth interaction analysis techniques. FINDINGS: GPs and patients may not be aware when misunderstandings have occurred. In-depth analysis of the case studies revealed the complexity of miscommunication: it was not a straightforward matter to locate when or why instances of communication mismatch had occurred, and each of the mismatches was quite distinctive: (1 they were identified in different ways; (2 they occurred at different points in the communication process; (3 they arose because of problems occurring at different levels of the communication, and (4 they had different consequences. CONCLUSION: Given the frequency and complexity of miscommunication in general practice consultations, GPs need to consider adopting various strategies, at both the practice/systems level and the level of the consultation interaction to minimise the risk of communication problems.

  2. The uses and implications of standards in general practice consultations

    DEFF Research Database (Denmark)

    Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm

    2017-01-01

    Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While ‘hard’ biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include...... as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the ‘softer’ aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients....

  3. General practice registrars' intentions for future practice: implications for rural medical workforce planning.

    Science.gov (United States)

    Harding, Catherine; Seal, Alexa; McGirr, Joe; Caton, Tim

    2016-11-01

    The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91)=3.528, P=0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88)=-4.280, Pmedical graduates intend to own their own practice compared with 52% of international medical graduates (χ 2 (1)=8.498, P=0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice.

  4. Australian general practitioner attitudes to clinical practice guidelines and some implications for translating osteoarthritis care into practice.

    Science.gov (United States)

    Basedow, Martin; Runciman, William B; Lipworth, Wendy; Esterman, Adrian

    2016-11-01

    Clinical practice guidelines (CPGs) have been shown to improve processes of care and health outcomes, but there is often a discrepancy between recommendations for care and clinical practice. This study sought to explore general practitioner (GP) attitudes towards CPGs, in general and specifically for osteoarthritis (OA), with the implications for translating OA care into practice. A self-administered questionnaire was conducted in January 2013 with a sample of 228 GPs in New South Wales and South Australia. Seventy-nine GPs returned questionnaires (response rate 35%). Nearly all GPs considered that CPGs support decision-making in practice (94%) and medical education (92%). Very few respondents regarded CPGs as a threat to clinical autonomy, and most recognised that individual patient circumstances must be taken into account. Shorter CPG formats were preferred over longer and more comprehensive formats, with preferences being evenly divided among respondents for short, 2-3-page summaries, flowcharts or algorithms and single page checklists. GPs considered accessibility to CPGs to be important, and electronic formats were popular. Familiarity and use of The Royal Australian College of General Practitioners OA Guideline was poor, with most respondents either not aware of it (30%; 95% confidence interval (CI) 27 - 41%), had never used it (19%; 95% CI 12 - 29%) or rarely used it (34%; 95% CI 25-45%). If CPGs are to assist with the translation of evidence into practice, they must be easily accessible and in a format that encourages use.

  5. Factors that affect general practice as a choice of medical speciality: implications for policy development.

    Science.gov (United States)

    Vohra, Amit; Ladyshewsky, Richard; Trumble, Stephen

    2017-11-28

    Objective This article critically appraises the range of personal, professional and social factors that affect the choice of speciality across medical students, prevocational doctors, general practice registrars and general practitioners. Methods This qualitative study applied constructs from the fields of decision theory and career theory to better understand the complex nature of choosing a speciality. In all, 47 in-depth interviews were conducted with participants at different stages of their career cycle. The data was codified and analysed using NVivo to identify key factors that influenced speciality choice. Results The research identified 77 individual findings influencing general practice as a choice of medical speciality. These were distilled into a matrix to show that factors such as money, prestige and peer interaction did not have a compelling effect, whereas clinical and academic role models, flexibility, work-life balance, scope of practice, connection with patients, training environment and practical opportunities did. Conclusion The findings indicate that the decision in relation to the choice of medical speciality is a complex cognitive process that is undertaken within a personal, social and professional context particular to each individual. What is known about the topic? Current literature aims to quantify changes in attitudes towards choice of speciality or the effect of particular variables in isolation while ignoring the complexity of this decision process and how the numerous variables compare with each other. What does this paper add? The present study is the first intergenerational research on this topic in the Australian context and the paper dismisses the role of prestige and remuneration as key drivers of choice in picking general practice as a speciality, noting that money is merely a 'hygiene factor'. What are the implications for policy makers? A policy framework outlining 10 key principles is presented to assist policy makers seeking

  6. Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

    Science.gov (United States)

    Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

    2015-02-01

    The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

  7. When and why do doctors decide to become general practitioners? Implications for recruitment into UK general practice specialty training.

    Science.gov (United States)

    Irish, Bill; Lake, Jonathan

    2011-01-01

    All applicants to round 1 of national recruitment into the general practice specialty recruitment process were surveyed as to the reasons for, and the timing of their career choices. Most applicants reported decision making after completing undergraduate training citing variety, continuity of care and work-life balance as their main drivers for a career in general practice. Applicants were statistically more likely to have undertaken a Foundation placement in general practice than their peers on a Foundation programme. Reasons for choice of deanery were largely related to location and social ties, rather than to the educational 'reputation' of its programmes.

  8. Coping with Secondary Traumatic Stress by General Duty Police Officers: Practical Implications

    Science.gov (United States)

    Conn, Stephanie M.; Butterfield, Lee D.

    2013-01-01

    This study used the Critical Incident Technique to examine the factors that helped, hindered, or might have helped 10 general duty police officers to cope with secondary traumatic stress. The data were best represented by 14 categories: self-care, family/significant other support, talking with co-workers, emotional engagement, work environment,…

  9. A population-based audit of ethnicity and breast cancer risk in one general practice catchment area in North London, UK: implications for practice

    Directory of Open Access Journals (Sweden)

    Ferris Michelle

    2007-09-01

    Full Text Available Abstract Objectives To conduct a pilot population-based study within a general practice catchment area to determine whether the incidence of breast cancer was increased in the Ashkenazi population. Design Population-based cohort study. Setting A single general practice catchment area in North London. Participants 1947 women over the age of 16 who responded to a questionnaire about ethnicity and breast cancer. Main outcome measures Incidence of breast cancer, ethnicity. Results This study showed a 1.5-fold (95% CI 0.93–2.39 increase in breast cancer risk in the Ashkenazim compared with the non-Ashkenazi white population. The increased incidence was for both premenopausal and postmenopausal breast cancer (expected incidence pre:post is 1:4 whereas in the Ashkenazim it was 1:1; 51 and 52% of cases respectively. This increase was not shown in the Sephardim. Asians had a reduction in incidence (OR = 0.44; 95% CI 0.10–1.89. Results were adjusted for other risk factors for breast cancer. Conclusion This study showed a 1.5-fold increase in breast cancer rates in Ashkenazim compared with the non-Jewish white population when adjusted for age (i.e. corrections were made to allow comparison of age groups and this is not observed in the Sephardic population. The proportion of premenopausal breast cancer was just over double that of the general population. This is the first general practice population-based study in the UK to address this issue and has implications for general practitioners who care for patients from the Ashkenazi community.

  10. Personality characteristics and attributes of international medical graduates in general practice training: Implications for supporting this valued Australian workforce.

    Science.gov (United States)

    Laurence, Caroline O; Eley, Diann S; Walters, Lucie; Elliott, Taryn; Cloninger, Claude Robert

    2016-10-01

    To describe the personality profiles of International Medical Graduates (IMGs) undertaking General Practice (GP) training in Australia. A better understanding of the personal characteristics of IMGs may inform their training and enhance support for their vital contribution to the Australian rural workforce. Cross-sectional self-report questionnaires. Independent variables included socio-demographics, prior training, the Temperament and Character Inventory, and the Resilience Scale. GP registrars (IMGs = 102; AMGs = 350) training in the Australian General Practice Training rural and general pathway and the Australian College of Rural and Remote Medicine independent pathway. Univariate analysis explored the differences in levels of traits between IMG and AMG registrars. Compared to the general population both groups have moderately high resilience, and well-organised characters with high Self-directedness, high Cooperativeness and low Self-transcendence, supported by temperaments which were high in Persistence and Reward Dependence. IMGs were different than AMGs in two temperament traits, Novelty Seeking and Persistence and two character traits, Self-directedness and Cooperativeness. Factors such as cultural and training backgrounds, personal and professional expectations, and adjustments necessary to assimilate to a new lifestyle and health system are likely to be responsible for differences found between groups. Understanding the personality profiles of IMGs provides opportunities for targeted training and support which may in turn impact on their retention in rural areas. © 2016 National Rural Health Alliance Inc.

  11. Recruitment of general practices

    DEFF Research Database (Denmark)

    Riis, Allan; Jensen, Cathrine Elgaard; Maindal, Helle Terkildsen

    2016-01-01

    -factors as determinants for successfully recruiting healthcare professionals: relationships, reputation, requirements, rewards, reciprocity, resolution, and respect. Method: This is a process evaluation of the seven R-factors. We applied these factors to guide the design of our recruitment strategy as well as to make......Introduction: Health service research often involves the active participation of healthcare professionals. However, their ability and commitment to research varies. This can cause recruitment difficulties and thereby prolong the study period and inflate budgets. Solberg has identified seven R...... adjustments when recruiting general practices in a guideline implementation study. In the guideline implementation study, we studied the effect of outreach visits, quality reports, and new patient stratification tools for low back pain patients. Results: During a period of 15 months, we recruited 60 practices...

  12. Oral cancer--current knowledge, practices and implications for training among an Irish general medical practitioner cohort.

    LENUS (Irish Health Repository)

    Ni Riordain, Richeal

    2009-11-01

    This study investigated the current knowledge and practices of general medical practitioners (GMPs) in Ireland regarding the examination of the oral cavity and the detection of oral malignancy and the training they had received at both undergraduate and postgraduate level and since commencing in practice. A questionnaire survey of GMPs in Ireland was conducted. One hundred and fifty four (65.3%) of the practitioners reported regularly examining the oral mucosa of their patients. Almost half of these (n=68) further qualified this response by stating that they only examined the oral mucosa if the patient reported pain in this area or if the patient specifically requested an oral examination for some reason. Eighty one (34.3%) practitioners surveyed felt confident in their ability to detect oral malignancies with the remaining two thirds unsure of whether they would be able to detect oral cancer. There was a significant association between the undergraduate and postgraduate teaching on examination of the oral cavity and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=4.811, p<0.05]. A statistically significant association was also found between the undergraduate and postgraduate teaching on the diagnosis of oral malignant disease and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=6.194, p<0.05]. In conclusion the level of knowledge of Irish general medical practitioners needs to be addressed with appropriate initiatives both at undergraduate level and via CME.

  13. A review of significant events analysed in general practice: implications for the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Bradley Nick

    2009-09-01

    Full Text Available Abstract Background Significant event analysis (SEA is promoted as a team-based approach to enhancing patient safety through reflective learning. Evidence of SEA participation is required for appraisal and contractual purposes in UK general practice. A voluntary educational model in the west of Scotland enables general practitioners (GPs and doctors-in-training to submit SEA reports for feedback from trained peers. We reviewed reports to identify the range of safety issues analysed, learning needs raised and actions taken by GP teams. Method Content analysis of SEA reports submitted in an 18 month period between 2005 and 2007. Results 191 SEA reports were reviewed. 48 described patient harm (25.1%. A further 109 reports (57.1% outlined circumstances that had the potential to cause patient harm. Individual 'error' was cited as the most common reason for event occurrence (32.5%. Learning opportunities were identified in 182 reports (95.3% but were often non-specific professional issues not shared with the wider practice team. 154 SEA reports (80.1% described actions taken to improve practice systems or professional behaviour. However, non-medical staff were less likely to be involved in the changes resulting from event analyses describing patient harm (p Conclusion The study provides some evidence of the potential of SEA to improve healthcare quality and safety. If applied rigorously, GP teams and doctors in training can use the technique to investigate and learn from a wide variety of quality issues including those resulting in patient harm. This leads to reported change but it is unclear if such improvement is sustained.

  14. Evaluation of a training program for device operators in the Australian Government's Point of Care Testing in General Practice Trial: issues and implications for rural and remote practices.

    Science.gov (United States)

    Shephard, Mark D; Mazzachi, Beryl C; Watkinson, Les; Shephard, Anne K; Laurence, Caroline; Gialamas, Angela; Bubner, Tanya

    2009-01-01

    From September 2005 to February 2007 the Australian Government funded the Point of Care Testing (PoCT) in General Practice Trial, a multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost-effectiveness and satisfaction of PoCT in General Practice. In total, 53 practices (23 control and 30 intervention) based in urban, rural or remote locations across three states (South Australia [SA], New South Wales [NSW] and Victoria [VIC]) participated in the Trial. Control practices had pathology testing performed by their local laboratory, while intervention practices conducted pathology testing by PoCT. In total, 4968 patients (1958 control and 3010 intervention) participated in the Trial. The point-of-care (PoC) tests performed by intervention practices were: haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) on patients with diabetes, total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol on patients with hyperlipidaemia, and international normalised ratio (INR) on patients on anticoagulant therapy. Three PoCT devices measured these tests: the Siemens DCA 2000 (Siemens HealthCare Diagnostics, Melbourne, VIC, Australia) for HbA1c and urine ACR; Point of Care Diagnostics Cholestech LDX analyser (Point of Care Diagnostics; Sydney, NSW, Australia) for lipids; and the Roche CoaguChek S (Roche Diagnostics; Sydney, NSW, Australia) for INR. Point-of-care testing in the General Practice Trial was underpinned by a quality management framework which included an on-going training and competency program for PoCT device operators. This article describes the design, implementation and results of the training and competency program. An education and training resource package was developed for the Trial consisting of a training manual, a set of A3 laminated posters and a CD ROM. Five initial training workshops were held for intervention practices from each geographic region between August and October 2005

  15. Implications for cancer genetics practice of pro-actively assessing family history in a General Practice cohort in North West London.

    Science.gov (United States)

    Kohut, Kelly; D'Mello, Lucia; Bancroft, Elizabeth K; Thomas, Sarah; Young, Mary-Anne; Myhill, Kathryn; Shanley, Susan; Briggs, Brian H J; Newman, Michelle; Saraf, Ifthikhar M; Cox, Penny; Scambler, Sarah; Wagman, Lyndon; Wyndham, Michael T; Eeles, Rosalind A; Ferris, Michelle

    2012-03-01

    At present cancer genetics referrals are reactive to individuals asking for a referral and providing a family history thereafter. A previous pilot study in a single General Practice (GP) catchment area in North London showed a 1.5-fold increase in breast cancer risk in the Ashkenazi Jewish population compared with the non-Ashkenazi mixed population. The breast cancer incidence was equal in the Ashkenazim in both pre- and postmenopausal groups. We wanted to investigate the effect of proactively seeking family history data from the entire female population of the practice to determine the effect on cancer genetics referral. Objectives To determine the need for cancer genetics intervention for women in a single GP catchment area. (1) to determine the incidence and strength of family history of cancer in women aged over 18 in the practice, (2) to offer cancer genetics advice and determine the uptake of counselling in those with a positive family history, (3) to identify potential BRCA1/BRCA2 gene mutation carriers who can be offered clinical follow up with appropriate translational research studies. Design Population-based cohort study of one General Practice female population. Participants Three hundred and eighty-three women over the age of 18 from one General Practice who responded to a questionnaire about family history of cancer. The whole female adult GP population was the target and the total number sampled was 3,820. Results 10% of patients completed the questionnaire (n = 383). A family history of cancer was present in 338 cases, 95 went on to have genetic counselling or had previously had counselling and 47 were genetically tested. We identified three carriers of an Ashkenazi Jewish founder mutation in BRCA1. Conclusions Response rate to a family history questionnaire such as that used in genetics centres was low (10%) and other approaches will be needed to proactively assess family history. Although the Ashkenazim are present in 39% of the GP catchment

  16. The temporomandibular opening index, report of headache and TMD, and implications for screening in general practice: an initial study.

    Science.gov (United States)

    Miller, Victor J; Karic, Vesna V; Ofec, Ronen; Nehete, Swati R; Smidt, Ami

    2014-01-01

    TMD and the control group. Age serves as a mild protective for reported headache. Younger patients tend to report more headaches. More frequent and severe headache occurred in the high-TOI group. This study serves as a reminder for clinicians in general practice to consider the effect of comorbidity when faced with TMD patients with headache.

  17. Impetigo in General Practice

    NARCIS (Netherlands)

    S. Koning (Sander)

    2005-01-01

    textabstractImpetigo is a common skin infection, usually caused by Staphylococcus aureus that mainly occurs in children. Patients with impetigo usually consult their general practitioner, who also treats the vast majority of cases. Impetigo is considered highly infectious, and consequently

  18. Impetigo in General Practice

    OpenAIRE

    Koning, Sander

    2005-01-01

    textabstractImpetigo is a common skin infection, usually caused by Staphylococcus aureus that mainly occurs in children. Patients with impetigo usually consult their general practitioner, who also treats the vast majority of cases. Impetigo is considered highly infectious, and consequently children are often barred from schools. Patients and doctors seek prompt treatment. Although we know the causative bacteria, we do not know what factors promote contagiousness or severity of impetigo. There...

  19. Behavioural science in general practice.

    Science.gov (United States)

    Wood, D R

    1979-10-01

    Dr Peter Sowerby has written an important criticism of Michael Balint's work based on his understanding of Karl Popper's writings. I dispute Sowerby's interpretation of Popper and disagree with his conclusions, which I suggest would lead general practice into a retreat. I believe Balint made a major contribution to general practice and has helped us towards practising whole-person medicine.

  20. Cancer Investigation in General Practice

    DEFF Research Database (Denmark)

    Jensen, Jacob Reinholdt; Møller, Henrik; Thomsen, Janus Laust

    2014-01-01

    Initiation of cancer investigations in general practice Background Close to 90% of all cancers are diagnosed because the patient presents symptoms and signs. Of these patients, 85% initiate the diagnostic pathway in general practice. Therefore, the initiation of a diagnostic pathway in general...... practice becomes extremely important. On average, a general practitioner (GP) is involved in 7500 consultations each year, and in the diagnostic process of 8-10 incident cancers. One half of cancer patients consult their GP with either general symptoms, which are not indicative of cancer, or vague and non......-specific symptoms. The other half present with what the GP assess as alarm symptoms. Three months prior to diagnosis, patients who are later diagnosed with cancer have twice as many GP consultations than a comparable reference population. Thus the complex diagnostic process in general practice requires the GP...

  1. Methodological practicalities in analytical generalization

    DEFF Research Database (Denmark)

    Halkier, Bente

    2011-01-01

    generalization. Theoretically, the argumentation in the article is based on practice theory. The main part of the article describes three different examples of ways of generalizing on the basis of the same qualitative data material. There is a particular focus on describing the methodological strategies......In this article, I argue that the existing literature on qualitative methodologies tend to discuss analytical generalization at a relatively abstract and general theoretical level. It is, however, not particularly straightforward to “translate” such abstract epistemological principles into more...... operative methodological strategies for producing analytical generalizations in research practices. Thus, the aim of the article is to contribute to the discussions among qualitatively working researchers about generalizing by way of exemplifying some of the methodological practicalities in analytical...

  2. Nigerian Journal of General Practice

    African Journals Online (AJOL)

    Nigerian Journal of General Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 1 (2011) >. Log in or Register to get access to full text downloads.

  3. Emergency medicine and general practice

    OpenAIRE

    Abela, Gunther

    2005-01-01

    Emergency Medicine and Immediate Medical Care are relatively new specialties. In Malta, there is quite a considerable area of overlap between these specialties and general practice. Indeed, the family physician is confronted with some sort of medical emergency quite regularly. The brief of this article is to go through recent developments in Emergency Medicine as applied to General Practice. The areas considered are Basic Life Support, Head Injury, Asthma, Anaphylaxis, Community Acquired Pneu...

  4. Weight Changes in General Practice

    DEFF Research Database (Denmark)

    Køster-Rasmussen, Rasmus

    2015-01-01

    INTRODUCTION: This PhD thesis is about weight changes. What determines long-term weight changes in the adult general population? Is it possible that weight loss may not always be healthy? The present clinical guidelines for general practice advice most overweight persons and patients with type 2 ...... lifestyle changes like for instance Mediterranean diet and increased exercise....

  5. Using MIQUEST in General Practice

    Directory of Open Access Journals (Sweden)

    Victoria Hammersley

    1998-11-01

    Full Text Available This paper describes ten months' experience with MIQUEST software used for the collection of data from computerised databases in General Practice. We report on the following: the MIQUEST software in use, the time costs to the practice, the completeness of confidentiality barriers and the accuracy of data collected using MIQUEST compared with similar data collected by the practice system (EMIS. There were no problems encountered with installation of MIQUEST-related software. With experience, MIQUEST was equal to the practice system for speed and ease of use. The confidentiality safeguards were found to be in accordance with the GMSC/RCGP Guidelines - patients could not be directly, or indirectly, identified from the data extracted by external searches. Inaccuracies in the data collected using MIQUEST were identified, but these were largely attributable to problems with the EMIS-written interpreter available on the practice system at the time, or with the coding schemes used by the practice. In an individual practice, MIQUEST represents an alternative data collection method to the practice-based software. For data collection from multiple general practices it should prove an invaluable tool for Health Authorities and research organisations.

  6. Periodontal Emergencies in General Practice.

    Science.gov (United States)

    Wadia, Reena; Ide, Mark

    2017-05-01

    Diagnosing and managing periodontal emergencies is a common part of general dental practice. This article summarises the presentation, aetiology and management of the key periodontal emergencies, including gingival abscess, periodontal abscess, peri-coronitis/peri-coronal abscess, perio-endo lesion/ abscess, necrotising gingivitis and periodontitis, acute herpetic gingivostomatitis, acute physical/chemical/thermal injury and subgingival root fracture.

  7. Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia

    OpenAIRE

    Ghosh, Abhijeet; Charlton, Karen E; Batterham, Marijka J

    2016-01-01

    Objectives To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Design Cross-sectional secondary analysis of data. Setting Primary healthcare?17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). Participants A subset (n=36?674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118?794) that included information on disease status of all adult patients who had hei...

  8. Epilepsy care in general practice.

    LENUS (Irish Health Repository)

    Varley, J

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  9. Drug users in contact with general practice.

    Science.gov (United States)

    Robertson, J R

    1985-01-05

    A group of heroin users who are in contact with a general practice in north west Edinburgh are described. The study group was younger and included more women than previous studies. These people used a large variety of drugs and mainly purchased them locally. Frequent and often prolonged abstinent periods occurred with no prescribed opiate treatment. The group had experienced a high rate of drug related medical disorders. All these points raise the possibility that opiate users who are known to general practitioners may be a distinctly different population from those who attend drug dependency clinics. The frequency of remission and the prevalence of polydrug use have profound implications for planning and evaluating an effective medical response.

  10. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  11. Nigerian Journal of General Practice: Submissions

    African Journals Online (AJOL)

    Author Guidelines. The Nigerian Journal of General Practice is the Official Publication of the Association of General and Private Medical Practitioners of Nigeria [AGPMPN] and a forum for family private/general practice medicine education and research. The Nigerian Journal of General Practice invites scholarly manuscripts ...

  12. A critical incident study of general practice trainees in their basic general practice term.

    Science.gov (United States)

    Diamond, M R; Kamien, M; Sim, M G; Davis, J

    1995-03-20

    To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

  13. Nigerian Journal of General Practice: Journal Sponsorship

    African Journals Online (AJOL)

    Nigerian Journal of General Practice: Journal Sponsorship. Journal Home > About the Journal > Nigerian Journal of General Practice: Journal Sponsorship. Log in or Register to get access to full text downloads.

  14. Weight Changes in General Practice.

    Science.gov (United States)

    Køster-Rasmussen, Rasmus

    2017-06-01

    This PhD thesis is about weight changes. What determines long-term weight changes in the adult general population? Is it possible that weight loss may not always be healthy? The present clinical guidelines for general practice advice most overweight persons and patients with type 2 diabetes to lose weight. Are the guidelines based on firm evidence?   METHODS: The back-bone of the thesis is constituted by three scientific articles based on three different population based cohort studies. Multivariable modeling and other epidemiological methods were used.   RESULTS: Article 1 examined weight changes in the general population in relation to smoking status, and proposed a graphical 'smoking cessation weight change model', demonstrating the importance of time, age and smoking status in relation to long-term weight changes. Article 2 suggested new methods to improve the processing of dietary data. It was demonstrated how median imputation for missing values and assumptions about standard portion sizes were inferior to stochastic methods conditioning on information about physiology of the individual. Article 3 evaluated the influence of prospectively planned intentional weight loss on long-term morbidity and mortality in patients with type 2 diabetes. Therapeutic intentional weight loss supervised by a medical doctor was not associated with reduced morbidity or mortality. In the general population the dietary intake of fructose and soft drinks sweetened with sugar was not associated with weight change over 9 years. Weight gain rates were large in young adults and incrementally smaller in middle aged adults. Subjects more than 60 years lost weight on average. Historical weight data suggest that the body weight increases throughout life to the age of 60-65years. A study with simulated data indicates that bias in baseline BMI may misleadingly have favored weight loss in earlier cohort studies of intentional weight loss and mortality.   DISCUSSION: The findings regarding

  15. Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia.

    Science.gov (United States)

    Ghosh, Abhijeet; Charlton, Karen E; Batterham, Marijka J

    2016-05-03

    To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Cross-sectional secondary analysis of data. Primary healthcare-17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). A subset (n=36 674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118 794) that included information on disease status of all adult patients who had height and weight measurements recorded in their electronic health records and had visited the included general practices within the Illawarra-Shoalhaven region of NSW between September 2011 and September 2013. Age-adjusted odds ratio (aOR) of overweight and obesity was determined for high and low levels of socioeconomic disadvantage based on Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD) scores of patients' residential statistical local area. In men, overweight was lowest in areas of highest socioeconomic disadvantage (aOR=0.910; 95% CI 0.830 to 0.998; pdisadvantage (aOR=1.292; 95% CI 1.210 to 1.379; pdata analysis reveals multiple layers of evidence that should be assessed for population health approaches to curb the epidemic of obesity and overweight. It strongly highlights the need for preventive health initiatives to be specific to gender and socioeconomic attributes of the target population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Course organizers in general practice.

    Science.gov (United States)

    Williams, A. H.

    1986-01-01

    In August/September 1984 a survey of the 267 course organizers in post in England and Wales was carried out. Eighty-two per cent replied to a questionnaire asking for details about their work and personal status. All 16 regions in England and Wales completed a questionnaire about levels of staffing and remuneration of those involved in general practice postgraduate education. The results show that there are considerable variations between regions in the role and responsibilities of course organizers, in their training, and in the facilities that are provided for them. The majority of course organizers reported a workload greater than the number of sessions for which they were remunerated. The effects of these factors on recruitment, tenure of post, and job satisfaction are discussed. Recommendations are made for improving the situation, including the removal of course organizer pay from the scale of trainers' pay, so that there can be flexibility in the number of sessions which can be held, improvement in training and certain facilities, and the implementation of national and local job descriptions. PMID:2577940

  17. Outcomes of endodontic therapy in general practice

    Science.gov (United States)

    Bernstein, Susan D.; Horowitz, Allan J.; Man, Martin; Wu, Hongyu; Foran, Denise; Vena, Donald A.; Collie, Damon; Matthews, Abigail G.; Curro, Frederick A.; Thompson, Van P.; Craig, Ronald G.

    2014-01-01

    Background The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy. Methods Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion. Results P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity. Conclusions These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data. Clinical Implications The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for

  18. How common is multiple general practice attendance in Australia?

    Science.gov (United States)

    Wright, Michael; Hall, Jane; van Gool, Kees; Haas, Marion

    2018-05-01

    Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.

  19. Implications of Risk Management Practices on Financial ...

    African Journals Online (AJOL)

    Implications of Risk Management Practices on Financial Performance of Sugar ... The respondents were functional heads of the companies under the survey. ... of downside losses in order to minimize the negative impact of risk on returns.

  20. Patients' satisfaction with healthcare: comparing general practice ...

    African Journals Online (AJOL)

    Patients' satisfaction with healthcare: comparing general practice services in a tertiary and primary healthcare settings. ... Nigerian Health Journal ... This research compared the level of patients' satisfaction with general practice care delivered at physicians-manned General Outpatient clinics at tertiary and primary health ...

  1. Sphygmomanometers--an audit in general practice.

    Science.gov (United States)

    Shah, Nayankumar C; Sibbritt, David W; Heaney, Susan; Sharples, Jan

    2004-11-01

    The accuracy of sphygmomanometers used in Australian general practice is unknown but potentially important. We measured the accuracy of sphygmomanometers in general practice in the Hunter region of New South Wales using a gold standard. Practices were recruited by an advertisement in the division newsletter. Sixty practices (35%) volunteered. A total of 404 instruments were checked. Over 95% of sphygmomanometers were within 4 mmHg of gold standard sphygmomanometer across the clinical pressure range. Mercury sphygmomanometers were more accurate than aneroid (pmercury.

  2. Nutrition communication in general practice

    NARCIS (Netherlands)

    Dillen, van S.M.E.; Hiddink, G.J.; Koelen, M.A.; Graaf, de C.; Woerkum, van C.M.J.

    2006-01-01

    General practitioners (GPs) are frequently confronted with patients who suffer from obesity or other nutrition-related diseases, such as diabetes and coronary heart disease. There is increasing evidence that nutrition communication is effective in changing nutrition behaviour. Moreover, it is widely

  3. Eating disorders in general practice.

    Science.gov (United States)

    King, M B

    1986-01-01

    A total of 748 patients who attended four south London group practices were screened using the eating attitudes test; 1% of women had bulimia nervosa and a further 3% a partial syndrome eating disorder. Eating and weight control behaviour and psychiatric indicators for an eating disorder were analysed. Patients with bulimia nervosa and partial syndromes were remarkably similar. They were mainly women, from the middle to upper classes, in the normal weight range but having had considerable weight fluctuation in the past, more likely to have had a history of menstrual irregularity, often psychologically troubled, and tended to have more family psychopathology. PMID:3099893

  4. Practical implications of 'postmodern philosophy'

    Directory of Open Access Journals (Sweden)

    Savić Mile V.

    2002-01-01

    Full Text Available The article examines the implications of the discourse about postmodernity. Postmodernity is analyzed as a complex discursive figure. Within the discourse about postmodernity three levels are distinguished: the postmodern condition, postmodernism, and reflection of the postmodern condition. Special attention is paid to globalization and the problem of the enforcement of modern projects in East-European societies, particularly Serbia. These societies are termed object-societies, while their modification of modernity is called eastmodernity. The author's answer to the complexity of the postmodern condition is a conception of the politics of subsistence.

  5. Accreditation in general practice in Denmark

    DEFF Research Database (Denmark)

    Andersen, Merethe K; Pedersen, Line B; Siersma, Volkert

    2017-01-01

    Background: Accreditation is used increasingly in health systems worldwide. However, there is a lack of evidence on the effects of accreditation, particularly in general practice. In 2016 a mandatory accreditation scheme was initiated in Denmark, and during a 3-year period all practices, as default...... general practitioners in Denmark. Practices allocated to accreditation in 2016 serve as the intervention group, and practices allocated to accreditation in 2018 serve as controls. The selected outcomes should meet the following criteria: (1) a high degree of clinical relevance; (2) the possibility...... practice and mortality. All outcomes relate to quality indicators included in the Danish Healthcare Quality Program, which is based on general principles for accreditation. Discussion: The consequences of accreditation and standard-setting processes are generally under-researched, particularly in general...

  6. Education in General Practice in the Netherlands*

    African Journals Online (AJOL)

    practice and the other half to research and group discus- sions with the students. In the 4th, 6th and 7th years, group discussions are held with students about capita selecta chosen in consultation with the students and about casuis- tics in the general practitioner~ practice. In Utrecht a university group-practice is Jeveloping,.

  7. Gastroenteritis in sentinel general practices, the Netherlands.

    NARCIS (Netherlands)

    Wit, M.A.S. de; Koopmans, M.P.G.; Kortbeek, L.M.; Leeuwen, N.J. van; Bartelds, A.I.M.; Duynhoven, Y.T.H.P. van

    2001-01-01

    From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for

  8. Guidelines for computer security in general practice.

    Science.gov (United States)

    Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

    2007-01-01

    As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making

  9. Some practical implications of source term reassessment

    International Nuclear Information System (INIS)

    1988-03-01

    This report provides a brief summary of the current knowledge of severe accident source terms and suggests how this knowledge might be applied to a number of specific aspects of reactor safety. In preparing the report, consideration has been restricted to source term issues relating to light water reactors (LWRs). Consideration has also generally been restricted to the consequences of hypothetical severe accidents rather than their probability of occurrence, although it is recognized that, in the practical application of source term research, it is necessary to take account of probability as well as consequences. The specific areas identified were as follows: Exploration of the new insights that are available into the management of severe accidents; Investigating the impact of source term research on emergency planning and response; Assessing the possibilities which exist in present reactor designs for preventing or mitigating the consequences of severe accidents and how these might be used effectively; Exploring the need for backfitting and assessing the implications of source term research for future designs; and Improving the quantification of the radiological consequences of hypothetical severe accidents for probabilistic safety assessments (PSAs) and informing the public about the realistic risks associated with nuclear power plants. 7 refs

  10. Mentoring medical students in your general practice.

    Science.gov (United States)

    Fraser, John

    2016-05-01

    Mentoring medical students in general practices is becoming more common in Australia due to formalised scholarship programs and informal approaches by students. This paper defines mentoring in Australian general practice. Practical suggestions are made on how to structure a mentorship program in your practice. Mentoring differs from leadership and teaching. It is a long-term relationship between a student and an experienced general practitioner. Avoiding summative assessment in mentorship is important to its success. Mentoring is about forming a safe place to confidentially discuss personal and professional issues between a mentor and student. This is based on defining roles and mutual trust. At the same time, students crave formative feedback. Unfortunately, present feedback models are based on teaching principles that can blur the differences between assessor, teacher and mentor. Mentorship can provide students with orientation and learning experiences so that they are prepared for practice as an intern.

  11. Organization and change in general practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl

    Organization and change in general practice Abstract for a symposium at Nordic Congress for General Practice Thursday 14 May at 15.30-17.00 General practice is under increasing pressure to assume new tasks, adopt new technologies and engage in new organizational structures. However, in a field...... of multiple actors and concerns such visions are rarely straightforward to realize. This symposium explores the significance of various organizational, cultural and regulative features of general practice in relation to proposals for change in the sector. Presentations: Thorkil Thorsen, Marius Kousgaard...... primary care. One purpose is to give more freedom to the patients to choose care-givers. Another is to create a more competitive health care system. These reforms will be evaluated in a research project to be presented. Chairman: John Sahl Andersen MESH-terms: Delivery of Health Care, Health Care Reform...

  12. Small business, cash budgets and general practice.

    Science.gov (United States)

    Jackson, A R

    1991-01-01

    In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

  13. Undertreatment of urinary incontinence in general practice.

    NARCIS (Netherlands)

    Penning-van Beest, F.J.A.; Sturkenboom, M.C.; Bemelmans, B.L.H.; Herings, R.M.C.

    2005-01-01

    BACKGROUND: In the urinary incontinence guidelines that are issued by the Dutch College of General Practitioners, treatment guidelines are related to the type of incontinence. It is unknown whether treatment of urinary incontinence in general practice complies with these guidelines. OBJECTIVE: To

  14. Teacher's experiences in PBL: implications for practice

    Science.gov (United States)

    Alves, Anabela C.; Sousa, Rui M.; Fernandes, Sandra; Cardoso, Elisabete; Carvalho, Maria Alice; Figueiredo, Jorge; Pereira, Rui M. S.

    2016-03-01

    Project-Based Learning (PBL) has been implemented in the first year of the Industrial Engineering and Management programme at the University of Minho, Portugal, since 2004/2005. The purpose of this paper is to analyse and discuss teachers' experiences in PBL in this programme and to explore its implications for student learning and for teaching practices in higher education. For data collection, the research method used was written narratives to these teachers, at the end of the PBL semester. Findings suggest that teachers express a positive view of PBL as a learning approach. They identify student motivation and engagement, along with a better understanding of the application of concepts in real-life situations, as important outcomes of the project for students. Besides this, teachers also highlight the importance of the development of transversal skills by students throughout the project. Recommendations for future work and implications for practice will also be discussed.

  15. Rating scales in general practice depression

    DEFF Research Database (Denmark)

    Bech, Per; Paykel, Eugene; Sireling, Lester

    2015-01-01

    BACKGROUND: Our objective was to investigate to what extent the Clinical Interview for Depression (CID) used in the general practice setting covers clinically valid subscales (depression, anxiety, and apathy) which can measure outcome of antidepressant therapy as well as identifying subsyndromes...... within major depressive disorder. The CID was compared to the Hamilton Depression Rating Scale (HAM-D17). METHODS: 146 patients from a previous study in general practice with the CID were investigated. The item response theory model established by Rasch was used to investigate the scalability (a scale...... (approximately 20%) had an atypical depression. LIMITATIONS: The samples were derived from a single study and were all rated by a single rater. CONCLUSION: The CID contains subscales of depression, anxiety, and apathy with an acceptable scalability for use in general practice. A subsyndrome of atypical...

  16. Management in general practice: the challenge of the new General Medical Services contract.

    Science.gov (United States)

    Checkland, Kath

    2004-10-01

    Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the

  17. Prognostic factors for neckpain in general practice.

    NARCIS (Netherlands)

    Hoving, J.L.; Vet, H.C.W. de; Twisk, J.W.R.; Devillé, W.L.J.M.; Windt, D. van der; Koes, B.W.; Bouter, L.M.

    2004-01-01

    Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age,

  18. Effects of electronic communication in general practice

    NARCIS (Netherlands)

    van der Kam, WJ; Moorman, PW; Koppejan-Mulder, MJ

    2000-01-01

    Objective: To obtain insight into the effects of electronic communication on GPs by studying those publications in literature describing the effects of structured electronic clinical communication in general practice. Methods: We retrieved all publications in the English language indexed in MEDLINE

  19. Guidelines for computer security in general practice

    Directory of Open Access Journals (Sweden)

    Peter Schattner

    2007-06-01

    Conclusions This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

  20. The existential dimension in general practice

    DEFF Research Database (Denmark)

    Assing Hvidt, Elisabeth; Søndergård, Jens; Ammentorp, Jette

    2016-01-01

    OBJECTIVE: The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP-patient encounter. DESIGN: A qualitative methodology with semi......-structured focus group interviews was employed. SETTING: General practice setting in Denmark. SUBJECTS: Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. RESULTS: Although understood to involve broad life conditions such as present and future being...... POINTS: Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs’ understanding and integration of this dimension in the GP-patient encounter. The existential dimension is understood to involve broad and universal life conditions...

  1. The existential dimension in general practice

    DEFF Research Database (Denmark)

    Assing Hvidt, Elisabeth; Søndergaard, Jens; Ammentorp, Jette

    2016-01-01

    Objective: The objective of this study is to identify points of agreement and disagreements among general practitioners (GPs) in Denmark concerning how the existential dimension is understood, and when and how it is integrated in the GP–patient encounter. Design: A qualitative methodology with semi......-structured focus group interviews was employed. Setting: General practice setting in Denmark. Subjects: Thirty-one GPs from two Danish regions between 38 and 68 years of age participated in seven focus group interviews. Results: Although understood to involve broad life conditions such as present and future being...... points Although integration of the existential dimension is recommended for patient care in general practice, little is known about GPs’ understanding and integration of this dimension in the GP–patient encounter. The existential dimension is understood to involve broad and universal life conditions...

  2. Management of upper dyspepsia in general practice

    DEFF Research Database (Denmark)

    Kjeldsen, Hans Christian; Kier, Svend; Husum, Gitte

    ) for two weeks. If symptoms were unchanged after to weeks => referral to endoscopy. Later recurrence of symptoms => endoscopy (> 45 year) or management strategy according to helicobacter pylori status and/or clinical reflux (measures...... of dyspepsia, dyspeptic episodes, main symptom, previous contact to general practice, previous gastroscopia, use of antacids or NSAID's, Helicobacter Pylori status and mental/physical well being (SF-36 measurement scale) (Table 1). After two weeks the GPs assessed 46 % of the patients to be free of symptoms...... Aim: To compare the effect of two strategies for management of dyspepsia. Evaluation based on GP's assessment after two weeks and patients assessment after three months.   Design: Prospective randomised controlled trial in general practice   Methods: 357 patients with dyspepsia where the general...

  3. E-dietician in general practice

    DEFF Research Database (Denmark)

    Brandt, Carl J.; Arendal, Cecilia; Glintborg, Dorte

    2010-01-01

    Obesity is according to WHO one of the greatest health challenges of our time. The aim of the pilot project was to investigate the weight loss efficacy and the cost of individual dietetic internet-based consultations in a Danish medical centre in combination with an internet community. A total...... of 46 obese patients in general practice were offered participation in a cohort study during May 15th to December 1st 2008. Patients from three different health centers were included. 32 patients gave informed consent to participate and were given access to weekly e-mail consultations with a dietician...... weight loss treatments in general practice. The utilization of e-mail consultations can furthermore result in a saving in expenses and premises if the e-mail correspondences are held outside of the health centre....

  4. Relational Coordination in Danish General Practice

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke

    . The dissertation present the research study and a collection of three research papers prepared during the period from May 2010 to June 2014. Relational coordination and organisational social capital are measures of novel aspects of an organisation's performance. Relational coordination analyse the communication...... and relationship networks through which work is coordinated across functional and organisational boundaries. Previous studies have shown that relational coordination is positively associated with delivery of care for patients with chronic illness. Organisational social capital is used when analysing...... the psychosocial work environment in organisations, and is seen as a powerful resources for improving organisational performance. Relational coordination and organisational social capital may oer new insight and opportunities for general practice to learn. General practice provides cost-efficient, first...

  5. Collaborative care for depression in general practice

    DEFF Research Database (Denmark)

    Brinck-Claussen, Ursula Ødum; Curth, Nadja Kehler; Davidsen, Annette Sofie

    2017-01-01

    Background: Depression is a common illness with great human costs and a significant burden on the public economy. Previous studies have indicated that collaborative care (CC) has a positive effect on symptoms when provided to people with depression, but CC has not yet been applied in a Danish...... context. We therefore developed a model for CC (the Collabri model) to treat people with depression in general practice in Denmark. Since systematic identification of patients is an “active ingredient” in CC and some literature suggests case finding as the best alternative to standard detection, the two...... detection methods are examined as part of the study. The aim is to investigate if treatment according to the Collabri model has an effect on depression symptoms when provided to people with depression in general practice in Denmark, and to examine if case finding is a better method to detect depression...

  6. Antibiotic Prescription in Danish General Practice

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Plejdrup Hansen, Malene; Pedersen, Line Bjørnskov

    2016-01-01

    1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...... will explore how the GPs prescription behaviour is influenced by selected factors. Antibiotics are essential when treating potentially lethal infections. An increasing development of resistant bacteria is considered one of the primary threats to public health. The majority of antibiotics (90%) are prescribed...... from general practice. The prescription of broad-spectrum antibiotics can cause unnecessary side effects for the individual and increases the risk of development of bacteria resistant to antibiotic treatment. Both the prescription of broad-spectrum antibiotics and the level of resistant bacteria...

  7. PROBLEMS OF GENERAL PRACTICE IN RURAL CALIFORNIA

    Science.gov (United States)

    Carey, Hollis L.; Andrews, Carroll B.

    1949-01-01

    Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of “local health councils.” Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods. The problem of providing additional adequately equipped and staffed hospitals must receive much consideration. Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice. PMID:18116230

  8. General practice registrars' views on maternity care in general practice in New Zealand.

    Science.gov (United States)

    Preston, Hanna; Jaye, Chrystal; Miller, Dawn L

    2015-12-01

    The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand.

  9. [Dealing with diagnostic uncertainty in general practice].

    Science.gov (United States)

    Wübken, Magdalena; Oswald, Jana; Schneider, Antonius

    2013-01-01

    In general, the prevalence of diseases is low in primary care. Therefore, the positive predictive value of diagnostic tests is lower than in hospitals where patients are highly selected. In addition, the patients present with milder forms of disease; and many diseases might hide behind the initial symptom(s). These facts lead to diagnostic uncertainty which is somewhat inherent to general practice. This narrative review discusses different sources of and reasons for uncertainty and strategies to deal with it in the context of the current literature. Fear of uncertainty correlates with higher diagnostic activities. The attitude towards uncertainty correlates with the choice of medical speciality by vocational trainees or medical students. An intolerance of uncertainty, which still increases as medicine is making steady progress, might partly explain the growing shortage of general practitioners. The bio-psycho-social context appears to be important to diagnostic decision-making. The effect of intuition and heuristics are investigated by cognitive psychologists. It is still unclear whether these aspects are prone to bias or useful, which might depend on the context of medical decisions. Good communication is of great importance to share uncertainty with the patients in a transparent way and to alleviate shared decision-making. Dealing with uncertainty should be seen as an important core component of general practice and needs to be investigated in more detail to improve the respective medical decisions. Copyright © 2013. Published by Elsevier GmbH.

  10. Psychiatric disorders and general medical conditions: implications ...

    African Journals Online (AJOL)

    African Journal of Psychiatry ... They are also at increased risk of contracting HIV. ... As medical practice becomes more specialized and arguably compartmentalized it may increasingly fail to integrate health care for patients with severe mental ...

  11. Medical Malpractice Implications of Clinical Practice Guidelines.

    Science.gov (United States)

    Ruhl, Douglas S; Siegal, Gil

    2017-08-01

    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  12. Prevalence of fatigue in general practice.

    Science.gov (United States)

    Cullen, W; Kearney, Y; Bury, G

    2002-01-01

    Fatigue is an important symptom in general practice due to its association with physical, psychological and social problems. To determine the prevalence of fatigue as an unsolicited symptom during general practice consultations. A random sample of GPs practising in Ireland was invited to provide data on consultations held over one day. Data were recorded on the presence of fatigue as a main or supporting symptom, social and demographic characteristics. Data were recorded by 89 GPs on 1,428 consultations. The prevalence of fatigue was 25%. It was the main reason for attending the doctor in 6.5% and a secondary reason in 19%. Sixty-two per cent of patients were female and 48% were eligible for free GP services. The mean age was 47.1 years. The presence of fatigue was associated with: attending a female GP, being female, attending a GP who had been qualified for fewer years and attending the GP frequently. The prevalence of fatigue reported in this study is over three times higher than that reported in earlier work. Doctor characteristics appear to be as important as patient characteristics in determining fatigue.

  13. Interacting institutional logics in general dental practice.

    Science.gov (United States)

    Harris, Rebecca; Holt, Robin

    2013-10-01

    We investigate the organisational field of general dental practice and how agents change or maintain the institution of values associated with the everyday work of health care provision. Our dataset comprise archival literature and policy documents, interview data from field level actors, as well as service delivery level interview data and secondary data gathered (2011-12) from 16 English dental practices. Our analysis provides a typology of institutional logics (prevailing systems of value) experienced in the field of dental practice. Confirming current literature, we find two logics dominate how care is assessed: business-like health care and medical professionalism. We advance the literature by finding the business-like health care logic further distinguished by values of commercialism on the one hand and those of accountability and procedural diligence on the other. The logic of professionalism we also find is further distinguished into a commitment to clinical expertise and independence in delivering patient care on the one hand, and concerns for the autonomy and sustainability of a business enterprise on the other. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. A qualitative study of collaboration in general practice: understanding the general practice nurse's role.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2017-07-01

    To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations. © 2016 John Wiley & Sons Ltd.

  15. Team climate for innovation: what difference does it make in general practice?

    Science.gov (United States)

    Proudfoot, Judith; Jayasinghe, Upali W; Holton, Chris; Grimm, Jane; Bubner, Tanya; Amoroso, Cheryl; Beilby, Justin; Harris, Mark F

    2007-06-01

    Teamwork in primary healthcare is associated with patient care processes and staff outcomes. The ability of teams to be innovative is a hypothesized mechanism. We examined the characteristics of general practices with good team climate for innovation, and assessed the impact of climate on chronically ill patients' assessment of their care and on the job satisfaction of the staff. Large cross-sectional study. Australian general practices. A total of 654 general practitioners and staff and 7505 chronically ill patients from 93 general practices in 6 Australian states and territories. The Team Climate Inventory and the Overall Job Satisfaction Scale, customized for use with general practices, were administered to general practitioners and practice staff, and the General Practice Assessment Survey was administered to patients. Practice characteristics were collected by survey from the principal doctor or practice manager. Mean scores of team climate in Australian general practices were similar to those reported in the UK, except that in our study there was no association between the number of doctors in a practice and their team climate. Better team climate was found in practices with fewer non-clinical staff. Team climate predicted the job satisfaction of the general practitioners and staff, irrespective of the number of practice staff. Better team climate was associated with greater satisfaction by patients with their care. Team climate is important for patient and staff satisfaction. In large general practices, separate sub-cultures may exist between administrative and clinical staff, which has implications for designing effective team interventions.

  16. General practice in the Nordic countries

    Directory of Open Access Journals (Sweden)

    Kim Rose Olsen

    2016-04-01

    Full Text Available Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly

  17. Language practice as games: Implications for sociology of ...

    African Journals Online (AJOL)

    Language practice as games: Implications for sociology of translation in development contexts in Africa. ... Abstract. Drawing from Game Theory, the article conceptualises language practice as games, that is ... AJOL African Journals Online.

  18. Child Rearing Practices in Nigeria: Implications for Mental Health ...

    African Journals Online (AJOL)

    Child Rearing Practices in Nigeria: Implications for Mental Health. ... over time are important, especially as this region is undergoing rapid transformation. ... Through policy and aggressive health education, traditional child rearing practices in ...

  19. Discontinuation of Preventive Drugs in General Practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Lindberg, Laura Maria Glahder; Nixon, Michael Simon

    Introduction: In Denmark about 600,000 persons are treated for hypertension and more than 300,000 people are receiving cholesterol lowering drugs. The prevalence of hypertension in people aged 80 years is 70%. For antidepressants the defined daily doses/1000 aged >80 years/day exceed 200. By far...... the most preventive drugs are prescribed in general practice. Special considerations exist in relation to medication of elderly patients. The prevalence of polypharmacy and the subsequent increased risk of side effects and drug interactions is high. Drug-related problems represent the fifth leading cause...... of death in the United States. The public expenses to drug treatment are constantly increasing. The possibility to withdraw the medication must be taken into account but the decision to discontinue drugs is complex and poorly understood. Planned studies: 1. Patients’ views upon discontinuation...

  20. An approach to vertigo in general practice.

    Science.gov (United States)

    Dommaraju, Sindhu; Perera, Eshini

    2016-04-01

    Dizziness is a common and very distressing presentation in general practice. In more than half of these cases, the dizziness is due to vertigo, which is the illusion of movement of the body or its surroundings. It can have central or peripheral causes, and determining the cause can be difficult. The aim of this article is to provide a clear framework for approaching patients who present with vertigo. A suggested approach to the assessment of vertigo is outlined. The causes of vertigo may be central (involving the brainstem or cerebellum) or peripheral (involving the inner ear). A careful history and physical examination can distinguish between these causes. The most common causes of vertigo seen in primary care are benign paroxysmal positional vertigo (BPPV), vestibular neuronitis (VN) and Ménière's disease. These peripheral causes of vertigo are benign, and treatment involves reassurance and management of symptoms.

  1. Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

    Directory of Open Access Journals (Sweden)

    Wagner AC

    2010-09-01

    Full Text Available Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS statistics, Quality and Outcomes Framework (QOF, 2001 Census and 2004 Index of Multiple Deprivation (IMD. Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.

  2. General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements.

    Science.gov (United States)

    Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun

    2012-01-01

    The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?

  3. Education System Reform in China after 1978: Some Practical Implications

    Science.gov (United States)

    Sun, Miantao

    2010-01-01

    Purpose: This paper aims to provide an overview of education system reform in China since 1978, and its practical implications. Design/methodology/approach: Data were collected from literature review and interview. An overview of education system reform and its practical implications was found through data analysis. Findings: There has been two…

  4. Practical implications of neutron survey instrument performance

    International Nuclear Information System (INIS)

    Tanner, R. J.; Bartlett, D. T.; Hager, I. G.; Jones, I. N.; Molinos, C.; Roberts, N. J.; Taylor, G. C.; Thomas, D. J.

    2004-01-01

    Improvements have been made to the Monte Carlo modelling used to calculate the response of the neutron survey instruments most commonly used in the UK, for neutron energies up to 20 MeV. The improved modelling of the devices includes the electronics and battery pack, allowing better calculations of both the energy and angle dependence of response. These data are used to calculate the response of the instruments in rotationally and fully isotropic, as well as unidirectional fields. Experimental measurements with radionuclide sources and monoenergetic neutron fields have been, and continue to be made, to test the calculated response characteristics. The enhancements to the calculations have involved simulation of the sensitivity of the response to variations in instrument manufacture, and will include the influence of the user and floor during measurements. The practical implications of the energy and angle dependence of response, variations in manufacture, and the influence of the user are assessed by folding the response characteristics with workplace energy and direction distributions. (authors)

  5. Relative age effect: implications for effective practice.

    Science.gov (United States)

    Andronikos, Georgios; Elumaro, Adeboye Israel; Westbury, Tony; Martindale, Russell J J

    2016-01-01

    Physical and psychological differences related to birthdate amongst athletes of the same selection year have been characterised as the "relative age effects" (RAEs). RAEs have been identified in a variety of sports, both at youth and adult level, and are linked with dropout of athletes and a reduction of the talent pool. This study examined the existence, mechanisms and possible solutions to RAEs using qualitative methodology. Seven experts in the field of talent identification and development were interviewed. Inductive analysis of the data showed that, while there was mixed evidence for the existence of RAEs across sports, the eradication of RAEs was attributed to controllable features of the development environment. The factors reported included the structure of "categories" used to group athletes within the sport (e.g. age, weight, size, skills), recognition and prioritisation of long-term development over "short term win focus." Education of relevant parties (e.g. coaches, scouts, clubs) about RAEs and the nature of "talent" within a long-term context was suggested, along with careful consideration of the structure of the development environment (e.g. delayed selection, provision for late developers, focus on skills not results, use of challenge). Implications for research and practice are discussed.

  6. Practical implications of the new risk perspectives

    International Nuclear Information System (INIS)

    Aven, Terje

    2013-01-01

    In recent years several authors have argued for the adoption of certain new types of risk perspectives which highlight uncertainties rather than probabilities in the way risk is understood and measured. The theoretical rationale for these new perspectives is well established, but the practical implications have not been so clearly demonstrated. There is a need to show how the new perspectives change the way risk is described and communicated in real-life situations and in its turn the effects on risk management and decision making. The present paper aims at contributing to this end by considering two cases, related to a national risk level, and a specific analysis concerning an LNG plant. The paper concludes that the new risk perspectives influence the current regime in many ways, in particular the manner in which the knowledge dimension is described and dealt with. Two methods for characterising the strength of knowledge are presented, one of them based on a new concept, the “assumption deviation risk”, reflecting risks related to the deviations from the conditions/states defined by the assumption made

  7. [Epidemiology of fatigue in general practice].

    Science.gov (United States)

    Fuhrer, R

    1994-11-01

    The epidemiology of fatigue is not well known in France, and this study reports on factors associated with fatigue in a sample of 3,784 general practice patients. Prevalence rates according to several definitions of fatigue are presented and factors are examined that have been reported to be associated with fatigue. Although 41.2% of the sample report having experienced symptoms of fatigue for at least three days, only 7.6% declare fatigue as a reason for consulting a doctor. Women report more symptoms of fatigue, but they do not consult more often than men for this reason. Age is strongly correlated with fatigue, but this is found only for men. Socioprofessional category bears no relationship to fatigue as a reason for consultation, however, the diagnosis of fatigue is more often attributed to professionals and upper management than it is to office staff or skilled and unskilled workers. We do find a strong relationship between depressive symptomatology as measured by the Center for Epidemiologic Studies (CES-D) and fatigue; nonetheless, fatigue is neither sensitive nor specific to the diagnosis of depression.

  8. Sex differences among recipients of benzodiazepines in Dutch general practice.

    NARCIS (Netherlands)

    Waals, F.W. van der; Mohrs, J.; Foets, M.

    1993-01-01

    Objective: To analyse sex differences among recipients of benzodiazepines in Dutch general practice. Design-Study of consultations and associated interventions as recorded in the Dutch national survey of general practice. Setting: Practices of 45 general practitioners monitored during 1 April to 30

  9. Teacher's reading comprehension: Implication for teaching practices

    Directory of Open Access Journals (Sweden)

    Adriana Benevides Soares

    2010-11-01

    Full Text Available A question of interest for educational workers is the reading comprehension process, a fundamental ability for progress in more advanced years of schooling, and its effect on pedagogical practices. This is a study that explores this question. A reading comprehension instrument composed by four structural levels of text and a scale of pedagogical practice composed by four sub-scales involving: cognitive practices with linguistic focus, cognitive practices, affective and motor practices, continuous education, was used. The results of 53 children suggest a slight tendency of teacher to prioritize cognitive practices independently of their reading comprehension level.

  10. General Practitioners' Familiarity, Attitudes and Practices with ...

    African Journals Online (AJOL)

    ... Practices with Regard to Attention Deficit Hyperactivity Disorder in Children and Adults. ... Log in or Register to get access to full text downloads. ... With regard to children the most important barriers were uninformed parents (70%), limited ...

  11. Engaging Musical Practices: A Sourcebook for Middle School General Music

    Science.gov (United States)

    Burton, Suzanne L., Ed.

    2012-01-01

    Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

  12. Implementing Comprehensive Reform: Implications for Practice

    Science.gov (United States)

    Stout, Karen A.

    2016-01-01

    This chapter describes the challenges and practical barriers community colleges face when implementing comprehensive reform, exploring how reforms are leading to some improvements but not often scaled improvements.

  13. General Practice Teaching--Within the Hospital

    Science.gov (United States)

    Drury, M.

    1976-01-01

    A program of integrated teaching by consultants and general practitioners is described. The teaching took place in the hospitals used for the purpose by the Medical Faculty of the University of Birmingham. (Author)

  14. Democratic Schooling in Norway: Implications for Leadership in Practice

    Science.gov (United States)

    Moller, Jorunn

    2006-01-01

    This article explores the meaning of an education based on democratic values and the implications for school leadership in practice. Based on findings from a case study in a Norwegian upper secondary school, the study describes democratic school leadership in practice, with particular attention to the distribution of power and leadership in the…

  15. Stakeholder experiences with general practice pharmacist services: a qualitative study.

    Science.gov (United States)

    Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

    2013-09-11

    To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of

  16. Quality of stroke prevention in general practice: relationship with practice organization

    NARCIS (Netherlands)

    J.S. de Koning (Johan); N.S. Klazinga (Niek); P.J. Koudstaal (Peter Jan); A. Prins (Ad); G.J.J.M. Borsboom (Gerard); J.P. Mackenbach (Johan)

    2005-01-01

    textabstractOBJECTIVE: To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. DESIGN: This study was conducted among 69 Dutch general practitioners in the

  17. Quality of stroke prevention in general practice: relationship with practice organization

    NARCIS (Netherlands)

    de Koning, Johan S.; Klazinga, Niek; Koudstaal, Peter J.; Prins, A. D.; Borsboom, Gerard J. J. M.; Mackenbach, Johan P.

    2005-01-01

    Objective. To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. Design. This study was conducted among 69 Dutch general practitioners in the Rotterdam region.

  18. Some Implications of Two Forms of the Generalized Uncertainty Principle

    Directory of Open Access Journals (Sweden)

    Mohammed M. Khalil

    2014-01-01

    Full Text Available Various theories of quantum gravity predict the existence of a minimum length scale, which leads to the modification of the standard uncertainty principle to the Generalized Uncertainty Principle (GUP. In this paper, we study two forms of the GUP and calculate their implications on the energy of the harmonic oscillator and the hydrogen atom more accurately than previous studies. In addition, we show how the GUP modifies the Lorentz force law and the time-energy uncertainty principle.

  19. Improvisational Practices in Elementary General Music Classrooms

    Science.gov (United States)

    Gruenhagen, Lisa M.; Whitcomb, Rachel

    2014-01-01

    Despite historic and ongoing support for the inclusion of improvisation in the elementary general music curriculum, music educators consistently report challenges with implementation of improvisational activities in their classes. This study was designed to examine (a) the extent to which improvisational activities were occurring in the…

  20. Heart Failure Care in General Practice

    NARCIS (Netherlands)

    Valk, M.J.M.

    2017-01-01

    Heart failure (HF) is an increasing health care problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the health care team is considered optimal. HF management has improved substantially over the last two decades, mainly for patients with HF with a reduced ejection

  1. TECHNICAL AND PRACTICAL IMPLICATIONS OF SHORT SELLING

    Directory of Open Access Journals (Sweden)

    Radu BORES

    2016-07-01

    Full Text Available This paper aims at providing insight into some of the implication of short selling for markets, investors as well as regulators. Findings show that capital flows are adversely affected by strict regulation and bans of short sales, while market liquidity, and bid-ask spread can be improved by allowing short selling. Additionally portfolios that incorporate short selling strategies can have lower volatility in returns. The informational content of short sales can provide important feedback for informed investors and lead to better price discovery.

  2. Prevalence of alcohol problems in general practice

    DEFF Research Database (Denmark)

    Rambaldi, A; Todisco, N; Gluud, C

    1996-01-01

    The Michigan Alcoholism Screening Test (MAST) and the response to a question about heavy alcohol consumption were used to assess the prevalence of alcohol problems in consecutive patients (77 males and 46 females) consulting a general practitioner in an urban area in the South of Italy (Castellam...... as a screening question in order to detect alcohol problems and give advice regarding reduction of alcohol consumption....

  3. Shoulder disorders in general practice : Prognostic indicators of outcome

    NARCIS (Netherlands)

    Van Der Windt, Daniëlle A W M; Koes, Bart W.; Boeke, A. Joan P; Devillé, Walter; De Jong, Bareld A.; Bouter, Lex M.

    Background. Shoulder pain is common in primary health care. Nevertheless, information on the outcome of shoulder disorders is scarce, especially for patients encountered in general practice. Aim. To study the course of shoulder disorders in general practice and to determine prognostic indicators of

  4. Effectiveness of empathy in general practice: a systematic review.

    NARCIS (Netherlands)

    Derksen, F.; Bensing, J.; Lagro-Janssen, A.

    2013-01-01

    Background: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice.

  5. Effectiveness of empathy in general practice: a systematic review

    NARCIS (Netherlands)

    Derksen, F.; Bensing, J.; Lagro-Janssen, A.

    2013-01-01

    BACKGROUND: Empathy as a characteristic of patient-physician communication in both general practice and clinical care is considered to be the backbone of the patient-physician relationship. Although the value of empathy is seldom debated, its effectiveness is little discussed in general practice.

  6. Integrating postgraduate and undergraduate general practice education: qualitative study.

    Science.gov (United States)

    O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

    2013-05-01

    Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

  7. Computerisation of general practice in the Republic of Croatia: experience gained in general practice use

    Directory of Open Access Journals (Sweden)

    Biserka Bergman-Markovi_

    2007-09-01

    Full Text Available Well-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/ systems employed within the family medicine frame, and the frame of evaluation of available and commonly- exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs. The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation.

  8. The development of professional practice standards for Australian general practice nurses.

    Science.gov (United States)

    Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

    2017-08-01

    The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.

  9. Opioid dependence - management in general practice.

    Science.gov (United States)

    Frei, Matthew

    2010-08-01

    Addiction to opioids, or opioid dependence, encompasses the biopsychosocial dysfunction seen in illicit heroin injectors, as well as aberrant behaviours in patients prescribed opioids for chronic nonmalignant pain. To outline the management of opioid dependence using opioid pharmacotherapy as part of a comprehensive chronic illness management strategy. The same principles and skills general practitioners employ in chronic illness management underpin the care of patients with opioid dependence. Opioid pharmacotherapy, with the substitution medications methadone and buprenorphine, is an effective management of opioid dependence. Training and regulatory requirements for prescribing opioid pharmacotherapies vary between jurisdictions, but this treatment should be within the scope of most Australian GPs.

  10. SOME IMPLICATIONS OF A CONCEPT OF GROWTH MOTIVATION FOR ADULT EDUCATION THEORY AND PRACTICE.

    Science.gov (United States)

    NOREEN, DAVID SHELDON

    THIS STUDY EXAMINED GROWTH MOTIVATION AS A DEVELOPING CONCEPT AND AS A THEORETICAL CONSTRUCT, AND THE IMPLICATIONS OF THIS THEORY FOR ADULT EDUCATION THEORY AND PRACTICE. SPECIAL ATTENTION WAS GIVEN TO THE THEORETICAL CONSTRUCTS OF ABRAHAM MASLOW, TO THE NATURE OF GROWTH MOTIVATION CONCEPTS IN GENERAL, AND TO FORMS OF SELF UNDERSTANDING AND…

  11. Shared learning in general practice--facilitators and barriers.

    Science.gov (United States)

    van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

    2013-03-01

    Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

  12. Management of needlestick injuries in general dental practice

    OpenAIRE

    Smith, A.J.; Cameron, S.O.; Bagg, J.; Kennedy, D.

    2001-01-01

    The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing con...

  13. Stem cell terminology: practical, theological and ethical implications.

    Science.gov (United States)

    Shanner, Laura

    2002-01-01

    Stem cell policy discussions frequently confuse embryonic and fetal sources of stem cells, and label untested, non-reproductive cloning as "therapeutic." Such misnomers distract attention from significant practical and ethical implications: accelerated research agendas tend to be supported at the expense of physical risks to women, theological implications in a multi-faith community, informed consent for participation in research, and treatment decisions altered by unrealistic expectations.

  14. Biomedicine, holism and general medical practice: responses to the 2004 General Practitioner contract.

    Science.gov (United States)

    Checkland, Kath; Harrison, Stephen; McDonald, Ruth; Grant, Suzanne; Campbell, Stephen; Guthrie, Bruce

    2008-07-01

    In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.

  15. Contemporary marketing practice : theoretical propositions and practical implications

    NARCIS (Netherlands)

    Lindgreen, A.; Palmer, R.; Vanhamme, J.

    2004-01-01

    Marketing has changed significantly since it first emerged as a distinct business and management phenomenon. We identify some of the major factors causing the observed change in marketing practice. We then describe a classification scheme that is based on transaction marketing and relationship

  16. Psychological stress and multimorbidity in general practice

    DEFF Research Database (Denmark)

    Prior, Anders

    2017-01-01

    . Additionally, stress is a common reason for contacting the general practitioner (GP), and yet no guidelines for management and treatment exist. Aims The aim of this thesis was to investigate the consequences of psychological stress on the health while taking into account mental‐physical multimorbidity, i...... found to be associated with adverse health outcomes and potentially suboptimal healthcare. The link between stress and multimorbidity could substantiate the efforts to develop management guidelines for primary care, stress‐targeted interventions, and to accommodate the healthcare system to better...... and poor prognosis of physical diseases, including increased mortality. However, little is known on the physical consequences of sub‐threshold psychological stress, which is more common than psychiatric disorders in the background population and is highly prevalent in persons with multimorbidity...

  17. Cheques and challenges: business performance in New Zealand general practice.

    Science.gov (United States)

    Greatbanks, Richard; Doolan-Noble, Fiona; McKenna, Alex

    2017-09-01

    INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.

  18. Undergraduate teaching in UK general practice: a geographical snapshot.

    Science.gov (United States)

    Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

    2014-06-01

    Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. National survey of all medical schools in the UK. All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK's health departments. All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum-maximum) of 142 (17-385) practices per school. The median (minimum-maximum) distance between a school and a teaching practice was 28 km (0-1421 km), 41 (0:00-23:26) minutes' travel by car and 1 hour 12 (0:00-17:29) minutes' travel by public transport. All teaching practices were accessible by public transport in one school and 90-99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. © British Journal of General Practice 2014.

  19. Implications of radiation risk for practical dosimetry

    International Nuclear Information System (INIS)

    Dennis, J.A.

    1984-01-01

    Radiobiological experiments with animals and cells have led to an expectation that the risks of cancer and hereditary effects are reduced at low doses and low dose rates of low LET radiation. Risk estimates derived from human exposures at high doses and dose rates usually contain an allowance for low dose effects in comparison with high dose effects, but no allowance may have been made for low dose rate effects. Although there are reasons for thinking that leukaemia risks may possibly have been underestimated, the total cancer risk assumed by ICRP for occupational exposures is reasonably realistic. For practical dosimetry the primary dose concepts and limits have to be translated into secondary quantities that are capable of practical realisation and measurement, and which will provide a stable and robust system of metrology. If the ICRP risk assumptions are approximately correct, it is extremely unlikely that epidemiological studies of occupational exposures will detect the influence of radiation. Elaboration of dosimetry and dose recording for epidemiological purposes is therefore unjustified except possibly in relation to differences between high and low LET radiations. (author)

  20. Going for gold: the health promoting general practice.

    Science.gov (United States)

    Watson, Michael

    2008-01-01

    The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

  1. Reflective practice and its implications for pharmacy education.

    Science.gov (United States)

    Tsingos, Cherie; Bosnic-Anticevich, Sinthia; Smith, Lorraine

    2014-02-12

    Pharmacy students require critical-thinking and problem-solving skills to integrate theory learned in the classroom with the complexities of practice, yet many pharmacy students fall short of acquiring these skills.(1-2) Reflective practice activities encourage learning from the student's own experiences and those of others, and offer a possible solution for the integration of knowledge-based curricula with the ambiguities of practice, as well as enhance communication and collaboration within a multidisciplinary team. Although reflective practices have been embraced elsewhere in health professions education, their strengths and shortcomings need to be considered when implementing such practices into pharmacy curricula. This review provides an overview of the evolution of theories related to reflective practice, critically examines the use of reflective tools (such as portfolios and blogs), and discusses the implications of implementing reflective practices in pharmacy education.

  2. Specialization and the Current Practices of General Surgeons

    Science.gov (United States)

    Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

    2014-01-01

    Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

  3. Computed tomographic practice and dosimetry: implications for nuclear medicine: editorial

    International Nuclear Information System (INIS)

    Mountford, P.J.; Harding, L.K.

    1992-01-01

    This editorial briefly discusses the results of an NRPB survey of x-ray computed tomography practice and dosimetry in the UK. A wide variation in practice and patient doses was revealed. The implications for nuclear medicine are considered. The NRPB is to issue formal guidance on protection of the patient undergoing a CT investigation with the aim of achieving a more systematic approach to the justification and optimization of such exposures. (UK)

  4. General practice ethnicity data: evaluation of a tool

    Directory of Open Access Journals (Sweden)

    Neuwelt P

    2014-03-01

    Full Text Available INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed.

  5. Emergency department surge: models and practical implications.

    Science.gov (United States)

    Nager, Alan L; Khanna, Kajal

    2009-08-01

    Emergency Department crowding has long been described. Despite the daily challenges of managing emergency department volume and acuity; a surge response during a disaster entails even greater challenges including collaboration, intervention, and resourcefulness to effectively carry out pediatric disaster management. Understanding surge and how to respond with appropriate planning will lead to success. To achieve this, we sought to analyze models of surge; review regional and national data outlining surge challenges and factors that impact surge; and to outline potential solutions. We conducted a systemic review and included articles and documents that best described the theoretical and practical basis of surge response. We organized the systematic review according to the following questions: What are the elements and models that are delineated by the concept of surge? What is the basis for surge response based on regional and national published sources? What are the broad global solutions? What are the major lessons observed that will impact effective surge capacity? Multiple models of surge are described including public health, facility-based and community-based; a 6-tiered response system; and intrinsic or extrinsic surge capacity. In addition, essential components (4 S's of surge response) are described along with regional and national data outlining surge challenges, impacting factors, global solutions, and lesions observed. There are numerous shortcomings regionally and nationally affecting our ability to provide an effective and coordinated surge response. Planning, education, and training will lead to an effective pediatric disaster management response.

  6. [The practice guideline 'Anemia' from the Dutch College of General Practitioners; a response from the perspective of general practice medicine

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2003-01-01

    The practice guideline 'Anaemia' from the Dutch College of General Practitioners will certainly be a support for the Dutch general practitioner. The inclusion of an algorithm to make a more precise diagnosis is an experiment that needs to be evaluated in the near future. However, many general

  7. Readiness for organisational change among general practice staff.

    Science.gov (United States)

    Christl, B; Harris, M F; Jayasinghe, U W; Proudfoot, J; Taggart, J; Tan, J

    2010-10-01

    Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; pchange which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

  8. Safeguarding and Protecting Children in Maternity Services: Implications for Practice

    Science.gov (United States)

    Lazenbatt, Anne; Greer, Jean

    2009-01-01

    This article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or are at risk of abuse, and…

  9. Implications of teacher educators' practices in assessment for ...

    African Journals Online (AJOL)

    This study presents findings on teacher educators' practices in assessment and their implications for student learning in Tanzania. Research on classroom assessment has been dichotomizing assessment and teaching-learning processes instead of viewing assessment as an integral part of the teachinglearning process.

  10. Education in General Practice in the Netherlands | Ten Cate | South ...

    African Journals Online (AJOL)

    Abstract. With the aid of a film the training in general practice is discussed at 4 of the 7 universities in the Netherlands: Groningen, Utrecht, Nijmegen and Leyden. The differences in training methods are shown.

  11. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-08-07

    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  12. Evidence-based treatment of atopic eczema in general practice

    African Journals Online (AJOL)

    banzi

    The exact cause is unknown but a ... Scratching may result in secondary infec- tion and associated ... general practice. Atopic eczema is a common chronic condition ... There was either insufficient or no .... itch and indirectly improving sleep.

  13. [MODERN EDUCATIONAL TECHNOLOGY MASTERING PRACTICAL SKILLS OF GENERAL PRACTITIONERS].

    Science.gov (United States)

    Kovalchuk, L I; Prokopchuk, Y V; Naydyonova, O V

    2015-01-01

    The article presents the experience of postgraduate training of general practitioners--family medicine. Identified current trends, forms and methods of pedagogical innovations that enhance the quality of learning and mastering the practical skills of primary professionals providing care.

  14. Position Paper: Dental General Practice Residency Programs: Financing and Operations.

    Science.gov (United States)

    Hanson, Paul W.

    1983-01-01

    A discussion of changeable economic issues that can affect dental general practice residency program planning includes costs and resource allocation, maximizing efficiency and productivity, ambulatory and inpatient revenue sources, management functions, faculty as practitioners, faculty appointments, and marketing. (MSE)

  15. Ambulatory blood pressure monitoring for hypertension in general practice.

    OpenAIRE

    Taylor, R S; Stockman, J; Kernick, D; Reinhold, D; Shore, A C; Tooke, J E

    1998-01-01

    Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension. 40 patients (aged 33-60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-ho...

  16. Global megatrends and their implications for environmental assessment practice

    Energy Technology Data Exchange (ETDEWEB)

    Retief, Francois, E-mail: francois.retief@nwu.ac.za [Research Unit for Environmental Sciences and Management, North-West University (South Africa); Bond, Alan [School of Environmental Sciences, University of East Anglia (United Kingdom); Research Unit for Environmental Sciences and Management, North-West University (South Africa); Pope, Jenny [Integral Sustainability (Australia); Research Unit for Environmental Sciences and Management, North-West University (South Africa); Morrison-Saunders, Angus [Murdoch University (Australia); Research Unit for Environmental, Sciences and Management, North-West University (South Africa); King, Nicholas [Research Unit for Environmental Sciences and Management, North-West University (South Africa)

    2016-11-15

    This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication and participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.

  17. Global megatrends and their implications for environmental assessment practice

    International Nuclear Information System (INIS)

    Retief, Francois; Bond, Alan; Pope, Jenny; Morrison-Saunders, Angus; King, Nicholas

    2016-01-01

    This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication and participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.

  18. Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

    Science.gov (United States)

    Lane, Riki; Halcomb, Elizabeth; McKenna, Lisa; Zwar, Nicholas; Naccarella, Lucio; Davies, Gawaine Powell; Russell, Grant

    2017-05-01

    . What does this paper add? This study delineates organisational support roles for PHCOs in strengthening nurses' roles and career development in Australian general practice. What are the implications for practitioners? Effective implementation of appropriate responsibilities by PHCOs can assist development of the primary care nursing workforce.

  19. Datasets collected in general practice: an international comparison using the example of obesity.

    Science.gov (United States)

    Sturgiss, Elizabeth; van Boven, Kees

    2018-06-04

    be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

  20. Nigerian Journal of General Practice: About this journal

    African Journals Online (AJOL)

    Policies. » Focus and Scope; » Section Policies; » Peer Review Process; » Publication Frequency; » Subscriptions; » The Association of General and Private Medical Practitioners of Nigeria [AGPMPN]; » Advertising in the Nigerian Journal of General Practice; » NJGP Editorial Board ...

  1. Positive experiences with a specialist as facilitator in general practice

    DEFF Research Database (Denmark)

    Kousgaard, Marius Brostrøm; Thorsen, Thorkil

    2012-01-01

    The use of facilitators for quality improvement in general practice has accelerated during the past decade. As general practitioners (GPs) or pharmacists have typically been used as facilitators, there is a lack of knowledge of how other professionals function as facilitators. This article explores...

  2. The quality of COPD care in general practice

    DEFF Research Database (Denmark)

    Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.

    2008-01-01

    We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... included in the first audit and 2394 in the second audit. We observed a significantly increased utilisation of spirometry from the first (52.7%) to the second audit (71.4%) (p quality of management. We conclude that participation in an educational...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...

  3. [The Dutch College of General Practitioners practice guideline 'The menopause'; reaction of the field of general practice

    NARCIS (Netherlands)

    Bosch, W.J.H.M. van den

    2002-01-01

    The Dutch College of General Practitioners' practice guideline on the menopause will not be any major cause for discussion. The hot issue of giving oestrogens to peri- and postmenopausal women to prevent osteoporosis or cardiovascular disease was already covered in the practice guideline on

  4. The problem of diagnostic variability in general practice.

    Science.gov (United States)

    Crombie, D L; Cross, K W; Fleming, D M

    1992-08-01

    The aim was to examine the scale, source, and relevance of variation between general practices in respect of the rates with which patients consulted with illnesses falling in each of several diagnostic groups. This study involved a general practice morbidity survey conducted over two years, 1970-72. All patients who consulted their general practitioners were identified and the number of these who consulted with diagnoses attributable to each of the 18 main chapters of the International classification of diseases were counted. Patients who consulted for more than one diagnosis within a chapter were counted once only; those who consulted for one or more diagnoses in each of several chapters were counted once for each chapter. This was a national survey involving general practitioners in England and Wales. The study involved 214,524 patients from 53 selected general practices (115 doctors) who were registered with their general practitioners for the whole of the year 1970-71 and for whom their morbidity data had been linked with their social data from the 1971 census. Using the numbers of patients on the practice lists as denominators, practice patient consulting rates (PPCR) were calculated for each practice and for each ICD chapter. Variability in chapter PPCR was examined by calculating coefficients of variation and, after allowance for random variation, coefficients of residual variation. There were large interpractice (doctor) variations in all chapter rates. These variations were only marginally attributable to: chance; different age, sex and social class mixes of practice populations; geographical locations; and practice organisation. The rates were, however, consistent from one year to the next for any one practice. Approximately half of the interpractice (doctor) diagnostic variability was associated with overall patient consulting behaviour. When the effects of this behaviour were discounted, any major residual diagnostic variability was confined largely to

  5. Nurses who work in general medical practices: a Victorian survey.

    Science.gov (United States)

    Bonawit, V; Watson, L

    1996-01-01

    A questionnaire survey of 452 general medical practices in Victoria attracted responses from 277 practices, many of which did not employ nurses. The 93 respondents from 85 practices who were nurses reported that they enjoyed flexible working hours and stable employment. While their main reason for working in GPs' rooms was convenience, the most important aspect of their work was interaction with patients and fellow workers. Sixtyseven percent of nurses thought continuing education in specific skills was necessary for their work, 43% thought a post-registration qualification in community health nursing would be desirable and 47% thought a special interest group of nurses working in medical practices would be useful.

  6. Epigenetics: general characteristics and implications for oral health

    Directory of Open Access Journals (Sweden)

    Ji-Yun Seo

    2015-02-01

    Full Text Available Genetic information such as DNA sequences has been limited to fully explain mechanisms of gene regulation and disease process. Epigenetic mechanisms, which include DNA methylation, histone modification and non-coding RNAs, can regulate gene expression and affect progression of disease. Although studies focused on epigenetics are being actively investigated in the field of medicine and biology, epigenetics in dental research is at the early stages. However, studies on epigenetics in dentistry deserve attention because epigenetic mechanisms play important roles in gene expression during tooth development and may affect oral diseases. In addition, understanding of epigenetic alteration is important for developing new therapeutic methods. This review article aims to outline the general features of epigenetic mechanisms and describe its future implications in the field of dentistry.

  7. Job satisfaction of practice assistants in general practice in Germany: an observational study.

    Science.gov (United States)

    Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Brodowski, Marc; Steinhaeuser, Jost; Wensing, Michel; Szecsenyi, Joachim

    2013-08-01

    Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations. The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design. The study population consisted of 1158 practice assistants from 345 general practices across Germany. Job satisfaction was measured with the 10-item Warr-Cook-Wall questionnaire. Organizational culture was evaluated with four items. A linear regression analysis was performed in which each of the job satisfaction items was handled as dependent variable. Out of 1716 staff member questionnaires handed out to practice assistants, 1158 questionnaires were completed (response rate: 67.5%). Practice assistants were most satisfied with their colleagues and least satisfied with their income. Higher job satisfaction was associated with issues of organizational culture, particularly a good working atmosphere, opportunities to suggest and influence areas for improvement and clear responsibilities within the practice team. Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.

  8. Analytical implications of using practice theory in workplace information literacy research

    DEFF Research Database (Denmark)

    Moring, Camilla Elisabeth; Lloyd, Annemaree

    2013-01-01

    Introduction: This paper considers practice theory and the analytical implications of using this theoretical approach in information literacy research. More precisely the aim of the paper is to discuss the translation of practice theoretical assumptions into strategies that frame the analytical...... focus and interest when researching workplace information literacy. Two practice theoretical perspectives are selected, one by Theodore Schatzki and one by Etienne Wenger, and their general commonalities and differences are analysed and discussed. Analysis: The two practice theories and their main ideas...... of what constitute practices, how practices frame social life and the central concepts used to explain this, are presented. Then the application of the theories within workplace information literacy research is briefly explored. Results and Conclusion: The two theoretical perspectives share some...

  9. Laboratory-supported influenza surveillance in Victorian sentinel general practices.

    Science.gov (United States)

    Kelly, H; Murphy, A; Leong, W; Leydon, J; Tresise, P; Gerrard, M; Chibo, D; Birch, C; Andrews, R; Catton, M

    2000-12-01

    Laboratory-supported influenza surveillance is important as part of pandemic preparedness, for identifying and isolating candidate vaccine strains, for supporting trials of anti-influenza drugs and for refining the influenza surveillance case definition in practice. This study describes the implementation of laboratory-supported influenza surveillance in Victorian sentinel general practices and provides an estimate of the proportion of patients with an influenza-like illness proven to have influenza. During 1998 and 1999, 25 sentinel general practices contributed clinical surveillance data and 16 metropolitan practices participated in laboratory surveillance. Serological, virus-antigen detection, virus culture and multiplex polymerase chain reaction procedures were used to establish the diagnosis of influenza. Two laboratories at major teaching hospitals in Melbourne provided additional data on influenza virus identification. General practice sentinel surveillance and laboratory identification of influenza provided similar data on the pattern of influenza in the community between May and September. The clinical suspicion of influenza was confirmed in 49 to 54 per cent of cases seen in general practice.

  10. Spot-checks to measure general hygiene practice.

    Science.gov (United States)

    Sonego, Ina L; Mosler, Hans-Joachim

    2016-01-01

    A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

  11. Job satisfaction of practice assistants in general practice in Germany: an observational study

    NARCIS (Netherlands)

    Goetz, K.; Campbell, S.; Broge, B.; Brodowski, M.; Steinhaeuser, J.; Wensing, M.; Szecsenyi, J.

    2013-01-01

    BACKGROUND: Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. OBJECTIVE: To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction,

  12. [General practice research units in Denmark: multidisciplinary research in support of practical work].

    Science.gov (United States)

    Reventlow, Susanne; Broholm, Katalin Alexa Király; Mäkelä, Marjukka

    2014-01-01

    In Denmark the general practice research units operating in connection with universities provide a home base, training and methodology support for researchers in the field from medical students to general practitioners carrying out practical work. Research issues frequently require a multidisciplinary approach and use of different kinds of materials. Problems arising from the practical work of general practitioners take priority in the wide selection of topics. The units have networked efficiently with organizations of general practitioners and medical education. The combination of research environments has created synergy benefiting everybody and increased the scientific productivity and visibility of the field.

  13. Resource depletion promotes automatic processing: implications for distribution of practice.

    Science.gov (United States)

    Scheel, Matthew H

    2010-12-01

    Recent models of cognition include two processing systems: an automatic system that relies on associative learning, intuition, and heuristics, and a controlled system that relies on deliberate consideration. Automatic processing requires fewer resources and is more likely when resources are depleted. This study showed that prolonged practice on a resource-depleting mental arithmetic task promoted automatic processing on a subsequent problem-solving task, as evidenced by faster responding and more errors. Distribution of practice effects (0, 60, 120, or 180 sec. between problems) on rigidity also disappeared when groups had equal time on resource-depleting tasks. These results suggest that distribution of practice effects is reducible to resource availability. The discussion includes implications for interpreting discrepancies in the traditional distribution of practice effect.

  14. Exploring accountability of clinical ethics consultants: practice and training implications.

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

    Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

  15. Practical implications of incentive systems are utilized by dental franchises.

    Science.gov (United States)

    Yavner, S B

    1989-01-01

    The success of any dental practice depends, among other factors, on the critical role of staff employees. In order to encourage desired staff behaviors, incentive systems can be designed for employee dentists, assistants/hygienists and managers. A survey of dental franchises was conducted in 1987 for the purpose of examining their incentive control systems. The specific incentives employed by these dental franchises for their employees are analyzed. The implications of these incentive systems used by dental franchise organizations for all dental practices are then discussed.

  16. General Purpose Technologies and their Implications for International Trade

    Directory of Open Access Journals (Sweden)

    Petsas Iordanis

    2015-09-01

    Full Text Available This paper develops a simple model of trade and “quality-ladders” growth without scale effects to study the implications of general purpose technologies (GPTs for international trade. GPTs refer to a certain type of drastic innovations, such as electrification, the transistor, and the Internet, that are characterized by the pervasiveness in use, innovational complementarities, and technological dynamism. The model presents a two-country (Home and Foreign dynamic general equilibrium framework and incorporates GPT diffusion within Home that exhibits endogenous Schumpeterian growth. The model analyzes the long-run and transitional dynamic effects of a new GPT on the pattern of trade and relative wages. The main findings of the paper are: 1 when the GPT diffusion across industries is governed by S-curve dynamics, there are two steady-state equilibria: the initial steadystate arises before the adoption of the new GPT and the final one is reached after the GPT diffusion process has been completed, 2 when all industries at Home have adopted the new GPT, Home enjoys comparative advantage in a greater range of industries compared to Foreign, 3 during the transitional dynamics, Foreign gains back its competitiveness in some of the industries that lost its comparative advantage to Home.

  17. Implementation of an Arranged Preventive Consultation in Danish General Practice

    DEFF Research Database (Denmark)

    Junge, Anne Gram; Kirkegaard, Pia; Thomsen, Janus Laust

    Background: In 2006 an arranged preventive consultation (0106-service) was implemented in Danish general practice. The purpose of the consultation is an attempt to improve the systematic prevention of the main chronic lifestyle diseases. Aim: This study examines the GP's experiences...... with the arranged preventive consultation with focus on facilitators and barriers in the implementation of the consultation. Material & Method: Semi-structured interviews with 10 GPs and nurses in general practice. Results & Conclusions: Economically lucrative services are not an isolated motivation for the GPs....../nurses, but must be accompanied with a basic belief in the effect of preventive consultations in general practice. The better payment of the 0106-service is used to spend more time per consultation and it makes the GPs/nurses feel rewarded for the preventive work they perform. The consultation frames a social...

  18. Social environment and frequent attendance in Danish general practice

    DEFF Research Database (Denmark)

    Vedsted, Peter; Olesen, Frede

    2005-01-01

    inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross......BACKGROUND: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social...... during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation. RESULTS: A total...

  19. Antibiotic prescribing in Danish general practice 2004-13

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Siersma, Volkert; Plejdrup Hansen, Malene

    2016-01-01

    Objectives: Antibiotic consumption in the primary care sector is often perceived as synonymous with consumption in general practice despite the fact that few countries stratify the primary care sector by providers' medical specialty. We aimed to characterize and quantify antibiotic use in Danish...... general practice relative to the entire primary care sector. Methods: This was a registry-based study including all patients who redeemed an antibiotic prescription between July 2004 and June 2013 at a Danish community pharmacy. Antibiotic use was expressed as DDDs and treatments/1000 inhabitants....../day (DIDs and TIDs, respectively) and assessed according to antibiotic spectrum (narrow versus broad) and their anatomical therapeutic classification codes in total as well as in six age groups. Results: The contribution of general practice to the entire antibiotic use in the primary care sector declined...

  20. Clinical indications for antibiotic use in Danish general practice

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Hansen, Malene Plejdrup; Siersma, Volkert Dirk

    2017-01-01

    of routine electronic antibiotic prescriptions from Danish general practice. Subjects: All 975,626 patients who redeemed an antibiotic prescription at outpatient pharmacies during the 1-year study period (July 2012 to June 2013). Main outcome measures: Number of prescriptions per clinical indication. Number......Objective: To assess the availability and applicability of clinical indications from electronic prescriptions on antibiotic use in Danish general practice. Design: Retrospective cohort register-based study including the Danish National Prescription Register. Setting: Population-based study...... from electronic prescriptions are accessible and available to provide an overview of drug use, in casu antibiotic prescriptions, in Danish general practice. These clinical indications may be further explored in detail to assess rational drug use and congruence with guidelines, but validation...

  1. Promoting Mental Health and Preventing Mental Illness in General Practice.

    Science.gov (United States)

    Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

    2016-01-01

    This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

  2. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education.

    Science.gov (United States)

    Engels, Paul T; de Gara, Chris

    2010-06-30

    Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p learning style found in the residents and faculty. The predominant learning styles of the residents and faculty were convergent and accommodative, with no statistically significant differences between the residents and the faculty. We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  3. Learning styles of medical students, general surgery residents, and general surgeons: implications for surgical education

    Directory of Open Access Journals (Sweden)

    de Gara Chris

    2010-06-01

    Full Text Available Abstract Background Surgical education is evolving under the dual pressures of an enlarging body of knowledge required during residency and mounting work-hour restrictions. Changes in surgical residency training need to be based on available educational models and research to ensure successful training of surgeons. Experiential learning theory, developed by David Kolb, demonstrates the importance of individual learning styles in improving learning. This study helps elucidate the way in which medical students, surgical residents, and surgical faculty learn. Methods The Kolb Learning Style Inventory, which divides individual learning styles into Accommodating, Diverging, Converging, and Assimilating categories, was administered to the second year undergraduate medical students, general surgery resident body, and general surgery faculty at the University of Alberta. Results A total of 241 faculty, residents, and students were surveyed with an overall response rate of 73%. The predominant learning style of the medical students was assimilating and this was statistically significant (p Conclusions We conclude that medical students have a significantly different learning style from general surgical trainees and general surgeons. This has important implications in the education of general surgery residents.

  4. The role of general practice in postgraduate basic training

    DEFF Research Database (Denmark)

    Kjaer, Niels Kristian; Kodal, Troels; Qvesel, Dorte

    2010-01-01

    BACKGROUND: In recent years, there has been growing interest in the role of primary care in postgraduate training. Relatively little has been published about benefits of early and sustained postgraduate basic training in general practice, especially for doctors with other ambitions than family...... scale and qualitative questions. We used a phenomenological approach. RESULTS: Almost all of the young Danish doctors responding felt that training in general practice is a necessary part of a postgraduate basic training programme. Early training in primary care not only gives doctors a broad...

  5. Video-assisted feedback in general practice internships using German general practitioner's guidelines

    NARCIS (Netherlands)

    Bolter, R.; Freund, T.; Ledig, T.; Boll, B.; Szecsenyi, J.; Roos, M.

    2012-01-01

    Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the

  6. Towards a rationalization of counselling in general practice

    Science.gov (United States)

    Rowland, Nancy; Irving, Jill

    1984-01-01

    While there is good evidence to show that counselling may be beneficial to those patients in general practice with non-organic problems, deployment of the available resources lacks standardization and rationalization. The Counselling in Medical Settings Working Party of the British Association for Counselling is pressing for standardized training and accreditation of counsellors so that general practitioners will feel more confident about taking on workers who will ultimately be incorporated into the NHS team. PMID:6512752

  7. Discourse analysis in general practice: a sociolinguistic approach.

    Science.gov (United States)

    Nessa, J; Malterud, K

    1990-06-01

    It is a simple but important fact that as general practitioners we talk to our patients. The quality of the conversation is of vital importance for the outcome of the consultation. The purpose of this article is to discuss a methodological tool borrowed from sociolinguistics--discourse analysis. To assess the suitability of this method for analysis of general practice consultations, the authors have performed a discourse analysis of one single consultation. Our experiences are presented here.

  8. Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

    Science.gov (United States)

    Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

    2015-01-01

    This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

  9. Open Access to General Practice Was Associated with Burnout among General Practitioners

    DEFF Research Database (Denmark)

    Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

    2013-01-01

    Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without....... In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach...... Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters...

  10. [Trends among medical students towards general practice or specialization].

    Science.gov (United States)

    Breinbauer K, Hayo; Fromm R, Germán; Fleck L, Daniela; Araya C, Luis

    2009-07-01

    A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Fifty three percent of students desired to enter a specialization program. Only 20% would work as a general practitioner (27% were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p specialized medicine in the teaching environment. Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

  11. Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar

    Directory of Open Access Journals (Sweden)

    Scott-Jones J

    2013-09-01

    Full Text Available INTRODUCTION: Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. AIM: To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. METHODS: A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. RESULTS: The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. DISCUSSION: Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

  12. Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar.

    Science.gov (United States)

    Scott-Jones, Joseph; Lucas, Sarah

    2013-09-01

    Undertaking training in rural areas is a recognised way of helping recruit staff to work in rural communities. Postgraduate year two medical doctors in New Zealand have been able to undertake a three-month placement in rural practice as part of their pre-vocational training experience since November 2010. To describe the experience of a rural general practice team providing training to a postgraduate year two medical trainee, and to describe the teaching experience and range of conditions seen by the trainee. A pre- and post-placement interview with staff, and analysis of a logbook of cases and teaching undertaken in the practice. The practice team's experience of having the trainee was positive, and the trainee was exposed to a wide range of conditions over 418 clinical encounters. The trainee received 22.5 hours of formal training over the three-month placement. Rural general practice can provide a wide range of clinical experience to a postgraduate year two medical trainee. Rural practices in New Zealand should be encouraged to offer teaching placements at this training level. Exposure to rural practice at every level of training is important to encourage doctors to consider rural practice as a career.

  13. Practice implications and recommendations for managing codeine misuse and dependence

    Directory of Open Access Journals (Sweden)

    Bergin Michael

    2015-12-01

    Full Text Available Codeine, a weak opiate, requires increased pharmacovigilance relating to availability, heterogeneous nature of misuse, dependence and associated harm. A scoping review of literature on codeine was conducted using Arksey & O’Malley’s framework (1. Databases searched included PubMed, EBSCO Host, Science Direct, EMBASE, PsycINFO, Cochrane library and Medline from 1994 to 2014. Follow-up search strategies involved hand searching and searching of pharmaceutical, health, medical and drug related websites. Initial zscreening identified 3,105 articles with 475 meeting the inclusion criteria. Eight broad categories organised the literature, data charting and qualitative synthesis. This paper presents implications for practice and makes recommendations to address these issues. Themes identified relate to raising public and practitioner awareness, risk management, dispensing practices and monitoring and surveillance of codeine. Evidence to inform law enforcement, drug surveillance, public health initiatives, harm reduction approaches, pharmacy, clinical and treatment practices is warranted.

  14. Social Case-work in General Practice: An Alternative Approach

    Science.gov (United States)

    Ratoff, L.; Pearson, Barbara

    1970-01-01

    During a two-year period a senior case-worker was seconded by a voluntary family case-work agency, the Liverpool Personal Service Society, to work with three general practitioners. The commonest reasons for referral of the 157 new patients to the social worker over this study period were extreme poverty; housing, matrimonial, and psychiatric problems; and problems of fatherless families. The successful and valuable co-operation between the general practitioners, case-worker, and various specialist professional and financial services of the Society have proved that a professional social worker has an important role in the general-practice team. PMID:5420213

  15. The South African Stroke Risk in General Practice Study | Connor ...

    African Journals Online (AJOL)

    Two hundred general practices were randomly selected from lists provided by pharmaceutical .representatives. Each GP approached 50 consecutive patients aged 30 years and older. Patients completed an information sheet and the GP documented the patient's risk factors. The resulting sample is relevant.if not necessarily ...

  16. Quality of routine spirometry tests in Dutch general practices.

    NARCIS (Netherlands)

    Schermer, T.R.J.; Crockett, A.J.; Poels, P.J.P.; Dijke, J.J. van; Akkermans, R.P.; Vlek, H.F.; Pieters, W.R.

    2009-01-01

    BACKGROUND: Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. AIM: To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. DESIGN OF STUDY: Analysis

  17. The quality and outcomes framework: QOF - transforming general practice

    National Research Council Canada - National Science Library

    Gillam, Stephen; Siriwardena, Aloysius Niroshan

    2011-01-01

    ... comprehensive scheme of its kind in the world. Champions claim the QOF advances the quality of primary care; detractors fear the end of general practice as we know it. The introduction of the QOF provides a unique opportunity for research, analysis and re ection. This book is the rst comprehensive analysis of the impact of the QOF, examining the claims and counter-claims ...

  18. Feasibility of automatic evaluation of clinical rules in general practice.

    NARCIS (Netherlands)

    Opondo, D.; Visscher, S.; Eslami, S.; Medlock, S.; Verheij, R.; Korevaar, J.C.; Abu-Hanna, A.

    2017-01-01

    Purpose: To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluationof quality of care in general practice.Methods: We assessed 81 clinical rules (CRs) adapted from a subset of Assessing Care of Vulnerable Elders(ACOVE) clinical rules, against Dutch College of

  19. Prognostic factors for neck pain in general practice

    NARCIS (Netherlands)

    Hoving, Jan L.; de Vet, Henrica C. W.; Twisk, Jos W. R.; Devillé, Walter L. J. M.; van der Windt, Daniëlle; Koes, Bart W.; Bouter, Lex M.

    2004-01-01

    Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age,

  20. Nutritional deficiency in general practice: a systematic review

    NARCIS (Netherlands)

    Wayenburg, van C.A.M.; Laar, van de F.A.; Weel, van C.; Staveren, van W.A.; Binsbergen, van J.J.

    2005-01-01

    Objective: Nutritional deficiency is an independent risk factor for mortality. Despite its clinical relevance, the prevalence in a primary care setting is poorly documented. We performed a systematic review of reported prevalence and clinical assessment of nutritional deficiency in general practice.

  1. Primary non-adherence to prescribed medication in general practice

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

    2013-01-01

    Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known....

  2. Characteristics of effective clinical guidelines for general practice.

    NARCIS (Netherlands)

    Burgers, J.S.; Grol, R.P.T.M.; Zaat, J.O.M.; Spies, T.H.; Bij, A.K. van der; Mokkink, H.G.A.

    2003-01-01

    BACKGROUND: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied. AIM: To identify characteristics of effective clinical guidelines for

  3. Respiratory Diseases in Children: studies in general practice

    NARCIS (Netherlands)

    J.H.J.M. Uijen (Hans)

    2011-01-01

    textabstractThe work presented in this thesis covers various aspects of the epidemiology, diagnosis and management of various respiratory symptoms and diseases in children frequently encountered in general practice. These respiratory tract symptoms and diseases can be categorized into symptoms and

  4. Potentials and pitfalls for nutrition counselling in general practice

    NARCIS (Netherlands)

    Verheijden, M.W.; Bakx, J.C.; Weel, C. van; Staveren, W.A. van

    2005-01-01

    This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and

  5. Knowledge, attitudes and practices of general practitions in the Free ...

    African Journals Online (AJOL)

    The aim of this study was to determine the knowledge, attitudes and practice of general practitioners ... identified include the fact that they are time consuming, disrupt schedules, parents are difficult and ... oral administration of methylphenidate. ... Department of Paediatrics and Child Health, Faculty of Health Sciences.

  6. Incidence and treatment of heavy menstrual bleeding in general practice

    NARCIS (Netherlands)

    van den Brink, Marian J.; Saaltink, Anne Linde; Groenhof, Feikje; Kollen, Boudewijn J.; Berger, Marjolein Y.; Lisman-van Leeuwen, Yvonne; Dekker, Janny H.

    2017-01-01

    Background. Heavy menstrual bleeding (HMB) is a common problem in women of reproductive age. In 2008, the Dutch guideline for general practitioners (GPs) was revised to recommend the levonorgestrel intrauterine system (LNG-IUS) as a first-choice treatment for HMB. However, GP prescribing practices

  7. Disease prevalence estimations based on contact registrations in general practice

    NARCIS (Netherlands)

    Hoogenveen, Rudolf; Westert, Gert; Dijkgraaf, Marcel; Schellevis, François; de Bakker, Dinny

    2002-01-01

    This paper describes how to estimate the prevalence of chronic diseases in a population using data from contact registrations in general practice with a limited time length. Instead of using only total numbers of observed patients adjusted for the length of the observation period, we propose the use

  8. 19 CFR 177.1 - General ruling practice and definitions.

    Science.gov (United States)

    2010-04-01

    ... authority to represent is known, any person appearing before the Customs Service as an agent in connection... 19 Customs Duties 2 2010-04-01 2010-04-01 false General ruling practice and definitions. 177.1 Section 177.1 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY...

  9. Information in general medical practices: the information processing model.

    Science.gov (United States)

    Crowe, Sarah; Tully, Mary P; Cantrill, Judith A

    2010-04-01

    The need for effective communication and handling of secondary care information in general practices is paramount. To explore practice processes on receiving secondary care correspondence in a way that integrates the information needs and perceptions of practice staff both clinical and administrative. Qualitative study using semi-structured interviews with a wide range of practice staff (n = 36) in nine practices in the Northwest of England. Analysis was based on the framework approach using N-Vivo software and involved transcription, familiarization, coding, charting, mapping and interpretation. The 'information processing model' was developed to describe the six stages involved in practice processing of secondary care information. These included the amendment or updating of practice records whilst simultaneously or separately actioning secondary care recommendations, using either a 'one-step' or 'two-step' approach, respectively. Many factors were found to influence each stage and impact on the continuum of patient care. The primary purpose of processing secondary care information is to support patient care; this study raises the profile of information flow and usage within practices as an issue requiring further consideration.

  10. Theory and interpretation in qualitative studies from general practice

    DEFF Research Database (Denmark)

    Malterud, Kirsti

    2016-01-01

    Objective: In this article, I want to promote theoretical awareness and commitment among qualitative researchers in general practice and suggest adequate and feasible theoretical approaches.  Approach: I discuss different theoretical aspects of qualitative research and present the basic foundations...... theory is a consistent and soundly based set of assumptions about a specific aspect of the world, predicting or explaining a phenomenon. Qualitative research is situated in an interpretative paradigm where notions about particular human experiences in context are recognized from different subject...... in qualitative analysis are presented, emphasizing substantive theories to sharpen the interpretative focus. Such approaches are clearly within reach for a general practice researcher contributing to clinical practice by doing more than summarizing what the participants talked about, without trying to become...

  11. Open-access ultrasound referrals from general practice.

    LENUS (Irish Health Repository)

    Hughes, P

    2015-03-01

    Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

  12. Problem solving therapy - use and effectiveness in general practice.

    Science.gov (United States)

    Pierce, David

    2012-09-01

    Problem solving therapy (PST) is one of the focused psychological strategies supported by Medicare for use by appropriately trained general practitioners. This article reviews the evidence base for PST and its use in the general practice setting. Problem solving therapy involves patients learning or reactivating problem solving skills. These skills can then be applied to specific life problems associated with psychological and somatic symptoms. Problem solving therapy is suitable for use in general practice for patients experiencing common mental health conditions and has been shown to be as effective in the treatment of depression as antidepressants. Problem solving therapy involves a series of sequential stages. The clinician assists the patient to develop new empowering skills, and then supports them to work through the stages of therapy to determine and implement the solution selected by the patient. Many experienced GPs will identify their own existing problem solving skills. Learning about PST may involve refining and focusing these skills.

  13. Influences of peer facilitation in general practice - a qualitative study

    DEFF Research Database (Denmark)

    Due, Tina Drud; Kousgaard, Marius Brostrøm; Waldorff, Frans Boch

    2018-01-01

    of the visited practices to gain a more detailed understanding of how peer facilitation influenced practices and how they valued the facilitation. METHODS: The facilitation intervention was conducted in general practice in the Capital Region of Denmark with the purpose of supporting the implementation of chronic...... visits had increased their knowledge and skills as well as their motivation and confidence to change. These positive influences were ascribed to a) the facilitation approach b) the credibility and know-how associated with the facilitators' being peers c) the recurring visits providing protected time...... and invoking a sense of commitment. Despite these positive influences, both the facilitation and the change process were impeded by several challenges, e.g. competing priorities, heavy workload, problems with information technology and in some cases inadequate facilitation. CONCLUSION: Practice facilitation...

  14. Electrocardiogram interpretation in general practice: relevance to prehospital thrombolysis.

    Science.gov (United States)

    McCrea, W A; Saltissi, S

    1993-01-01

    OBJECTIVE--To assess, in the context of their possible role in prehospital thrombolysis, the ability of general practitioners to recognise acute transmural myocardial ischaemia/infarction on an electrocardiogram. DESIGN--150 doctors (every fifth name) were selected from the alphabetical list of 750 on Merseyside general practitioner register and without prior warning were asked to interpret a series of six 12 lead electrocardiograms. Three of these showed acute transmural ischaemia/infarction, one was normal, and two showed non-acute abnormalities. Details of doctors' ages, postgraduate training, and clinical practice were sought. SETTING--General practitioners' surgeries and postgraduate centres within the Merseyside area. PARTICIPANTS--106 general practitioners (mean age 45 years) agreed to participate. MAIN OUTCOME MEASURE--Accuracy of general practitioners' interpretations of the six electrocardiograms. RESULTS--82% of general practitioners correctly recognised a normal electrocardiogram. Recognition of acute abnormalities was less reliable. Between 33% and 61% correctly identified acute transmural ischaemia/infarction depending on the specific trace presented. Accurate localisation of the site of the infarct was achieved only by between 8% and 30% of participants, while between 22% and 25% correctly interpreted non-acute abnormalities. Neither routine use of electrocardiography nor postgraduate hospital experience in general medicine was associated with significantly greater expertise. CONCLUSION--The current level of proficiency of a sample of general practitioners in the Merseyside area in recognising acute transmural ischaemia/infarction on an electrocardiogram suggests that refresher training is needed if general practitioners are to give prehospital thrombolysis. Images PMID:8398491

  15. Ideology and community social psychology: theoretical considerations and practical implications.

    Science.gov (United States)

    Montenegro, Marisela

    2002-08-01

    This paper addresses the importance of the concept of ideology in community work. The implications of a Marxist approach to ideology in community practice are analyzed in terms of the concepts of problematization (P. Freire, 1979) and consciousness-raising (J. Barreiro, 1976), illustrating the point with some examples. The traditional Marxist perspective is also examined in relation to the perspectives of social constructionism (I. Ibáñez, 1996), cultural studies (A. McRobbie, 1992), post-Marxism (E. Laclau & C. Mouffe, 1985), and feminism (D. Haraway, 1991). It is argued that the concepts of hegemony and habitus (P. Bourdieu, 1985) can be useful to community social psychology theory and practice. A "situated perspective"--in which it is possible to dialogue from different "subject positions," and articulate transformation and political action--is argued. The implications of this shifting in the concept of ideology by means of theoretical developments outside social communitypsychology can help to define the external (outside) agent's position in community practice.

  16. Practice patterns and career satisfaction of Canadian female general surgeons.

    Science.gov (United States)

    Hebbard, Pamela C; Wirtzfeld, Debrah A

    2009-06-01

    We wanted to study how female general surgeons in Canada manage lifestyle and career demands. All female Canadian general surgeons registered with the Royal College of Physicians and Surgeons of Canada were asked to complete a survey evaluating their practice patterns, personal lives, and levels of satisfaction related to these factors. Eighty-five surveys (66%) were returned. Most respondents work in full-time clinical practices. While it was rare to find women in part-time or shared practices, 35% of women reported interest in these alternative models. Respondents described the necessary factors for a transition into alternative models. Job satisfaction was high (3.8 out of 5), with personal and parenting satisfaction being less highly rated (3.3 and 3.2, respectively). Canadian female general surgeons have active and satisfying careers, although many would like to work in alternative practice models that better conform to their lifestyle demands. This pressure will have a significant impact on the future surgical workforce.

  17. Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.

    Science.gov (United States)

    Huby, Guro; Guthrie, Bruce; Grant, Suzanne; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

    2008-01-01

    The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact? The article is based on comparative in-depth case studies of four UK practices. There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract. The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

  18. General practice and primary health care in Denmark

    DEFF Research Database (Denmark)

    Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergaard, Jens

    2012-01-01

    General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized...... education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges...... by 5 key components: (1) a list system, with an average of close to 1600 persons on the list of a typical GP; (2) the GP as gatekeeper and first-line provider in the sense that a referral from a GP is required for most office-based specialists and always for in- and outpatient hospital treatment; (3...

  19. Open Access to General Practice Was Associated with Burnout among General Practitioners.

    Science.gov (United States)

    Vedsted, Peter; Sokolowski, Ineta; Olesen, Frede

    2013-01-01

    Walk-in open access in general practice may influence the general practitioner's (GP's) work, but very little research has been done on the consequences. In this study from Danish general practice, we compare the prevalence of burnout between GPs with a walk-in open access and those without. In a questionnaire study (2004), we approached all 458 active GPs in the county of Aarhus, Denmark, and 376 (82.8%) GPs returned the questionnaire. Walk-in open access was defined as at least 30 minutes every weekday where patients could attend practice without an appointment. Burnout was measured by the Maslach Burnout Inventory. Analyses using logistic regression were adjusted for gender, age, marital status, job satisfaction, minutes per consultation, practice organisation, working hours, number of listed patients per GP, number of contacts per GP, continuing medical education- (CME-) activities, and clusters of GPs. In all, 8% of GPs had open access and the prevalence of burnout was 24%. GPs with walk-in open access were more likely to suffer from burnout. Having open access was associated with a 3-fold increased likelihood of burnout (OR = 3.1 (95% CI: 1.1-8.8, P = 0.035)). Although the design cannot establish causality, it is recommended to closely monitor possible negative consequences of open access in general practice.

  20. TEHORIES OF CONNECTIONS – PRACTICAL IMPLICATIONS IN ACQUIRING MOTOR SKILLS

    Directory of Open Access Journals (Sweden)

    Zoran Milošević

    2010-09-01

    Full Text Available Theories of learning which are classified in two broad schools as theories of connections and cognitive theories, differ among themselves according to specific interaction relationships between external stimulus (S, reaction and behavior and organism (R, i.e. particular learner (O. In relation to pedagogical practices, predominance of a certain school is not rare, often without any objective insight into their potentials related to age, sex, learning contents and other determinants. Well-known approaches within the theories of relations include classical Pavlov reflex, Guthry’s close conditioning, associating of Thorndyke, and Skinner’s efficient conditioning. Practical implications of these theories in acquiring motor skills are related to an active learner’s approach, significance of repetition – exercising, supporting, and rewarding correct answers, as well as strengthening a new behavior by imitation of a sample – modeling.

  1. The purpose of the general practice consultation from the patients perspective - theoretical aspects

    DEFF Research Database (Denmark)

    Thorsen, Hanne; Witt, Klaus; Malterud, Kirsti

    2001-01-01

    Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness......Consultation purposes, general practice, patients´expectations, patients satosfaction, patientcenteredness...

  2. Pinch grafting for chronic venous leg ulcers in general practice

    OpenAIRE

    Steele, Keith

    1985-01-01

    Twenty-five patients with chronic venous leg ulcers were treated in general practice by pinch grafting. Fifteen of the ulcers (60%) were completely healed one year after grafting. Prior to grafting 19 patients (76%) complained of daily pain in the ulcer. These patients experienced complete relief from pain after grafting. Pinch grafting is a simple, safe and effective therapy when applied in a domiciliary environment.

  3. Risk factors for potential drug interactions in general practice

    DEFF Research Database (Denmark)

    Bjerrum, Lars; Gonzalez Lopez-Valcarcel, Beatriz; Petersen, Gert

    2008-01-01

    interactions during 1 year. Patient factors associated with increased risk of potential drug interactions were high age, a high number of concurrently used drugs, and a high number of prescribers. Practice factors associated with potential drug interactions were a high percentage of elderly patients and a low......Objective: To identify patient- and practice-related factors associated with potential drug interactions. Methods: A register analysis study in general practices in the county of Funen, Denmark. Prescription data were retrieved from a population-based prescription database (Odense University......, depending on the severity of outcome and the quality of documentation. A two-level random coefficient logistic regression model was used to investigate factors related to potential drug interactions. Results: One-third of the population was exposed to polypharmacy, and 6% were exposed to potential drug...

  4. Evolutionary adaptations: theoretical and practical implications for visual ergonomics.

    Science.gov (United States)

    Fostervold, Knut Inge; Watten, Reidulf G; Volden, Frode

    2014-01-01

    The literature discussing visual ergonomics often mention that human vision is adapted to light emitted by the sun. However, theoretical and practical implications of this viewpoint is seldom discussed or taken into account. The paper discusses some of the main theoretical implications of an evolutionary approach to visual ergonomics. Based on interactional theory and ideas from ecological psychology an evolutionary stress model is proposed as a theoretical framework for future research in ergonomics and human factors. The model stresses the importance of developing work environments that fits with our evolutionary adaptations. In accordance with evolutionary psychology, the environment of evolutionary adaptedness (EEA) and evolutionarily-novel environments (EN) are used as key concepts. Using work with visual display units (VDU) as an example, the paper discusses how this knowledge can be utilized in an ergonomic analysis of risk factors in the work environment. The paper emphasises the importance of incorporating evolutionary theory in the field of ergonomics. Further, the paper encourages scientific practices that further our understanding of any phenomena beyond the borders of traditional proximal explanations.

  5. [Respiratory syncytial virus infections in children in general practice].

    Science.gov (United States)

    Nielsen, Lisa Monica; Halgrener, Jørgen; Hansen, Bjarne V Lühr

    2003-06-30

    The aim of the study was to describe the course of respiratory syncytial virus (RSV) infections in children under two years of age seen in general practice. Children under two years of age presenting acute respiratory infection during the registration period on 59 GPs' lists participated in the study. The GPs recorded data on a registration chart and a questionnaire was sent to the parents of the children in question one month after the date of inclusion. The children were tested in general practice for the presence of RSV. The GPs' objective findings and choice of treatment as well as the parents' account of the course of disease were compared in children with and without the presence of RSV. A total of 221 children participated in the study. Fifty-seven children were found RSV positive (25.8%). Among the RSV positive children there were significantly more with wheezing audibly detected with examination by stethoscope than among the RSV negative. The remaining parameters (the GP's objective examination, treatment and course of the disease) were distributed independently of the result of the RSV analysis. The results showed that RSV infections in children under two years in general practice are frequent and that the clinical picture most often is uncomplicated.

  6. Medical students, early general practice placements and positive supervisor experiences.

    Science.gov (United States)

    Henderson, Margaret; Upham, Susan; King, David; Dick, Marie-Louise; van Driel, Mieke

    2018-03-01

    Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptions of student development; and triggers enhancing the experience. A model was developed to reflect these themes. Conclusions Training experiences were enhanced for GPs supervising medical students in early longitudinal clinical placements by the synergy of motivated students and keen teachers with support from patients, practice staff and academic institutions. We developed an explanatory model to better understand the mechanism of positive experiences. Understanding the interaction of factors enhancing teaching satisfaction is important for clinical disciplines wishing to maintain sustainable, high quality teaching.

  7. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  8. Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress.

    Science.gov (United States)

    Cousins, Rosanna; Donnell, Christine

    2012-04-01

    Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

  9. Developing a general practice library: a collaborative project between a GP and librarian.

    Science.gov (United States)

    Pearson, D; Rossall, H

    2001-12-01

    The authors report on a self-completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work.

  10. General practice training and virtual communities of practice - a review of the literature.

    Science.gov (United States)

    Barnett, Stephen; Jones, Sandra C; Bennett, Sue; Iverson, Don; Bonney, Andrew

    2012-08-21

    Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs) in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Major online databases Scopus, Psychlit and Pubmed were searched for the terms "Community of Practice" (CoP) AND (Online OR Virtual OR Electronic) AND (health OR healthcare OR medicine OR "Allied Health"). Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders rather than single company VCoPs. Specific goals are important

  11. The causes of prescribing errors in English general practices: a qualitative study.

    Science.gov (United States)

    Slight, Sarah P; Howard, Rachel; Ghaleb, Maisoon; Barber, Nick; Franklin, Bryony Dean; Avery, Anthony J

    2013-10-01

    Few detailed studies exist of the underlying causes of prescribing errors in the UK. To examine the causes of prescribing and monitoring errors in general practice and provide recommendations for how they may be overcome. Qualitative interview and focus group study with purposive sampling of English general practices. General practice staff from 15 general practices across three PCTs in England participated in a combination of semi-structured interviews (n = 34) and six focus groups (n = 46). Thematic analysis informed by Reason's Accident Causation Model was used. Seven categories of high-level error-producing conditions were identified: the prescriber, the patient, the team, the working environment, the task, the computer system, and the primary-secondary care interface. These were broken down to reveal various error-producing conditions: the prescriber's therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health; the patient's characteristics and the complexity of the individual clinical case; the importance of feeling comfortable within the practice team was highlighted, as well as the safety implications of GPs signing prescriptions generated by nurses when they had not seen the patient for themselves; the working environment with its extensive workload, time pressures, and interruptions; and computer-related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts were all highlighted as possible causes of prescribing errors and were often interconnected. Complex underlying causes of prescribing and monitoring errors in general practices were highlighted, several of which are amenable to intervention.

  12. Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

    Science.gov (United States)

    Catzikiris, Nigel; Tapley, Amanda; Morgan, Simon; Holliday, Elizabeth G; Ball, Jean; Henderson, Kim; Elliott, Taryn; Spike, Neil; Regan, Cathy; Magin, Parker

    2017-08-10

    Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (Pinterest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to

  13. General practice training and virtual communities of practice - a review of the literature

    Directory of Open Access Journals (Sweden)

    Barnett Stephen

    2012-08-01

    Full Text Available Abstract Background Good General Practice is essential for an effective health system. Good General Practice training is essential to sustain the workforce, however training for General Practice can be hampered by a number of pressures, including professional, structural and social isolation. General Practice trainees may be under more pressure than fully registered General Practitioners, and yet isolation can lead doctors to reduce hours and move away from rural practice. Virtual communities of practice (VCoPs in business have been shown to be effective in improving knowledge sharing, thus reducing professional and structural isolation. This literature review will critically examine the current evidence relevant to virtual communities of practice in General Practice training, identify evidence-based principles that might guide their construction and suggest further avenues for research. Methods Major online databases Scopus, Psychlit and Pubmed were searched for the terms “Community of Practice” (CoP AND (Online OR Virtual OR Electronic AND (health OR healthcare OR medicine OR “Allied Health”. Only peer-reviewed journal articles in English were selected. A total of 76 articles were identified, with 23 meeting the inclusion criteria. There were no studies on CoP or VCoP in General Practice training. The review was structured using a framework of six themes for establishing communities of practice, derived from a key study from the business literature. This framework has been used to analyse the literature to determine whether similar themes are present in the health literature and to identify evidence in support of virtual communities of practice for General Practice training. Results The framework developed by Probst is mirrored in the health literature, albeit with some variations. In particular the roles of facilitator or moderator and leader whilst overlapping, are different. VCoPs are usually collaborations between stakeholders

  14. Quality of routine spirometry tests in Dutch general practices

    Science.gov (United States)

    Schermer, Tjard RJ; Crockett, Alan J; Poels, Patrick JP; van Dijke, Jacob J; Akkermans, Reinier P; Vlek, Hans F; Pieters, Willem R

    2009-01-01

    Background Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care. Aim To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics. Design of study Analysis of routine spirometry test records. Setting Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation. Method Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression. Results Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age, sex, and severity of obstruction were associated with test quality markers. Conclusion The quality of routine spirometry tests was better than in previous reports from primary care research settings, but there is still substantial room for improvement. Sufficient duration of forced expiratory time is the quality marker with the highest rate of inadequacy. Primary care professionals should be aware of patient characteristics that may diminish the quality of their spirometry tests. Further research is needed to establish to what extent spirometry tests that are inadequate, according to stringent international expert criteria

  15. Chinese hotel general managers' perspectives on energy-saving practices

    Science.gov (United States)

    Zhu, Yidan

    As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

  16. Screening for diabetes in unconventional locations: resource implications and economics of screening in optometry practices.

    Science.gov (United States)

    Howse, Jennifer H; Jones, Steve; Hungin, A Pali S

    2011-10-01

    Unconventional locations outwith general medical practice may prove opportunities for screening. The aim was to determine the resource implications and economics of a screening service using random capillary blood glucose (rCBG) tests to detect raised blood glucose levels in the "at risk" population attending high street optometry practices. A screening service was implemented in optometry practices in North East England: the cost of the service and the implication of different screening strategies was estimated. The cost of a screening test was £5.53-£11.20, depending on the screening strategy employed and who carried out the testing. Refining the screening strategy to target those ≥40 years with BMI of ≥25 kg/m(2) and/or family history of diabetes resulted in a cost per case referred to the GP of £14.38-£26.36. Implementing this strategy in half of optometric practices in England would have the potential to identify up to 150,000 new cases of diabetes and prediabetes a year. Optometry practices provide an effective way of identifying people who would benefit from further investigation for diabetes. Effectiveness could be improved further by improving cooperation and communication between optometrists and medical practitioners. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  17. Audit and feedback by medical students to improve the preventive care practices of general practice supervisors.

    Science.gov (United States)

    Gilkes, Lucy A; Liira, Helena; Emery, Jon

    Medical students benefit from their contact with clinicians and patients in the clinical setting. However, little is known about whether patients and clinicians also benefit from medical students. We developed an audit and feedback intervention activity to be delivered by medical students to their general practice supervisors. We tested whether the repeated cycle of audit had an effect on the preventive care practices of general practitioners (GPs). The students performed an audit on topics of preventive medicine and gave feedback to their supervisors. Each supervisor in the study had more than one student performing the audit over the academic year. After repetitive cycles of audit and feedback, the recording of social history items by GPs improved. For example, recording alcohol history increased from 24% to 36%. This study shows that medical students can be effective auditors, and their repeated audits may improve their general practice supervisors' recording of some aspects of social history.

  18. The use of financial incentives in Australian general practice.

    Science.gov (United States)

    Kecmanovic, Milica; Hall, Jane P

    2015-05-18

    To examine the uptake of financial incentive payments in general practice, and identify what types of practitioners are more likely to participate in these schemes. Analysis of data on general practitioners and GP registrars from the Medicine in Australia - Balancing Employment and Life (MABEL) longitudinal panel survey of medical practitioners in Australia, from 2008 to 2011. Income received by GPs from government incentive schemes and grants and factors associated with the likelihood of claiming such incentives. Around half of GPs reported receiving income from financial incentives in 2008, and there was a small fall in this proportion by 2011. There was considerable movement into and out of the incentives schemes, with more GPs exiting than taking up grants and payments. GPs working in larger practices with greater administrative support, GPs practising in rural areas and those who were principals or partners in practices were more likely to use grants and incentive payments. Administrative support available to GPs appears to be an increasingly important predictor of incentive use, suggesting that the administrative burden of claiming incentives is large and not always worth the effort. It is, therefore, crucial to consider such costs (especially relative to the size of the payment) when designing incentive payments. As market conditions are also likely to influence participation in incentive schemes, the impact of incentives can change over time and these schemes should be reviewed regularly.

  19. Diagnostic strategies for urinary tract infections in French general practice.

    Science.gov (United States)

    Kinouani, S; de Lary de Latour, H; Joseph, J-P; Letrilliart, L

    2017-10-01

    We aimed to describe the diagnostic management procedures for detection of urinary tract infections in general practice and their correlated factors. We analyzed data from the ECOGEN study on urinary tract infections, collected in France between November 2011 and April 2012. This national cross-sectional study was carried out in general practices. Data was coded according to the International Classification of Primary Care. A total of 340 consultations or home visits were held for urinary tract infections. The five most frequent diagnostic procedures were (in descending order) clinical examination (67.6%), urine cytobacteriological examination (UCBE) (47.9%), urine dipstick test (15.6%), blood test (8.5%), and imaging (6.5%). No urine dipstick test or UCBE was performed in 43% of cases. Factors correlated with diagnostic procedures were age and gender of patients, annual number of consultations held by family physicians, and duration of consultation. Family physicians did not comply with guidelines on diagnostic management for detection of urinary tract infections. We hypothesized that this non-compliance could be due to the family physicians' environment and characteristics, and to clinical practice guidelines. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: views of general practitioners and practice nurses.

    Science.gov (United States)

    Halcomb, Elizabeth J; Furler, John S; Hermiz, Oshana S; Blackberry, Irene D; Smith, Julie P; Richmond, Robyn L; Zwar, Nicholas A

    2015-08-01

    Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role. The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized controlled trial in Australian general practice. Process evaluation was conducted by means of semi-structured telephone interviews with GPs and PNs allocated in the intervention arm (Quit with PN) of the Quit in General Practice trial. Interviews focussed on nurse training, content and implementation of the intervention. Twenty-two PNs and 15 GPs participated in the interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified. The Quit with PN intervention was acceptable to participating PNs and GPs. Issues to be addressed in the planning and wider implementation of future trials of nurse-led intervention in general practice include providing ongoing mentoring support, integration into practice management systems and strategies to promote greater collaboration in GPs and PN teams in general practice. The ongoing feasibility of the intervention was impacted by the funding model supporting PN employment and the competing demands on the PNs time. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Understanding "revolving door" patients in general practice: a qualitative study.

    Science.gov (United States)

    Williamson, Andrea E; Mullen, Kenneth; Wilson, Philip

    2014-02-13

    'Revolving door' patients in general practice are repeatedly removed from general practitioners' (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients. We conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise 'revolving door' patients and their impact from professionals' perspectives. 'Revolving door' patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when 'revolving door' patients interacted with NHS staff. We utilise the 'sensitising concepts' of legitimacy by drawing on literature about 'good and bad' patients and 'dirty work designations.' We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with 'revolving door' patients. We suggest this may have wider relevance for the problem doctor patient relationship literature.

  2. Management of venous leg ulcers in general practice - a practical guideline.

    Science.gov (United States)

    Sinha, Sankar; Sreedharan, Sadhishaan

    2014-09-01

    Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.

  3. Adherence to COPD guidelines in general practice: impact of an educational programme delivered on location in Danish general practices.

    Science.gov (United States)

    Ulrik, Charlotte Suppli; Sørensen, Tina Brandt; Højmark, Torben Brunse; Olsen, Kim Rose; Vedsted, Peter

    2013-03-01

    The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD guidelines. A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted of a 3-hr teaching lesson with a respiratory specialist and five visits by a representative from the sponsoring pharmaceutical company focusing on assessment and management of patients including written algorithms. A one-to-one propensity-matched control group of practices was selected. Register data were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. Data for 102 participating GP practices were analysed. Participating clinics had a significant increase in preventive consultations and influenza vaccinations (peducation of GPs and their staff delivered in the GPs' own practices may improve adherence to COPD guidelines, not least for clinics with a high potential for improvement.

  4. Description of a practice model for pharmacist medication review in a general practice setting

    DEFF Research Database (Denmark)

    Brandt, Mette; Hallas, Jesper; Hansen, Trine Graabæk

    2014-01-01

    BACKGROUND: Practical descriptions of procedures used for pharmacists' medication reviews are sparse. OBJECTIVE: To describe a model for medication review by pharmacists tailored to a general practice setting. METHODS: A stepwise model is described. The model is based on data from the medical chart...... no indication (n=47, 23%). Most interventions were aimed at cardiovascular drugs. CONCLUSION: We have provided a detailed description of a practical approach to pharmacists' medication review in a GP setting. The model was tested and found to be usable, and to deliver a medication review with high acceptance...

  5. Nursing intellectual capital theory: implications for research and practice.

    Science.gov (United States)

    Covell, Christine L; Sidani, Souraya

    2013-05-31

    Due to rising costs of healthcare, determining how registered nurses and knowledge resources influence the quality of patient care is critical. Studies that have investigated the relationship between nursing knowledge and outcomes have been plagued with conceptual and methodological issues. This has resulted in limited empirical evidence of the impact of nursing knowledge on patient or organizational outcomes. The nursing intellectual capital theory was developed to assist with this area of inquiry. Nursing intellectual capital theory conceptualizes the sources of nursing knowledge available within an organization and delineates its relationship to patient and organizational outcomes. In this article, we review the nursing intellectual capital theory and discuss its implications for research and practice. We explain why the theory shows promise for guiding research on quality work environments and how it may assist with administrative decision-making related to nursing human resource management and continuing professional development.

  6. Medical engagement and organizational characteristics in general practice.

    Science.gov (United States)

    Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders; Kristensen, Troels; Lykkegaard, Jesper; Nexøe, Jørgen; Barwell, Fred; Spurgeon, Peter; Søndergaard, Jens

    2016-02-01

    Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale (MES) was developed by Applied Research Ltd (2008) on the basis of emerging evidence that medical engagement is critical for implementing radical improvements. To study the importance of medical engagement in general practice and to analyse patterns of association with individual and organizational characteristics. A cross-sectional study using a sampled survey questionnaire and the official register from the Danish General Practitioners' Organization comprising all registered Danish GPs. The Danish version of the MES Questionnaire was distributed and the survey results were analysed in conjunction with the GP register data. Statistically adjusted analyses revealed that the GPs' medical engagement varied substantially. GPs working in collaboration with colleagues were more engaged than GPs from single-handed practices, older GPs were less engaged than younger GPs and female GPs had higher medical engagement than their male colleagues. Furthermore, GPs participating in vocational training of junior doctors were more engaged than GPs not participating in vocational training. Medical engagement in general practice varies a great deal and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Managing corneal foreign bodies in office-based general practice.

    Science.gov (United States)

    Fraenkel, Alison; Lee, Lawrence R; Lee, Graham A

    2017-03-01

    Patients with a corneal foreign body may first present to their general practitioner (GP). Safe and efficacious management of these presentations avoids sight-threatening and eye-threatening complications. Removal of a simple, superficial foreign body without a slit lamp is within The Royal Australian College of General Practitioners' (RACGP's) curriculum and scope of practice. Knowing the rele-vant procedural skills and indications for referral is equally important. The objective of this article is to provide an evidence-based and expert-based guide to the management of corneal foreign bodies in the GP's office. History is key to identifying patient characteristics and mechanisms of ocular injury that are red flags for referral. Examination tech-niques and methods of superficial foreign body removal without a slit lamp are outlined, as well as the procedural threshold for referral to an ophthalmologist.

  8. Relations between task delegation and job satisfaction in general practice

    DEFF Research Database (Denmark)

    Riisgaard, Helle; Nexøe, Jørgen; Videbæk Le, Jette

    2016-01-01

    practitioners' and their staff's job satisfaction appears to be sparse even though job satisfaction is acknowledged as an important factor associated with both patient satisfaction and medical quality of care. Therefore, the overall aim of this study was 1) to review the current research on the relation between...... task delegation and general practitioners' and their staff's job satisfaction and, additionally, 2) to review the evidence of possible explanations for this relation. METHODS: A systematic literature review. We searched the four databases PubMed, Cinahl, Embase, and Scopus systematically. The immediate...... attitude towards task delegation was positive and led to increased job satisfaction, probably because task delegation comprised a high degree of work autonomy. CONCLUSIONS: The few studies included in our review suggest that task delegation within general practice may be seen by the staff as an overall...

  9. Teaching Improvisation through Processes. Applications in Music Education and Implications for General Education

    Directory of Open Access Journals (Sweden)

    Michele Biasutti

    2017-06-01

    Full Text Available Improvisation is an articulated multidimensional activity based on an extemporaneous creative performance. Practicing improvisation, participants expand sophisticated skills such as sensory and perceptual encoding, memory storage and recall, motor control, and performance monitoring. Improvisation abilities have been developed following several methodologies mainly with a product-oriented perspective. A model framed under the socio-cultural theory of learning for designing didactic activities on processes instead of outcomes is presented in the current paper. The challenge is to overcome the mere instructional dimension of some practices of teaching improvisation by designing activities that stimulate self-regulated learning strategies in the students. In the article the present thesis is declined in three ways, concerning the following three possible areas of application: (1 high-level musical learning, (2 musical pedagogy with children, (3 general pedagogy. The applications in the music field focusing mainly on an expert's use of improvisation are discussed. The last section considers how these ideas should transcend music studies, presenting the benefits and the implications of improvisation activities for general learning. Moreover, the application of music education to the following cognitive processes are discussed: anticipation, use of repertoire, emotive communication, feedback and flow. These characteristics could be used to outline a pedagogical method for teaching music improvisation based on the development of reflection, reasoning, and meta-cognition.

  10. Teaching Improvisation through Processes. Applications in Music Education and Implications for General Education.

    Science.gov (United States)

    Biasutti, Michele

    2017-01-01

    Improvisation is an articulated multidimensional activity based on an extemporaneous creative performance. Practicing improvisation, participants expand sophisticated skills such as sensory and perceptual encoding, memory storage and recall, motor control, and performance monitoring. Improvisation abilities have been developed following several methodologies mainly with a product-oriented perspective. A model framed under the socio-cultural theory of learning for designing didactic activities on processes instead of outcomes is presented in the current paper. The challenge is to overcome the mere instructional dimension of some practices of teaching improvisation by designing activities that stimulate self-regulated learning strategies in the students. In the article the present thesis is declined in three ways, concerning the following three possible areas of application: (1) high-level musical learning, (2) musical pedagogy with children, (3) general pedagogy. The applications in the music field focusing mainly on an expert's use of improvisation are discussed. The last section considers how these ideas should transcend music studies, presenting the benefits and the implications of improvisation activities for general learning. Moreover, the application of music education to the following cognitive processes are discussed: anticipation, use of repertoire, emotive communication, feedback and flow. These characteristics could be used to outline a pedagogical method for teaching music improvisation based on the development of reflection, reasoning, and meta-cognition.

  11. Employment of people with disabilities: Implications for HR management practices

    Directory of Open Access Journals (Sweden)

    P. Gida

    2007-12-01

    Full Text Available Purpose: The purpose of this paper is to, firstly, present the findings of an empirical study in which the human resource management practices associated with the employment of people with disabilities were investigated. The human resource management challenges related to employment of people with disabilities were also identified in the empirical study and are presented in this paper. A further purpose of this paper is to propose a number of recommendations focused on human resource management practices and principles aimed at assisting managers and human resource management specialists in their endeavours to effectively deal with the employment of people with disabilities. Design/Methodology/Approach: This paper is based on an empirical study in which interviews were conducted with respondents from 19 different organisations identified in the Financial Mail's 'Top 100 Organisations in South Africa' list. Findings: The findings from the empirical study suggest that very few organisations are dealing with the employment of people with disabilities as a priority in their equity strategies. Where attention is being given to this issue, respondents seem to either address it as a legal compliance issue or a social responsibility 'project'. Furthermore, very little has been done to review current human resource management practices to determine whether they are discriminatory towards people with disabilities. Based on the insights gained from these findings and in line with best practice principles identified in the relevant literature, a number of recommendations focusing on human resource management practices and principles in relation to the employment of people with disabilities are proposed. Implications: This paper provides a number of practical steps to consider as part of an organisation's response to equity strategies related to the employment of people with disabilities. Originality/Value: In the Employment Equity Commission's Annual Report

  12. Practice nurses in general practice: a rapidly growing profession in The Netherlands.

    NARCIS (Netherlands)

    Heiligers, P.J.M.; Noordman, J.; Korevaar, J.; Dorsman, S.W.; Hingstman, L.; Dulmen, S. van; Bakker, D. de

    2012-01-01

    Background: In 1999, nurse practitioners were introduced. The main objectives were to improve quality of care for chronic ill and to reduce workload of general practitioners. In ten years the number of practice nurses has grown tremendously. Meanwhile there are new tasks as a result of aging.

  13. [Possibilities and limitations of telemedicine in general practitioner practices].

    Science.gov (United States)

    van den Berg, N; Meinke, C; Hoffmann, W

    2009-09-01

    According to the AGnES concept (general-practitioner-supporting, community-based, e-health-assisted systemic intervention), general practitioners (GPs) can delegate certain components of medical care in the context of home visits by qualified AGnES employees. Within the framework of six AGnES projects, different telemedical applications have been implemented. Telemedical monitoring of patients was implemented to analyse the feasibility and acceptance within GP practices. One hundred sixty-two patients used a telemedical monitoring system (e.g. scale/sphygmomanometer and intraocular pressure measurement system). Regarding communication in cases of acutely necessary GP consultations, telephone calls and videoconferences between the GP and the AGnES employee were analysed. Unscheduled telephone calls or videoconferences were necessary for only a few home visits; the reasons included pain, anomalous values, and medication problems. The main result of the analysis was that implementation of telemedicine in GP practices is feasible and is accepted both by patients and GPs.

  14. Clinical usefulness of teleradiology in general dental practice

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo [Dept. of Oral and Maxillofacial Radiology, Dankook University College of Dentistry, Cheonan (Korea, Republic of)

    2013-06-15

    This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient's chief complaint, the necessity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. Differential diagnoses of normal anatomic structures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radiographs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentists. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. A teleradiology system in general dental practice could be helpful in the differential diagnosis of common lesions and reduce unnecessary costs.

  15. TEHORIES OF CONNECTIONS – PRACTICAL IMPLICATIONS IN ACQUIRING MOTOR SKILLS

    Directory of Open Access Journals (Sweden)

    Zoran Milošević

    2010-03-01

    Full Text Available Theories of learning which are classified in two broad schools as theories of connections and cognitive theories, differ among themselves according to specific interaction relationships between external stimulus (S, reaction and behavior and organism (R, i.e. particular learner (O. In relation to pedagogical practices, predominance of a certain school is not rare, often without any objective insight into their potentials related to age, sex, learning contents and other determinants. Supporters of the theories of connections treat behavior as a result of relations or associations, whereas learning occurs when these relations are strengthened by repetition or when new relations are formed. These theories are usually classified as theories of stimulus-reaction (S-R, whereas associating in this sense is used to stress the concept most theories usually agree upon: that learning consists of relations and link between stimuli (S-S, between stimuli and reactions (S-R, or between reaction and impulse (R-P. Well-known approaches within the theories of relations include classical Pavlov reflex, Guthry’s close conditioning, associating of Thorndyke, and Skinner’s efficient conditioning. Practical implications of these theories in acquiring motor skills are related to an active learner’s approach, significance of repetition – exercising, supporting, and rewarding correct answers, as well as strengthening a new behavior by imitation of a sample – modeling.

  16. The actual role of general practice in the Dutch health-care system: results of the Second Dutch National Survey of General Practice.

    OpenAIRE

    Schellevis, F.G.; Westert, G.P.; Bakker, D.H. de

    2005-01-01

    A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners, practices) and included morbidity (self-report and presented to general practitioners), diagnostic and therapeutic interventions, doctor-patient communication, and background characteristics. Compared ...

  17. Variation in clinical coding lists in UK general practice: a barrier to consistent data entry?

    Science.gov (United States)

    Tai, Tracy Waize; Anandarajah, Sobanna; Dhoul, Neil; de Lusignan, Simon

    2007-01-01

    Routinely collected general practice computer data are used for quality improvement; poor data quality including inconsistent coding can reduce their usefulness. To document the diversity of data entry systems currently in use in UK general practice and highlight possible implications for data quality. General practice volunteers provided screen shots of the clinical coding screen they would use to code a diagnosis or problem title in the clinical consultation. The six clinical conditions examined were: depression, cystitis, type 2 diabetes mellitus, sore throat, tired all the time, and myocardial infarction. We looked at the picking lists generated for these problem titles in EMIS, IPS, GPASS and iSOFT general practice clinical computer systems, using the Triset browser as a gold standard for comparison. A mean of 19.3 codes is offered in the picking list after entering a diagnosis or problem title. EMIS produced the longest picking lists and GPASS the shortest, with a mean number of choices of 35.2 and 12.7, respectively. Approximately three-quarters (73.5%) of codes are diagnoses, one-eighth (12.5%) symptom codes, and the remainder come from a range of Read chapters. There was no readily detectable consistent order in which codes were displayed. Velocity coding, whereby commonly-used codes are placed higher in the picking list, results in variation between practices even where they have the same brand of computer system. Current systems for clinical coding promote diversity rather than consistency of clinical coding. As the UK moves towards an integrated health IT system consistency of coding will become more important. A standardised, limited list of codes for primary care might help address this need.

  18. Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study.

    Science.gov (United States)

    Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Scott, John; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrie A; Davey, Andrew R; Catzikiris, Nigel F; Magin, Parker J

    2015-01-01

    setting. In addition, our findings have implications more broadly for the delivery of travel medicine in general practice. © 2015 International Society of Travel Medicine.

  19. Impact of robotic general surgery course on participants' surgical practice.

    Science.gov (United States)

    Buchs, Nicolas C; Pugin, François; Volonté, Francesco; Hagen, Monika E; Morel, Philippe

    2013-06-01

    Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the impact of robotic general surgery course on the practice of participants. Between 2007 and 2011, 101 participants attended the Geneva International Robotic Surgery Course, held at the University Hospital of Geneva, Switzerland. This 2-day course included theory lectures, dry lab, live surgery, and hands-on session on cadavers. After a mean of 30.1 months (range, 2-48), a retrospective review of the participants' surgical practice was performed using online research and surveys. Among the 101 participants, there was a majority of general (58.4 %) and colorectal surgeons (10.9 %). Other specialties included urologists (7.9 %), gynecologists (6.9 %), pediatric surgeons (2 %), surgical oncologists (1 %), engineers (6.9 %), and others (5.9 %). Data were fully recorded in 99 % of cases; 46 % of participants started to perform robotic procedures after the course, whereas only 6.9 % were already familiar with the system before the course. In addition, 53 % of the attendees worked at an institution where a robotic system was already available. All (100 %) of participants who started a robotic program after the course had an available robotic system at their institution. A course that includes lectures, live surgery, and hands-on session with cadavers is an effective educational method for spreading robotic skills. However, this is especially true for participants whose institution already has a robotic system available.

  20. Health profiles of overweight and obese youth attending general practice.

    Science.gov (United States)

    Paulis, Winifred D; Palmer, Millicent; Chondros, Patty; Kauer, Sylvia; van Middelkoop, Marienke; Sanci, Lena A

    2017-05-01

    Literature suggests that overweight and obese young people use healthcare services more often, but this awaits confirmation in primary care. To identify health profiles of underweight, overweight and obese young people attending general practice and compare them to normal-weight youth and also to explore the weight-related health risks of eating and exercise behaviour in the four different weight categories. This study used a cross-sectional design with baseline data from a trial including 683 young people (14-24 years of age) presenting to general practice. Through computer-assisted telephone interviews data were obtained on number and type of health complaints and consultations, emotional distress, health-related quality of life (HRQoL) and eating and exercise behaviour. General practitioners (GPs) were consulted more often by overweight (incidence rate ratio (IRR): 1.28, 95% CI (1.04 to 1.57)) and obese youth (IRR: 1.54, 95% CI (1.21 to 1.97), but not for different health problems compared with normal-weight youth. The reason for presentation was seldom a weight issue. Obese youth reported lower physical HRQoL. Obese and underweight youth were less likely to be satisfied with their eating behaviour than their normal-weight peers. Exercise levels were low in the entire cohort. Our study highlights the need for effective weight management given that overweight and obese youth consult their GP more often. Since young people do not present with weight issues, it becomes important for GPs to find ways to initiate the discussion about weight, healthy eating and exercise with youth. ISRCTN16059206. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands

    Directory of Open Access Journals (Sweden)

    Grol Richard

    2009-07-01

    Full Text Available Abstract Background The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Methods Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Results and discussion Workload and job stress are associated with practice performance. Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16. After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45. When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care. Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21 and insufficient practice management (b = 0.25. Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35. Conclusion Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using

  2. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.

    Science.gov (United States)

    van den Hombergh, Pieter; Künzi, Beat; Elwyn, Glyn; van Doremalen, Jan; Akkermans, Reinier; Grol, Richard; Wensing, Michel

    2009-07-15

    The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Workload and job stress are associated with practice performance.Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care.Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35). Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP.

  3. Implications of a positive cosmological constant for general relativity.

    Science.gov (United States)

    Ashtekar, Abhay

    2017-10-01

    Most of the literature on general relativity over the last century assumes that the cosmological constant [Formula: see text] is zero. However, by now independent observations have led to a consensus that the dynamics of the universe is best described by Einstein's equations with a small but positive [Formula: see text]. Interestingly, this requires a drastic revision of conceptual frameworks commonly used in general relativity, no matter how small [Formula: see text] is. We first explain why, and then summarize the current status of generalizations of these frameworks to include a positive [Formula: see text], focusing on gravitational waves.

  4. Referrals and relationships: in-practice referrals meetings in a general practice.

    Science.gov (United States)

    Rowlands, G; Willis, S; Singleton, A

    2001-08-01

    GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted

  5. Generalized bootstrap equations and possible implications for the NLO Odderon

    Energy Technology Data Exchange (ETDEWEB)

    Bartels, J. [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik; Vacca, G.P. [INFN, Sezione di Bologna (Italy)

    2013-07-15

    We formulate and discuss generalized bootstrap equations in nonabelian gauge theories. They are shown to hold in the leading logarithmic approximation. Since their validity is related to the self-consistency of the Steinmann relations for inelastic production amplitudes they can be expected to be valid also in NLO. Specializing to the N=4 SYM, we show that the validity in NLO of these generalized bootstrap equations allows to find the NLO Odderon solution with intercept exactly at one.

  6. Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Siersma, Volkert Dirk; Sandholdt, Håkon

    2017-01-01

    practice-related factors driving high antibiotic prescribing rates. Results: We included 98% of general practices in Denmark (n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case...... prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics. Conclusions: An apparent...

  7. General practice and the new science emerging from the theories of 'chaos' and complexity.

    OpenAIRE

    Griffiths, F; Byrne, D

    1998-01-01

    This paper outlines the general practice world view and introduces the main features of the theories of 'chaos' and complexity. From this, analogies are drawn between general practice and the theories, which suggest a different way of understanding general practice and point to future developments in general practice research. A conceptual and practical link between qualitative and quantitative methods of research is suggested. Methods of combining data about social context with data about in...

  8. The actual role of general practice in the Dutch health-care system: results of the Second Dutch National Survey of General Practice.

    NARCIS (Netherlands)

    Schellevis, F.G.; Westert, G.P.; Bakker, D.H. de

    2005-01-01

    A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners,

  9. Implementing portfolio in postgraduate general practice training. Benefits and recommendations.

    Science.gov (United States)

    Alotaibi, Fawaz S

    2012-10-01

    This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.

  10. Determinants related to gender differences in general practice utilization

    DEFF Research Database (Denmark)

    Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne

    2016-01-01

    OBJECTIVE: This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years. DESIGN: Cohort-based cross-sectional study. SETTING: Danish general practice. SUBJECTS: Totally, 54,849 participants of the Danish Diet, Cancer...... information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire. RESULTS: Women had on average 4.1 and men 2.8 consultations per year. In a crude....... Strongest determinants for GP use among Danish adults aged 50-65 years were the presence of medical conditions (somatic and mental) and unemployment, while lifestyle factors (e.g., body mass index, alcohol consumption and smoking) had minor effect....

  11. Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

    DEFF Research Database (Denmark)

    Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S

    2010-01-01

    Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...... breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor...

  12. The motivation to teach as a registrar in general practice.

    Science.gov (United States)

    Thampy, Harish; Agius, Steven; Allery, Lynne A

    2013-07-01

    The General Medical Council (GMC) states that teaching should be an integral part of the doctor's role and the Royal College of General Practitioners (RCGP) have incorporated teaching outcomes into the GP training curriculum. However, there are suggestions that the teaching role of a GP trainee declines as they move from hospital posts to the registrar community year. Using doctors in training as near-peer tutors offers multiple advantages. Trainees themselves benefit as teaching others is a strong driver of the tutor's own learning. In addition there are also practical incentives to mobilising this under-utilised pool of primary care clinical teachers given the continuing shift of focusing medical education in the community. This study forms part of a larger body of work exploring the attitudes and perceived learning needs of GP registrars with regards to developing a teaching role. A primary area of investigation was trainees' motivation to teach. This paper describes our attempts to establish: a) how strongly motivated are GP registrars to take on teaching roles? b) in consequence how strongly motivated are they to learn more about teaching? c) what are the factors which affect motivation to teach? Three themes emerged from the data. First, teaching was felt to be of low priority in comparison to competing clinical learning needs. Secondly, the clinical dominance to both formative and summative assessment during training further compounded this situation. Thirdly, registrars identified a number of practical barriers and incentives that influenced their teaching engagement. This included potential negative views from trainers as to their trainee's ability and requirement to be involved with teaching activities.By understanding and addressing these issues, it is hoped that GP trainees' engagement with teaching activities can be better engendered with subsequent benefits for both the trainee and those they teach.

  13. Sampling in forests for radionuclide analysis. General and practical guidance

    Energy Technology Data Exchange (ETDEWEB)

    Aro, Lasse (Finnish Forest Research Inst. (METLA) (Finland)); Plamboeck, Agneta H. (Swedish Defence Research Agency (FOI) (Sweden)); Rantavaara, Aino; Vetikko, Virve (Radiation and Nuclear Safety Authority (STUK) (Finland)); Straalberg, Elisabeth (Inst. Energy Technology (IFE) (Norway))

    2009-01-15

    The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)

  14. Practices in communicating technical issues to the general public

    International Nuclear Information System (INIS)

    Drabova, D.; Storey, P.

    2006-01-01

    The conclusions and recommendations of this session can be summarized this way. - Basic goal for the regulator is to protect the public and communication is a must to fully achieve this goal. - Regulator should become the prime source of information to the public and the media, regulator should base its actions upon values of competence, independence, transparency and stringency. - Set up of a Information and Communication Policy will help for consistency and efficiency. Policy will include setting goals, strategies, organisational aspects, procedures, and tools. Practices should be developed in accordance with local culture. - Challenges will consider transparency, public involvement and consultation with the stakeholders. - Practices will include in general: - Interactions with the media like press releases, news conferences, media workshops. Printed materials from plant periodical status reports, to periodical and annual reports and specific reports. Audio-visual materials. Use of radio and TV. Web site and electronic mail. - Method chosen depends on the targeted audience and the relevance of the topic. - Messages should be clearly understandable. Do not dehumanize the message by making it technically unintelligible. - Two excellent examples presented. How local culture and social characteristics were taken into account in designing and implementing plans is key for success. - Municipalities are to be considered as front line stakeholders. - Communicators role is relevant to meet regulatory needs. Good collaboration between communicators and technical staff produces benefits for the nuclear regulator and the public. (authors)

  15. Sampling in forests for radionuclide analysis. General and practical guidance

    International Nuclear Information System (INIS)

    Aro, Lasse; Plamboeck, Agneta H.; Rantavaara, Aino; Vetikko, Virve; Straelberg, Elisabeth

    2009-01-01

    The NKS project FOREST was established to prepare a guide for sampling in forest ecosystems for radionuclide analysis. The aim of this guide is to improve the reliability of datasets generated in future studies by promoting the use of consistent, recommended practices, thorough documentation of field sampling regimes and robust preparation of samples from the forest ecosystem. The guide covers general aims of sampling, the description of major compartments of the forest ecosystem and outlines key factors to consider when planning sampling campaigns for radioecological field studies in forests. Recommended and known sampling methods for various sample types are also compiled and presented. The guide focuses on sampling practices that are applicable in various types of boreal forests, robust descriptions of sampling sites, and documentation of the origin and details of individual samples. The guide is intended for scientists, students, forestry experts and technicians who appreciate the need to use sound sampling procedures in forest radioecological projects. The guide will hopefully encourage readers to participate in field studies and sampling campaigns, using robust techniques, thereby fostering competence in sampling. (au)

  16. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.

    NARCIS (Netherlands)

    Hombergh, P. van den; Kunzi, B.; Elwyn, G.; Doremalen, J.H.M. van; Akkermans, R.P.; Grol, R.P.T.M.; Wensing, M.J.P.

    2009-01-01

    BACKGROUND: The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. METHODS: Secondary analysis of data

  17. Policy implementation in practice: the case of national service frameworks in general practice.

    Science.gov (United States)

    Checkland, Kath; Harrison, Stephen

    2004-10-01

    National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

  18. The role of culture in the general practice consultation process.

    Science.gov (United States)

    Ali, Nasreen; Atkin, Karl; Neal, Richard

    2006-11-01

    In this paper, we will examine the importance of culture and ethnicity in the general practice consultation process. Good communication is associated with positive health outcomes. We will, by presenting qualitative material from an empirical study, examine the way in which communication within the context of a general practitioner (GP) consultation may be affected by ethnicity and cultural factors. The aim of the study was to provide a detailed understanding of the ways in which white and South Asian patients communicate with white GPs and to explore any similarities and differences in communication. This paper reports on South Asian and white patients' explanations of recent videotaped consultations with their GP. We specifically focus on the ways in which issues of ethnic identity impacted upon the GP consultation process, by exploring how our sample of predominantly white GPs interacted with their South Asian patients and the extent to which the GP listened to the patients' needs, gave patients information, engaged in social conversation and showed friendliness. We then go on to examine patients' suggestions on improvements (if any) to the consultation. We conclude, by showing how a non-essentialist understanding of culture helps to comprehend the consultation process when the patients are from Great Britain's ethnicised communities. Our findings, however, raise generic issues of relevance to all multi-racial and multi-ethnic societies.

  19. Contracting for safety with patients: clinical practice and forensic implications.

    Science.gov (United States)

    Garvey, Keelin A; Penn, Joseph V; Campbell, Angela L; Esposito-Smythers, Christianne; Spirito, Anthony

    2009-01-01

    The contract for safety is a procedure used in the management of suicidal patients and has significant patient care, risk management, and medicolegal implications. We conducted a literature review to assess empirical support for this procedure and reviewed legal cases in which this practice was employed, to examine its effect on outcome. Studies obtained from a PubMed search were reviewed and consisted mainly of opinion-based surveys of clinicians and patients and retrospective reviews. Overall, empirically based evidence to support the use of the contract for safety in any population is very limited, particularly in adolescent populations. A legal review revealed that contracting for safety is never enough to protect against legal liability and may lead to adverse consequences for the clinician and the patient. Contracts should be considered for use only in patients who are deemed capable of giving informed consent and, even in these circumstances, should be used with caution. A contract should never replace a thorough assessment of a patient's suicide risk factors. Further empirical research is needed to determine whether contracting for safety merits consideration as a future component of the suicide risk assessment.

  20. Interactions In Online Education Implications For Theory & Practice

    Directory of Open Access Journals (Sweden)

    Askim KURT

    2007-04-01

    Full Text Available This book was edited by, Charles Juwah, Senior EducationDevelopment Officer at Robert Gordon University, where heruns the postgraduate learning and teaching qualificationcourse. It was published by Routledge in 2006.Interaction is very important in open and flexible learning,and apparent at all levels of engagement, whether betweenstudents, students and tutors, online learning materials orinterfacing with the learning environment. A student whoactively engages with learning materials, interactions helpto improve learning by fortifying knowledge and providingcontext, encouraging reflection, questioning and deeplyunderstanding of a subject.This book provides international perspectives on key topics including analyzing and designing e-learning interactions, social and conceptual dimensions of learning, interactions in online discussions, interactions in pair learning, and professional development of online facilitators. In this book a collection of research and innovative case material drawn from practitioners and academicians and it covers the theory and the practical implications of related issues. It is essential reading for all those involved in the design,implementation, management and use of open and flexible learning.

  1. Cognitive load theory: Practical implications and an important challenge

    Directory of Open Access Journals (Sweden)

    Jimmie Leppink, Ph.D.

    2017-10-01

    Full Text Available The field of medical education has adopted a wide variety of theories from other fields. A fairly recent example is cognitive load theory, which originated in educational psychology. Several empirical studies inspired by cognitive load theory and reviews of practical implications of cognitive load theory have contributed to guidelines for the design of medical education. Simultaneously, several research groups have developed instruments for the measurement of cognitive load in a medical education context. These developments notwithstanding, obtaining evidence for different types of cognitive load remains an important challenge. Therefore, the aim of this article is twofold: to provide medical educators with three key guidelines for the design of instruction and assessment and to discuss several fundamental issues in the remaining challenges presented by different types of cognitive load. The guidelines revolve around minimizing cognitive activity that does not contribute to learning, working with specific learning goals in mind, and appreciating the multifaceted relation between learning and assessment. Key issues around the types of cognitive load include the context in which learning occurs, the continued use of single-item mental effort ratings, and the timing of cognitive load and learning outcome measurements.

  2. Practical implications of pre-employment nurse assessments.

    Science.gov (United States)

    Kuthy, James E; Ramon, Cheree; Gonzalez, Ronald; Biddle, Dan A

    2013-01-01

    Hiring nurses is a difficult task that can have serious repercussions for medical facilities. If nurses without proper skills are hired, patients can suffer from insufficient quality of care and potentially life-threatening conditions. Nurse applicants' technical knowledge is extremely important to avoid negative outcomes; however, there are soft skills that factor into their success, such as bedside manner, personality, communication, and decision making. In order for medical facilities to select and maintain high-performing nurse staff, hiring managers must incorporate evaluations for these types of skills in their hiring process. The current study focused on using content/criterion-related validation design to create assessments by which nurse applicants can be evaluated for both technical knowledge/skills and soft skills. The study included participation of more than 876 nursing staff members. To rank applicants on divergent skills, 3 assessment types were investigated, resulting in the creation of an assessment with 3 components. The clinical, situational, and behavioral components that were created measure applicants' job knowledge, interpersonal competency in medical facility-related situations, and aspects of personality and behavior, respectively. Results indicate that using the assessment can predict 45% of a nurse applicant's future job performance. Practical implications include hiring and maintaining a higher quality of nurses and decreased hiring costs.

  3. General Psychological Implications of the Human Capacity for Grief.

    Science.gov (United States)

    Brinkmann, Svend

    2018-06-01

    Much theorizing in psychology and related disciplines begins with a given model of the mind that is then applied in research projects to study concrete phenomena. Sometimes psychological research can be theory-driven in quite an explicit way, approaching the logic of the hypothetico-deductive method. Others reject this and prefer to work inductively, and, in the extreme case of positivism, perhaps try to avoid theorizing altogether. In this article I shall suggest another way to think of the relationship between psychological theories and psychological phenomena. My suggestion is not simply to replace the hypothetico-deductive model with an inductive one, but to argue that the most direct route to theories of the human mind that grasp its complexity is to begin with the Kantian question of transcendental philosophy: X exists - how is X possible? In the context of this article, I apply this questioning to the phenomenon of grief: Grief exists - what general psychological theory of the mind do we need in order to account for its possibility? I attempt to extract three general psychological points from the existence of grief, viz. (1) the deep relationality of the self, (2) the limitations of evolutionary accounts, and (3) the normativity of psychological phenomena. I shall argue that these are general psychological lessons to be learned from grief, although they could also be arrived at by considering several other significant psychological phenomena.

  4. Practice nurse and health visitor management of acute minor illness in a general practice.

    Science.gov (United States)

    Pritchard, A; Kendrick, D

    2001-11-01

    To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

  5. THE MAIN NOVELTIES AND IMPLICATIONS OF THE NEW GENERAL DATA PROTECTION REGULATION

    Directory of Open Access Journals (Sweden)

    Simona Chirica

    2017-12-01

    Full Text Available Regulation (EU 2016/679 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation - GDPR will become applicable beginning with 25.05.2018. As a general characteristic, the regulations adopted at EU level, have direct applicability in all EU member states, and they are automatically integrated in the national legislation beginning with entry into force. Therefore, as of 25.05.2018, the GDPR provisions will be applicable and mandatory for all natural and legal persons that process personal data, including in Romania. Based on the above, GDPR brings a series of changes affecting all the involved parties (data subjects, data controllers, supervisory authorities. This article aims to present an analysis of the main novelties brought by the new regulation, and to present a comparison with the current regulation together with the practical implications of these changes in relation to the data subjects, data controllers, and supervisory authorities.

  6. Making the links between domestic violence and child safeguarding: an evidence-based pilot training for general practice.

    Science.gov (United States)

    Szilassy, Eszter; Drinkwater, Jess; Hester, Marianne; Larkins, Cath; Stanley, Nicky; Turner, William; Feder, Gene

    2017-11-01

    We describe the development of an evidence-based training intervention on domestic violence and child safeguarding for general practice teams. We aimed - in the context of a pilot study - to improve knowledge, skills, attitudes and self-efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two-stage consensus process with a multi-professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co-ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi-agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to

  7. Multi-disciplinary decision making in general practice.

    Science.gov (United States)

    Kirby, Ann; Murphy, Aileen; Bradley, Colin

    2018-04-09

    Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

  8. Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer.

    NARCIS (Netherlands)

    Poels, P.J.E.; Schermer, T.R.J.; Jacobs, A.; Akkermans, R.P.; Hartman, J.; Bottema, B.J.A.M.; Weel, C. van

    2006-01-01

    OBJECTIVE: To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. DESIGN: Multivariate multilevel cross-sectional analysis of a questionnaire survey. SETTING: Some 61 general practices involved in a

  9. [Summary of the practice guideline 'Thyroid disorders' (first revision) from the Dutch College of General Practitioners

    NARCIS (Netherlands)

    Lieshout, J. van; Wessels, P.; Rijswijk, E. van; Boer, A.M; Wiersma, A.; Goudswaard, A.N.

    2007-01-01

    --The practice guideline 'Thyroid disorders' developed by the Dutch College of General Practitioners replaces the practice guideline 'Functional thyroid disorders' from 1996. Recommendations for palpable thyroid disorders have been added. --Hypothyroidism can often be treated by the general

  10. Delivering stepped care for depression in general practice : Results of a survey amongst general practitioners in the Netherlands

    NARCIS (Netherlands)

    Sinnema, Henny; Franx, Gerdien; Spijker, Jan; Ruiter, Marijke; van Haastrecht, Harry; Verhaak, Peter; Nuyen, Jasper

    2013-01-01

    Background: Revised guidelines for depression recommend a stepped care approach. Little is known about the implementation of the stepped care model by general practitioners (GPs) in daily practice. Objectives: To evaluate the performance of Dutch GPs in their general practice regarding important

  11. The identification of the general practice registrar needing assistance

    Directory of Open Access Journals (Sweden)

    Gladman G

    2011-06-01

    Full Text Available BackgroundDoctors undertaking vocational training in general practicein Australia may require assistance, in addition to thenormal training offered as part of their training programme.Issues requiring assistance may go undetected for a periodof time. Delay in the identification of issues leads to delay inthe provision of the assistance. The aim of this study is todetermine the most common reasons registrars requireextra assistance, and how these issues are identified. Thefindings of this study will provide direction for 21 regionallybased training providers (RTPs to develop improved toolsto ensure earlier detection of registrars requiring assistance.MethodThis study is based on qualitative research methods, usingsemi-structured interviews with senior medical educationstaff of four regional general practice training providers inVictoria, Australia.ResultsIssues identified included language and cultural issues,applied knowledge and skills, attitude and professionalism,and health and family issues.The principal method that training providers identifiedissues was via the GP supervisor. This was predominantly byinformal communication, rather than formal evaluationsheets. Other methods included the external clinicalteaching visit and other training formative assessments.These more formalised procedures were more likely toidentify issues later than desired. They were also used as away of clarifying suspected problems. The selection processwas not felt to be helpful, and the examinations providedinformation too late.ConclusionAn increased awareness of the potential issues leading to aregistrar to require assistance enables identification andsubsequent action to occur in a more timely and moreuseful fashion. Informal communication between practicesand training programme staff should be encouraged toenable these issues to be dealt with early in training.

  12. Expanding access to rheumatology care: the rheumatology general practice toolbox.

    LENUS (Irish Health Repository)

    Conway, R

    2015-02-01

    Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant\\'s confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant\\'s self-assessed competence in diagnosis and management of common rheumatic diseases.

  13. Empathy Variation in General Practice: A Survey among General Practitioners in Denmark

    Science.gov (United States)

    Ahnfeldt-Mollerup, Peder; Søndergaard, Jens

    2018-01-01

    Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informed approach to improve empathy among GPs. Objective: Our objective is to measure and analyze variation in physician empathy and its association with GP demographic, professional, and job satisfaction characteristics. Methods: 464 Danish GPs responded to a survey containing the Danish version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP) and questions related to their demographic, professional and job satisfaction characteristics. Descriptive statistics and a quantile plot of the ordered empathy scores were used to describe empathy variation. In addition, random-effect logistic regression analysis was performed to explore the association between empathy levels and the included GP characteristics. Results: Empathy scores were negatively skewed with a mean score of 117.9 and a standard deviation of 10.1 within a range from 99 (p5) to 135 (p95). GPs aged 45–54 years and GPs who are not employed outside of their practice were less likely to have high empathy scores (≥120). Neither gender, nor length of time since specialization, length of time in current practice, practice type, practice location, or job satisfaction was associated with odds of having high physician empathy. However, odds of having a high empathy score were higher for GPs who stated that the physician-patient relationship and interaction with colleagues has a high contribution to job satisfaction compared to the reference groups (low and medium contribution of these factors). This was also the trend for GPs who stated a high contribution to job satisfaction from intellectual stimulation. In contrast, high contribution of economic profit and prestige did not contribute to increased odds

  14. Variability of CSF Alzheimer's disease biomarkers: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Stephanie J B Vos

    Full Text Available BACKGROUND: Cerebrospinal fluid (CSF biomarkers are increasingly being used for diagnosis of Alzheimer's disease (AD. OBJECTIVE: We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. METHODS: We measured CSF amyloid-β (Aβ 1-42, total tau (t-tau, and phosphorylated tau (p-tau by INNOTEST enzyme-linked-immunosorbent assays (ELISA in a memory clinic population (n = 126. Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. RESULTS: CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. CONCLUSIONS: Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.

  15. Psychoacoustic entropy theory and its implications for performance practice

    Science.gov (United States)

    Strohman, Gregory J.

    This dissertation attempts to motivate, derive and imply potential uses for a generalized perceptual theory of musical harmony called psychoacoustic entropy theory. This theory treats the human auditory system as a physical system which takes acoustic measurements. As a result, the human auditory system is subject to all the appropriate uncertainties and limitations of other physical measurement systems. This is the theoretic basis for defining psychoacoustic entropy. Psychoacoustic entropy is a numerical quantity which indexes the degree to which the human auditory system perceives instantaneous disorder within a sound pressure wave. Chapter one explains the importance of harmonic analysis as a tool for performance practice. It also outlines the critical limitations for many of the most influential historical approaches to modeling harmonic stability, particularly when compared to available scientific research in psychoacoustics. Rather than analyze a musical excerpt, psychoacoustic entropy is calculated directly from sound pressure waves themselves. This frames psychoacoustic entropy theory in the most general possible terms as a theory of musical harmony, enabling it to be invoked for any perceivable sound. Chapter two provides and examines many widely accepted mathematical models of the acoustics and psychoacoustics of these sound pressure waves. Chapter three introduces entropy as a precise way of measuring perceived uncertainty in sound pressure waves. Entropy is used, in combination with the acoustic and psychoacoustic models introduced in chapter two, to motivate the mathematical formulation of psychoacoustic entropy theory. Chapter four shows how to use psychoacoustic entropy theory to analyze the certain types of musical harmonies, while chapter five applies the analytical tools developed in chapter four to two short musical excerpts to influence their interpretation. Almost every form of harmonic analysis invokes some degree of mathematical reasoning

  16. REJUVENATING CHRONIC DISEASE MANAGEMENT IN MALAYSIAN PRIVATE GENERAL PRACTICE

    Directory of Open Access Journals (Sweden)

    PITERMAN L

    2010-01-01

    Full Text Available Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden tothe patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary careglobally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT(strengths, weaknesses, opportunities and threats analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.

  17. Generalized causal mediation and path analysis: Extensions and practical considerations.

    Science.gov (United States)

    Albert, Jeffrey M; Cho, Jang Ik; Liu, Yiying; Nelson, Suchitra

    2018-01-01

    Causal mediation analysis seeks to decompose the effect of a treatment or exposure among multiple possible paths and provide casually interpretable path-specific effect estimates. Recent advances have extended causal mediation analysis to situations with a sequence of mediators or multiple contemporaneous mediators. However, available methods still have limitations, and computational and other challenges remain. The present paper provides an extended causal mediation and path analysis methodology. The new method, implemented in the new R package, gmediation (described in a companion paper), accommodates both a sequence (two stages) of mediators and multiple mediators at each stage, and allows for multiple types of outcomes following generalized linear models. The methodology can also handle unsaturated models and clustered data. Addressing other practical issues, we provide new guidelines for the choice of a decomposition, and for the choice of a reference group multiplier for the reduction of Monte Carlo error in mediation formula computations. The new method is applied to data from a cohort study to illuminate the contribution of alternative biological and behavioral paths in the effect of socioeconomic status on dental caries in adolescence.

  18. SEX-DIFFERENCES AMONG RECIPIENTS OF BENZODIAZEPINES IN DUTCH GENERAL-PRACTICE

    NARCIS (Netherlands)

    van der Waals, F. W.; Mohrs, J.; Foets, M.

    1993-01-01

    Objective-To analyse sex differences among recipients of benzodiazepines in Dutch general practice. Design-Study of consultations and associated interventions as recorded in the Dutch national survey of general practice. Setting-Practices of 45 general practitioners monitored during 1 April to 30

  19. A comparison of disease prevalence in general practice in the Netherlands and in England & Wales.

    NARCIS (Netherlands)

    Fleming, D.; Schellevis, F.; Linden, M. van der; Westert, G.

    2006-01-01

    General practice-based morbidity surveys have been conducted in the Netherlands and in England and Wales primarily to estimate disease prevalence and examine health inequalities. We have compared disease prevalence in general practice reported in the second Dutch Natinal Survey of General Practice

  20. Assessment of general education teachers' Tier 1 classroom practices: contemporary science, practice, and policy.

    Science.gov (United States)

    Reddy, Linda A; Fabiano, Gregory A; Jimerson, Shane R

    2013-12-01

    Progress monitoring is a type of formative assessment. Most work on progress monitoring in elementary school settings has been focused on students. However, teachers also can benefit from frequent evaluations. Research addressing teacher progress monitoring is critically important given the recent national focus on teacher evaluation and effectiveness. This special topic section of School Psychology Quarterly is the first to showcase the current research on measuring Tier 1 instructional and behavioral management practices used by prekindergarten and elementary school teachers in general education settings. The three studies included in the special section describe the development and validation efforts of several teacher observational and self-report measures of instruction and/or behavioral management. These studies provide evidence for the utility of such assessments for documenting the use of classroom practices, and these assessment results may be leveraged in innovative coaching models to promote best practice. These articles also offer insight and ideas for the next generation of teacher practice assessment for the field. Finally, the special topic is capped by a commentary synthesizing the current work and offers "big ideas" for future measurement development, policy, and professional development initiatives. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  1. Women's evaluation of abuse and violence care in general practice: a cluster randomised controlled trial (weave

    Directory of Open Access Journals (Sweden)

    Feder Gene

    2010-01-01

    Full Text Available Abstract Background Intimate partner abuse (IPA is a major public health problem with serious implications for the physical and psychosocial wellbeing of women, particularly women of child-bearing age. It is a common, hidden problem in general practice and has been under-researched in this setting. Opportunities for early intervention and support in primary care need to be investigated given the frequency of contact women have with general practice. Despite the high prevalence and health consequences of abuse, there is insufficient evidence for screening in primary care settings. Furthermore, there is little rigorous evidence to guide general practitioners (GPs in responding to women identified as experiencing partner abuse. This paper describes the design of a trial of a general practice-based intervention consisting of screening for fear of partner with feedback to GPs, training for GPs, brief counselling for women and minimal practice organisational change. It examines the effect on women's quality of life, mental health and safety behaviours. Methods/Design weave is a cluster randomised controlled trial involving 40 general practices in Victoria, Australia. Approximately 500 women (16-50 years seen by the GP in the previous year are mailed a short lifestyle survey containing an item to screen for IPA. Women who indicate that they were afraid of a partner/ex-partner in the last year and provide contact details are invited to participate. Once baseline data are collected, GPs are randomly assigned to either a group involving healthy relationship and responding to IPA training plus inviting women for up to 6 sessions of counselling or to a group involving basic education and usual care for women. Outcomes will be evaluated by postal survey at 6 and 12 months following delivery of the intervention. There will be an economic evaluation, and process evaluation involving interviews with women and GPs, to inform understanding about implementation

  2. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study.

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

    2011-11-03

    To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy

  3. Organisational development in general practice: lessons from practice and professional development plans (PPDPs

    Directory of Open Access Journals (Sweden)

    Hocking Paul

    2000-12-01

    Full Text Available Abstract Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development and education (self-directed adult learning theories and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4 where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of

  4. A spatial analysis of the expanding roles of nurses in general practice

    Directory of Open Access Journals (Sweden)

    Pearce Christopher

    2012-08-01

    Full Text Available Abstract Background Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. Method This study used a mixed methods, ‘rapid appraisal’ approach involving observation, photographs, and interviews. Results Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. Conclusion The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

  5. Perceptions of the role of general practice and practical support measures for carers of stroke survivors: a qualitative study

    Directory of Open Access Journals (Sweden)

    Harris Ruth

    2011-06-01

    Full Text Available Abstract Background Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored. The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. Methods Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. Results Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves. General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. Conclusions Carers' expectations of support from general practice for

  6. Doctors' attitudes and confidence towards providing nutrition care in practice: Comparison of New Zealand medical students, general practice registrars and general practitioners.

    Science.gov (United States)

    Crowley, Jennifer; Ball, Lauren; Han, Dug Yeo; McGill, Anne-Thea; Arroll, Bruce; Leveritt, Michael; Wall, Clare

    2015-09-01

    Improvements in individuals' nutrition behaviour can improve risk factors and outcomes associated with lifestyle-related chronic diseases. This study describes and compares New Zealand medical students, general practice registrars and general practitioners' (GPs') attitudes towards incorporating nutrition care into practice, and self-perceived skills in providing nutrition care. A total of 183 New Zealand medical students, 51 general practice registrars and 57 GPs completed a 60-item questionnaire investigating attitudes towards incorporating nutrition care into practice and self-perceived skills in providing nutrition care. Items were scored using a 5-point Likert scale. Factor analysis was conducted to group questionnaire items and a generalised linear model compared differences between medical students, general practice registrars and GPs. All groups indicated that incorporating nutrition care into practice is important. GPs displayed more positive attitudes than students towards incorporating nutrition in routine care (ppractice registrars were more positive than students towards performing nutrition recommendations (p=0.004), specified practices (p=0.037), and eliciting behaviour change (p=0.024). All groups displayed moderate confidence towards providing nutrition care. GPs were more confident than students in areas relating to wellness and disease (pmedical students, general practice registrars and GPs have positive attitudes and moderate confidence towards incorporating nutrition care into practice. It is possible that GPs' experience providing nutrition care contributes to greater confidence. Strategies to facilitate medical students developing confidence in providing nutrition care are warranted.

  7. SLT Beliefs about Collaborative Practice: Implications for Education and Learning

    Science.gov (United States)

    Jago, Suzanne; Radford, Julie

    2017-01-01

    Effective collaborative practice is expected of newly qualified speech and language therapists (SLTs) in order to achieve the best outcomes for clients. Research into collaborative practice has identified a number of barriers to and facilitators of collaborative practice, but there has been limited research into how well prepared newly qualified…

  8. Use of general practice by intravenous heroin users on a methadone programme.

    OpenAIRE

    Leaver, E J; Elford, J; Morris, J K; Cohen, J

    1992-01-01

    Users of intravenous heroin represent a major challenge for general practice. A study was undertaken in a general practice in central London in 1990 to investigate the use of general practice made by intravenous heroin users who were on a methadone programme. Using information recorded in the patients' notes, 29 intravenous heroin users on a methadone programme were identified; 58 non-drug users (two controls per case) were matched for age, sex and general practitioner. A study of the number ...

  9. Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

    Science.gov (United States)

    Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

    2012-01-01

    Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

  10. Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

    Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

  11. Public health implications of post-harvest fish handling practices in ...

    African Journals Online (AJOL)

    A wide range of handling practices for harvested fish exists and they have economic as well as public health implications. This paper is a review of the existing problems in fish handling technologies at post-harvest in Nigeria. The public health aspects with the associated implications are highlighted. Status of policy on fish ...

  12. Sexual violence associated with poor mental health in women attending Australian general practices.

    Science.gov (United States)

    Tarzia, Laura; Maxwell, Sarah; Valpied, Jodie; Novy, Kitty; Quake, Rebecca; Hegarty, Kelsey

    2017-10-01

    Sexual violence (SV) against adult women is prevalent and associated with a range of mental health issues. General practitioners could potentially have a role in responding, however, there is little information to help guide them. Data around prevalence of all forms of adult SV (not just rape) is inconsistent, particularly in clinical samples, and the links between other forms of SV and mental health issues are not well supported. This study aimed to address these gaps in the knowledge base. A descriptive, cross-sectional study was conducted in Australian general practice clinics. Two hundred and thirty adult women completed an anonymous iPad survey while waiting to see the doctor. More than half the sample had experienced at least one incident of adult SV. Most commonly, women reported public harassment or flashing, unwanted groping and being coerced into sex. Women who had experienced adult SV were more likely to experience anxiety than women who had not, even after controlling for other factors. Women who had experienced adult SV were more likely to feel down, depressed or hopeless than women who had not; however, this association disappeared after controlling for childhood sexual abuse. The findings support the association between SV and poor mental health, even when 'lesser' incidents have occurred. Implications for public health: General practitioners should consider an experience of SV as a possible factor in otherwise unexplained anxiety and depressive symptoms in female patients. © 2017 The Authors.

  13. 11. Basic Practice Methods in University General Piano Classes

    Directory of Open Access Journals (Sweden)

    Raducanu Cristina Andra

    2018-03-01

    Full Text Available The purpose of this article was to present and analyse some practicing piano methods which are used during secondary piano lessons at the university. The final goal was to show the benefits of these practice strategies in the process of learning a new piano piece. Experience demonstrated that in order to keep students motivated, there is a need for them to know how to approach and study a new repertoire and to be sure that implementing these practice methods will help them gain the necessary skills which will enable them to fluently perform a musical piece.

  14. Management and marketing for the general practice dental office.

    Science.gov (United States)

    Clarkson, Earl; Bhatia, Sanjeev

    2008-07-01

    This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

  15. Research productivity in Australian general practice: what has changed since the 1990s?

    Science.gov (United States)

    Askew, Deborah A; Schluter, Philip J; Gunn, Jane M

    2008-07-21

    The Primary Health Care Research, Evaluation and Development (PHCRED) Strategy aims to improve Australia's output of high-quality research from primary care. We compared publication rates from general practice, medicine and surgery for the period 2000-2007, and found that general practice publications increased since 1990-1999 from 1.0 to 3.0 publications per 1000 general practitioners per year. However, general practice publication rates have plateaued since 2000, and represent only 2%-5% of the equivalent rates for medicine and surgery. This finding suggests that more time and sustained investment in PHCRED are essential to see tangible outputs from funded research in general practice.

  16. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

    Science.gov (United States)

    Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

    2015-01-01

    Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve

  17. Decision-making in general practice: the effect of financial incentives on the use of laboratory analyses.

    Science.gov (United States)

    Munkerud, Siri Fauli

    2012-04-01

    This paper examines the reaction of general practitioners (GPs) to a reform in 2004 in the remuneration system for using laboratory services in general practice. The purpose of this paper is to study whether income motivation exists regarding the use of laboratory services in general practice, and if so, the degree of income motivation among general practitioners (GPs) in Norway. We argue that the degree of income motivation is stronger when the physicians are uncertain about the utility of the laboratory service in question. We have panel data from actual physician-patient encounters in general practices in the years 2001-2004 and use discrete choice analysis and random effects models. Estimation results show that an increase in the fees will lead to a small but significant increase in use. The reform led to minor changes in the use of laboratory analyses in GPs' offices, and we argue that financial incentives were diluted because they were in conflict with medical recommendations and existing medical practice. The patient's age has the most influence and the results support the hypothesis that the impact of income increases with increasing uncertainty about diagnosis and treatment. The policy implication of our results is that financial incentives alone are not an effective tool for influencing the use of laboratory services in GPs' offices.

  18. Subjective memory complaints in general practice predicts future dementia: a 4-year follow-up study

    DEFF Research Database (Denmark)

    Waldorff, Frans Boch; Vogel, Asmus Mejling; Siersma, Volkert Dirk

    2012-01-01

    Many older patients in general practice have subjective memory complaints (SMC); however, not all share this information with their general practitioner (GP). The association between SMC and future cognitive decline or dementia is not clear, especially in a general practice population. The aim...

  19. Overseas Voter Mobilisation in Singapore: Implications from Malaysia’s 13th General Election

    OpenAIRE

    James Gomez; Rusdi Omar

    2013-01-01

    "This paper discusses voter mobilisation and other election-related activities of Malaysian voters living, studying and working in Singapore in the context of Malaysia's 13th general election (GE13). According to the World Bank, nearly 400,000 Malaysians reside in the city-state. Thus these figures represent a significant Malaysian voter pool based in Singapore. Efforts to mobilise these voters for general elections or other causes have political implications for both countries, which became ...

  20. Depression in general practice | Lans | South African Medical Journal

    African Journals Online (AJOL)

    Abstract. The object of this study is to increase the general practitioner's awareness of the prevalence of depression, its multifaceted presentation in all age groups and the concomitant danger of suicide. It highlights the vital role the general practitioner can play in the early diagnosis and adequate treatment of this disorder.

  1. The importance of the GHQ in general practice.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Wennink, H.J.; Tijhuis, M.A.R.

    1990-01-01

    The relationship between General Health Questionnaire (GHQ) score and complaints presented at the general practitioners office was examined, and showed that the correlation between them is not as high as might be expected. Many patients who present psychosocial problems to their GP appear to have a

  2. Hesitative introduction of E-mail consultations in general practice.

    NARCIS (Netherlands)

    Verheij, R.; Ton, C.; Tates, K.

    2008-01-01

    Introduction: The Dutch Council for Public Health and Health Care reported in 2005 that 70% of internet users would want to have the opportunity to consult their own general practitioner by e-mail [1]. Since January 1, 2006, general practitioners in the Netherlands are reimbursed 4.50 euro for

  3. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice.

    Science.gov (United States)

    McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth

    2015-09-01

    To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Integrative literature review. CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention. © 2015 John Wiley & Sons Ltd.

  4. Relational Aggression, Victimization, and Language Development: Implications for Practice

    Science.gov (United States)

    Ostrov, Jamie M.; Godleski, Stephanie A.

    2007-01-01

    This review explores the development of relational aggression and relational victimization among peers, with specific emphasis on clinical implications for speech-language pathologists. Developmental manifestations of relational aggression and victimization are reviewed from early childhood through emerging adulthood. The concurrent and…

  5. Pumps vs. airlifts: Theoretical and practical energy implications

    Science.gov (United States)

    In the design of a recirculating aquaculture system five life-supporting issues should be considered which include aeration, degasification, circulation, biofiltration, and clarification. The implications associated with choosing a pumped system versus an airlift system to address these issues was e...

  6. Practices, patients and (imperfect data - feasibility of a randomised controlled clinical drug trial in German general practices

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2011-04-01

    Full Text Available Abstract Background Randomised controlled clinical (drug trials supply high quality evidence for therapeutic strategies in primary care. Until now, experience with drug trials in German general practice has been sparse. In 2007/2008, the authors conducted an investigator-initiated, non-commercial, double-blind, randomised controlled pilot trial (HWI-01 to assess the clinical equivalence of ibuprofen and ciprofloxacin in the treatment of uncomplicated urinary tract infection (UTI. Here, we report the feasibility of this trial in German general practices and the implementation of Good Clinical Practice (GCP standards as defined by the International Conference on Harmonisation (ICH in mainly inexperienced general practices. Methods This report is based on the experience of the HWI-01 study conducted in 29 German general practices. Feasibility was defined by 1 successful practice recruitment, 2 sufficient patient recruitment, 3 complete and accurate data collection and 4 appropriate protection of patient safety. Results The final practice recruitment rate was 18%. In these practices, 79 of 195 screened UTI patients were enrolled. Recruitment differed strongly between practices (range 0-12, mean 2.8 patients per practice and was below the recruitment goal of approximately 100 patients. As anticipated, practice nurses became the key figures in the screening und recruitment of patients. Clinical trial demands, in particular for completing symptom questionnaires, documentation of source data and reporting of adverse events, did not agree well with GPs' documentation habits and required support from study nurses. In many cases, GPs and practice staff seemed to be overwhelmed by the amount of information and regulations. No sudden unexpected serious adverse reactions (SUSARs were observed during the trial. Conclusions To enable drug trials in general practice, it is necessary to adapt the setup of clinical research infrastructure to the needs of GPs and

  7. Influences on final year medical students' attitudes to general practice as a career.

    Science.gov (United States)

    Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

    2014-03-01

    General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

  8. Recapitalization, Implications for Educational Policy and Practice and Future Research

    NARCIS (Netherlands)

    Scheerens, Jaap; Scheerens, Jaap

    2017-01-01

    In this concluding chapter conclusions are drawn, and the relevance of the results for educational science and policy and practice are discussed. Illustrations are provided that were drawn from the exploration of policy and practices in the Netherlands. Synthetic answers to the three research

  9. Practical implications of empirically studying moral decision making

    NARCIS (Netherlands)

    Heinzelmann, N.; Ugazio, G.; Tobler, P.N.

    2012-01-01

    This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main

  10. Integrating Practice Guidelines into Professional Training: Implications for Diversity Competence

    Science.gov (United States)

    Miville, Marie L.; Duan, Changming; Nutt, Roberta L.; Waehler, Charles A.; Suzuki, Lisa; Pistole, M. Carole; Arredondo, Patricia; Duffy, Michael; Mejia, Brenda X.; Corpus, Melissa

    2009-01-01

    The authors present the findings of a special task group (STG) organized to explore effective training strategies for the practice guidelines focused on diverse populations. They provide a brief literature review and summarize survey data from academic training directors regarding current use of practice guidelines. The authors then describe the…

  11. Relational Coordination and Organisational Social Capital Association with Characteristics of General Practice

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke; Edwards, Kasper; Bøllingtoft Knudsen, Thomas

    2014-01-01

    Background. Relational coordination (RC) and organisational social capital (OSC) aremeasures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives.The aim of this studywas to analyse the associations between RC and OSC......, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC...... and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type...

  12. [Dealing with uncertainty--the hypermodernity of general practice].

    Science.gov (United States)

    Barth, Niklas; Nassehi, Armin; Schneider, Antonius

    2014-01-01

    The general practitioner is fundamentally dealing with uncertainty. On the one hand, we want to demonstrate that uncertainty cannot simply be stipulated as a matter of fact. Instead, we will show that this uncertainty is a performative effect of the primary care setting. On the other hand, we want to point out that the general practitioner's ability to bear uncertainty is a genuinely hypermodern way of productively dealing with uncertainty. Copyright © 2013. Published by Elsevier GmbH.

  13. Treatment of urinary incontinence in women in general practice: observational study.

    OpenAIRE

    Seim, A.; Sivertsen, B.; Eriksen, B. C.; Hunskaar, S.

    1996-01-01

    OBJECTIVE--To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN--Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING--General practice in the rural district of Rissa, Norway. SUBJECTS--105 women aged 20 or more with urinary incontinence. INTERVENTIONS--Treatment with pelvic floor exercises, electrostimula...

  14. Trends in dermatology practices and the implications for the workforce.

    Science.gov (United States)

    Ehrlich, Alison; Kostecki, James; Olkaba, Helen

    2017-10-01

    The American Academy of Dermatology (AAD) practice profile surveys have been conducted for more than a decade to gauge trends in our workforce supply and demand. To update the trends and current workforce issues for the field of dermatology. The AAD Practice Profile Survey is sent by both e-mail and postal mail to a random sample of practicing dermatologists who are AAD members. Shifts are noted in the primary practice setting; fewer dermatologists are in solo practice and more are in group practices than in previous years. Teledermatology use trended upward from 7% to 11% between 2012 and 2014. The implementation of electronic health records increased from 51% in 2011 to 70% in 2014. There is potential for response bias and inaccurate self-reporting. Survey responses collected may not be representative of all geographic areas. The demand for dermatology services remains strong. Shifts in the practice setting may be related to increases in overhead costs that are partially associated with the implementation of technology-based medical records. Integration of electronic health records and utilization of telemedicine are increasing. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Medicine as a Community of Practice: Implications for Medical Education.

    Science.gov (United States)

    Cruess, Richard L; Cruess, Sylvia R; Steinert, Yvonne

    2018-02-01

    The presence of a variety of independent learning theories makes it difficult for medical educators to construct a comprehensive theoretical framework for medical education, resulting in numerous and often unrelated curricular, instructional, and assessment practices. Linked with an understanding of identity formation, the concept of communities of practice could provide such a framework, emphasizing the social nature of learning. Individuals wish to join the community, moving from legitimate peripheral to full participation, acquiring the identity of community members and accepting the community's norms.Having communities of practice as the theoretical basis of medical education does not diminish the value of other learning theories. Communities of practice can serve as the foundational theory, and other theories can provide a theoretical basis for the multiple educational activities that take place within the community, thus helping create an integrated theoretical approach.Communities of practice can guide the development of interventions to make medical education more effective and can help both learners and educators better cope with medical education's complexity. An initial step is to acknowledge the potential of communities of practice as the foundational theory. Educational initiatives that could result from this approach include adding communities of practice to the cognitive base; actively engaging students in joining the community; creating a welcoming community; expanding the emphasis on explicitly addressing role modeling, mentoring, experiential learning, and reflection; providing faculty development to support the program; and recognizing the necessity to chart progress toward membership in the community.

  16. Cultural relativism and cultural diversity: implications for nursing practice.

    Science.gov (United States)

    Baker, C

    1997-09-01

    This article examines the doctrine of cultural relativism in nursing practice. To introduce the issue, an overview of the intellectual history of cultural relativism is presented. The academic themes of the debate surrounding cultural relativism are illustrated with an example of the social controversy in France involving cultural relativism as used to defend the practice of female genital excision among immigrant communities. The dilemma faced by nursing in making cross-cultural judgments is then examined in the light of the academic and social debates. The article concludes with a theoretical resolution of the issue of cultural relativism for nursing practice that is based on hermeneutic philosophy.

  17. Gouty arthritis: An approach for general practice | Tikly | South ...

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 55, No 4 (2013) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  18. Research in general practice--the germination of an idea.

    Science.gov (United States)

    Nichols, W P; Dookun, R

    1998-09-12

    The concept, planning and initiation of a research project into the treatment of temporomandibular dysfunction carried out by a group of GDPs in their own practices is described. Reports of the experimental studies will be presented as a further series of papers.

  19. Knowledge, Attitudes and Behaviors Related to AIDS among Prisoners: Implications for Social Work Practice.

    Science.gov (United States)

    Miah, M. Mizanur Rahman; Olivero, J. Michael

    1995-01-01

    A survey of 33 male and 5 female prisoners examined their knowledge of AIDS and HIV transmission modes, current sexual behavior and safe sex practices, and sources of AIDS information and degree of trust in these sources. Discusses implications for social work practices and development of AIDS education for prisoners. (SV)

  20. Analytical Implications of Using Practice Theory in Workplace Information Literacy Research

    Science.gov (United States)

    Moring, Camilla; Lloyd, Annemaree

    2013-01-01

    Introduction: This paper considers practice theory and the analytical implications of using this theoretical approach in information literacy research. More precisely the aim of the paper is to discuss the translation of practice theoretical assumptions into strategies that frame the analytical focus and interest when researching workplace…

  1. Nursing practice implications of the year of ethics.

    Science.gov (United States)

    Harris, Karen T

    2015-01-01

    e 2015 ANA Code of Ethics is foundational to professional nursing practice and is aligned with AWHONN’s core values, standards of care and position statement on ethical decision-making in the clinical setting. Understanding the roles and responsibilities of nurses to ensure an ethical practice environment is critical to perinatal health outcomes and sta engagement and to the prevention of moral distress.

  2. Robotic general surgery: current practice, evidence, and perspective.

    Science.gov (United States)

    Jung, M; Morel, P; Buehler, L; Buchs, N C; Hagen, M E

    2015-04-01

    Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. This article reviews the current literature and the perspective of robotic general surgery. While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.

  3. Urinary tract infections in general practice patients: diagnostic tests versus bacteriological culture.

    NARCIS (Netherlands)

    Nys, S.; Merode, T. van; Bartelds, A.I.M.; Stobberingh, E.E.

    2006-01-01

    Objectives: Urinary tract infections (UTIs) are common bacterial infections encountered in general practice. For the optimal treatment the general practitioner (GP) should rely on the results of diagnostic tests and recent antimicrobial susceptibility of uropathogens. Patients and methods: In total

  4. [What factors aid in the recruitment of general practice as a career? An enquiry by interview of general practitioners].

    Science.gov (United States)

    Natanzon, Iris; Ose, D; Szecsenyi, J; Joos, S

    2010-05-01

    In some parts of Germany there is already a lack of general practitioners (GPs). The reasons for this lack are complex. On the one hand there is an increasing demand for GPs as a result to demographic changes and an increase in the number of chronic diseases. On the other hand fewer medical students decide to become a general practitioner. The aim of this study was to explore, from the perspective of GPs, factors influencing the choice of general practice as a career. Also analysed is the extent to which those factors influence medical students in their carrier choice. 16 GPs were interviewed. Qualitative content analysis according to Mayring has been assisted by the Atlas.ti software program. GPs thought that the occupational orientation of medical students would be strongly dependent on the attractiveness of their future profession. Factors affecting the day-to-day work of general practice and may deterring the carrier choice of students were: poor working and general conditions leading to an increasing dissatisfaction among GPs; decreasing prestige of GPs caused by changed personal and occupational values and attitudes within the society; as well as poor representation and image of general practice as a discipline within the medical curriculum. Various approaches aimed at different target groups can be derived from these identified factors: the government providing general and occupational conditions that would relieve GPs of excessive bureaucracy; universities and medical associations meeting the challenge by improving undergraduate and postgraduate education in general practice; and GPs themselves giving a more self-confident presentation of general practice. Georg Thieme Verlag KG Stuttgart * New York.

  5. Improvements in cross-infection control in general dental practice.

    Science.gov (United States)

    Bentley, E M; Sarll, D W

    1995-07-08

    A questionnaire about cross-infection control was sent to all GDPs in five FHSAs in the North Western Region. Replies came from 312 dentists, a response rate of 74%. They worked in 185 practices, a response rate of 85%. Gloves were worn routinely by 86% of dentists and 80% of DSAs. Handpieces were autoclaved between patients in 77% of practices. Much however, remains to be improved. DSAs could be better protected if more ultrasonic cleaners were used, eye protection encouraged and heavy duty gloves were available for cleaning instruments. BDA guidelines were reported as being the most influential factor, though it would appear that the media did persuade many practitioners to use autoclavable handpieces and sterilise them after each use.

  6. Standard practice for liquid penetrant examination for general industry

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2009-01-01

    1.1 This practice covers procedures for penetrant examination of materials. Penetrant testing is a nondestructive testing method for detecting discontinuities that are open to the surface such as cracks, seams, laps, cold shuts, shrinkage, laminations, through leaks, or lack of fusion and is applicable to in-process, final, and maintenance testing. It can be effectively used in the examination of nonporous, metallic materials, ferrous and nonferrous metals, and of nonmetallic materials such as nonporous glazed or fully densified ceramics, as well as certain nonporous plastics, and glass. 1.2 This practice also provides a reference: 1.2.1 By which a liquid penetrant examination process recommended or required by individual organizations can be reviewed to ascertain its applicability and completeness. 1.2.2 For use in the preparation of process specifications and procedures dealing with the liquid penetrant testing of parts and materials. Agreement by the customer requesting penetrant inspection is strongly rec...

  7. Criteria for the diagnosis of hypertension in general practice

    OpenAIRE

    Patterson, H. R.

    1984-01-01

    An accurate age-sex register was used to identify patients in a practice who might be suffering from hypertension and to record the criteria on which the diagnosis was based. Information about blood pressure readings, diagnostic labels and treatment at the time of diagnosis were noted. The definition of hypertension sufficient to require treatment was a recorded diastolic pressure of 110 mm Hg or more on three occasion. Using these criteria, only 12 per cent of patients qualified.

  8. Patient exposure in general dental practice in the Netherlands

    International Nuclear Information System (INIS)

    Velders, X.L.; Selling, H.A.

    1988-01-01

    To estimate the population risk due to dental radiography an investigation was started among 1200 dental practitioners. A questionnaire was set up to inventory commonly applied indications of X-ray examinations, the number of examinations and the organizational actions taken by the dentists to limit radiation doses to the patients. Information was gathered on the type of X-ray machines, the use of aiming devices, protective measurements for patients and dental staff, developing procedures and the type of films. A number of practical tests was applied to obtain a quantitative impression of patient doses in accordance with special circumstances. For the practical tests films and lithium fluoride TLD-100 chips (Harshaw) were used to determine the beam diameter, the exposure of the X-ray machine and the scatter at a set distance of the middle of the beam, developing circumstances as well as entrance and exist skin doses measured on the skin of a patient. The results of 544 dental practices will be discussed. Finally an estimation of the possible extent of reduction in patient exposure in the Netherlands will be made

  9. Continuous Morbidity Registration at Dutch Sentinel General Practice Network 2009.

    NARCIS (Netherlands)

    Donker, G.A.

    2011-01-01

    The Mexican flu pandemic was limited to a mild pandemic, although the flu incidence rate was higher than in the previous three seasons. At the peak of the epidemic 189 per 100.000 registered patients consulted their general practitioner (GP). The sentinel GP’s of NIVEL registered the number of new

  10. Gestational Diabetes in General Practice | Notelovitz | South African ...

    African Journals Online (AJOL)

    The role of the general practitioner in the diagnosis and management of the gestational diabetic is defined. Recognition of this condition is important for improving the perinatal mortality; as is advice regarding steroid contraception; and as a means of predicting the development of overt diabetes. Methods of diagnosis are ...

  11. Nigerian Journal of General Practice - Vol 11, No 1 (2013)

    African Journals Online (AJOL)

    Prevalence and pattern of Dyslipidaemia among adult hypertensives in the general pratice clinic of University of Benin Teaching Hospital, Benin City Edo State Nigeria · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. DD Uyagu, O Ebomwonyi, PO Dienye ...

  12. Chest radiography and abdominal ultrasound in general practice

    NARCIS (Netherlands)

    Speets, Anouk Mariëlle

    2006-01-01

    Chest radiography (CXR) and abdominal ultrasound (US) are two widely used diagnostic imaging techniques in Western societies. General practitioners (GPs) in The Netherlands annually request approximately 500,000 CXRs and 200,000 abdominal US, and therefore clearly place a burden on health care.

  13. Memory during general anesthesia : Practical and methodological aspects

    NARCIS (Netherlands)

    Bonebakker, AE; Jelicic, M; Passchier, J; Bonke, B

    1996-01-01

    Evidence coming from several studies into memory and awareness during general anesthesia suggests that in surgical patients who seem to be adequately anesthetized (i.e., unaware of what happens in the operating theater), some form of cognitive functioning is preserved. This finding has important

  14. Nutrition counselling in general practice: the stages of change model

    NARCIS (Netherlands)

    Verheijden, M.W.

    2004-01-01

    Healthy lifestyles in the prevention of cardiovascular diseases are of utmost importance for people with non insulin-dependent diabetes mellitus, hypertension, and/or dyslipidemia. Because of their continuous contact with almost all segments of the population, general practitioners can play an

  15. Communicating fatigue in general practice and the role of gender

    NARCIS (Netherlands)

    Meeuwesen, L.; Bensing, J.; Brink-Muinen, A. van den

    2002-01-01

    The aim of this study has been to obtain more insight into the health condition of fatigued patients, their expectations when visiting the general practitioner (GP), the way they communicate, and possible gender differences. Data consisted of 579 patient questionnaires and 440 video-observations of

  16. General principles of advertising practices and consumer protection

    OpenAIRE

    Slánská, Martina

    2008-01-01

    Diploma thesis provides an overview of legal and ethical regulation of advertising, defines the basic concepts in advertising, summarizes the functions and objectives of advertising and characterized various forms of advertising by the communication media. Through the questionnaire survey detects and analyzes the general attitudes towards advertising as specific views on ethically problematic advertisements.

  17. Diffusion of new drugs in Danish general practice

    DEFF Research Database (Denmark)

    Steffensen, Flemming Hald; Sørensen, Henrik Toft; Olesen, Frede

    1999-01-01

    , compared with intermediate prescribing, was associated with female physicians (odds ratio (OR) 5.7; 95% CI 1.5-21.3), smaller list size (OR 0.1; 95% CI 0.0-0.8), a strong general restrictive attitude to pharmacotherapy (OR 0.07; 95% CI 0.01-0.68) and a tendency to lower diagnostic activity per patient (OR...

  18. Remuneration, workload, and allocation of time in general practice.

    NARCIS (Netherlands)

    Berg, M.J. van den; Westert, G.P.; Groenewegen, P.P.; Bakker, D.H. de; Zee, J. van der

    2006-01-01

    Background: General Practitioners (GPs) can cope with workload by, among others, spending more hours in patient care or by spending less time per patient. The way GPs are paid might affect the way they cope with workload. From an economical point of view, capitation payment is an incentive to

  19. Factors influencing adherence to guidelines in general practice

    NARCIS (Netherlands)

    Stewart, RE; Vroegop, S; van der Werf, GT; Meyboom-de Jong, B; Kamps, G.

    2003-01-01

    Objectives: To identify and assess the effects of general practitioner and patient characteristics on global adherence to pharmacotherapeutic guidelines. Methods: In a cross-sectional study in the northern Netherlands, a two-level multilevel model was applied to patients (n = 269,067) in 190

  20. New drugs in general practice: prescribing patterns and external influences

    NARCIS (Netherlands)

    Florentinus, S.R.

    2006-01-01

    In this thesis several studies are presented with the objective to detect and elucidate the patterns by which new drugs are prescribed by general practitioners (GPs). Furthermore, we studied the influences of medical specialists and community pharmacists as important factors on the GP's decision to

  1. Vertical Integration in Teaching And Learning (VITAL): an approach to medical education in general practice.

    Science.gov (United States)

    Dick, Marie-Louise B; King, David B; Mitchell, Geoffrey K; Kelly, Glynn D; Buckley, John F; Garside, Susan J

    2007-07-16

    There is increasing demand to provide clinical and teaching experiences in the general practice setting. Vertical integration in teaching and learning, whereby teaching and learning roles are shared across all learner stages, has the potential to decrease time demands and stress on general practitioners, to provide teaching skills and experience to GP registrars, and to improve the learning experience for medical students, and may also help meet the increased demand for teaching in general practice. We consider potential advantages and barriers to vertical integration of teaching in general practice, and provide results of focus group discussions with general practice principals and registrars about vertical integration. We recommend further research into the feasibility of using vertical integration to enhance the capacity to teach medical students in general practice.

  2. Flexible but boring: medical students' perceptions of a career in general practice.

    Science.gov (United States)

    Koehler, Nicole; McMenamin, Christine

    2016-07-01

    Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.

  3. Improving statistical reasoning theoretical models and practical implications

    CERN Document Server

    Sedlmeier, Peter

    1999-01-01

    This book focuses on how statistical reasoning works and on training programs that can exploit people''s natural cognitive capabilities to improve their statistical reasoning. Training programs that take into account findings from evolutionary psychology and instructional theory are shown to have substantially larger effects that are more stable over time than previous training regimens. The theoretical implications are traced in a neural network model of human performance on statistical reasoning problems. This book apppeals to judgment and decision making researchers and other cognitive scientists, as well as to teachers of statistics and probabilistic reasoning.

  4. "Is general surgery still relevant to the subspecialised trainee?" A 10 year comparison of general versus specialty surgical practice.

    Science.gov (United States)

    Fleming, C A; Khan, Z; Andrews, E J; Fulton, G J; Redmond, H P; Corrigan, M A

    2015-02-01

    The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center. A cross-sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines. 11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10-year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 (p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62-2.58 bed days, p = 0.342) & emergency admissions (7.36-5.65, p = 0.026). General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub-specialisation.

  5. Role of Patient and Practice Characteristics in Variance of Treatment Quality in Type 2 Diabetes between General Practices

    NARCIS (Netherlands)

    Cho, Yeon Young; Sidorenkov, Grigory; Denig, Petra

    2016-01-01

    Background Accounting for justifiable variance is important for fair comparisons of treatment quality. The variance between general practices in treatment quality of type 2 diabetes (T2DM) patients may be attributed to the underlying patient population and practice characteristics. The objective of

  6. Practical likelihood analysis for spatial generalized linear mixed models

    DEFF Research Database (Denmark)

    Bonat, W. H.; Ribeiro, Paulo Justiniano

    2016-01-01

    We investigate an algorithm for maximum likelihood estimation of spatial generalized linear mixed models based on the Laplace approximation. We compare our algorithm with a set of alternative approaches for two datasets from the literature. The Rhizoctonia root rot and the Rongelap are......, respectively, examples of binomial and count datasets modeled by spatial generalized linear mixed models. Our results show that the Laplace approximation provides similar estimates to Markov Chain Monte Carlo likelihood, Monte Carlo expectation maximization, and modified Laplace approximation. Some advantages...... of Laplace approximation include the computation of the maximized log-likelihood value, which can be used for model selection and tests, and the possibility to obtain realistic confidence intervals for model parameters based on profile likelihoods. The Laplace approximation also avoids the tuning...

  7. Exploring Principals' Instructional Leadership Practices in Malaysia: Insights and Implications

    Science.gov (United States)

    Harris, Alma; Jones, Michelle; Cheah, Kenny Soon Lee; Devadason, Edward; Adams, Donnie

    2017-01-01

    Purpose: The purpose of this paper is to outline the findings from a small-scale, exploratory, study of principals' instructional leadership practice in Malaysian primary schools. The dimensions and functions of instructional leadership, explicitly explored in this study, are those outlined in the Hallinger and Murphy's (1985) model.…

  8. Critical Theory: Implications for School Leadership Theory and Practice.

    Science.gov (United States)

    Peca, Kathy

    The school leader's behaviors are inspired by theories, and theories are intrinsic to practice. This paper provides an overview of an emerging perspective in educational administration, critical theory. The paper first highlights the philosophies of Immanuel Kant, Fichte, Hegel, Marx, and the Frankfurt School. It then discusses critical theory…

  9. Typologies of Cohabitation: Implications for Clinical Practice and Research

    Science.gov (United States)

    Gold, Joshua M.

    2012-01-01

    This article will explore the current evolution in the practice of cohabitation. The intent of this literature- and web-based article is to acquaint counselors with three typologies of cohabitation. These categories can be utilized in the development of psychoeducational and remedial interventions and in the identification of areas of future…

  10. Integrating Social Class into Vocational Psychology: Theory and Practice Implications

    Science.gov (United States)

    Diemer, Matthew A.; Ali, Saba Rasheed

    2009-01-01

    Although social class plays a salient and significant role in career development and occupational attainment, social class is underrepresented in vocational psychology theory, scholarship, and practice. Vocational psychologists are in a unique position to meet the career development needs of persons from all social classes by integrating a fuller…

  11. Freudian Notion of Psychoanalysis: Its Implications in Contemporary Teaching Practices

    Science.gov (United States)

    Awan, Muhammad Afzal

    2017-01-01

    The author has engaged in a critical review of Frued's notion of psychoanalysis and its vitality in teaching. Illustrating from Freud's own assertions and through the interpretations of the later critics, the author has pointed out certain noticeable pitfalls and, or incapacities of contemporary teaching practices. The forces of aggression and sex…

  12. Implications of the law on video recording in clinical practice.

    Science.gov (United States)

    Henken, Kirsten R; Jansen, Frank Willem; Klein, Jan; Stassen, Laurents P S; Dankelman, Jenny; van den Dobbelsteen, John J

    2012-10-01

    Technological developments allow for a variety of applications of video recording in health care, including endoscopic procedures. Although the value of video registration is recognized, medicolegal concerns regarding the privacy of patients and professionals are growing. A clear understanding of the legal framework is lacking. Therefore, this research aims to provide insight into the juridical position of patients and professionals regarding video recording in health care practice. Jurisprudence was searched to exemplify legislation on video recording in health care. In addition, legislation was translated for different applications of video in health care found in the literature. Three principles in Western law are relevant for video recording in health care practice: (1) regulations on privacy regarding personal data, which apply to the gathering and processing of video data in health care settings; (2) the patient record, in which video data can be stored; and (3) professional secrecy, which protects the privacy of patients including video data. Practical implementation of these principles in video recording in health care does not exist. Practical regulations on video recording in health care for different specifically defined purposes are needed. Innovations in video capture technology that enable video data to be made anonymous automatically can contribute to protection for the privacy of all the people involved.

  13. Beauty: A Concept with Practical Implications for Teacher Researchers

    Science.gov (United States)

    Winston, Joe

    2011-01-01

    Hillman's (2001) simple affirmation that "an idea of beauty is useful, functional, practical" is one this article attempts to pursue with teacher researchers in mind, based on the belief that to move from the "re"pression of beauty to its "ex"pression--or, at the very least, to its articulation--will enlighten rather than distract individuals. The…

  14. The Future of General Surgery: Evolving to Meet a Changing Practice.

    Science.gov (United States)

    Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

    2016-01-01

    Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  15. Epidemiology of unintentional injuries in childhood: a population-based survey in general practice.

    NARCIS (Netherlands)

    Otters, H.; Schellevis, F.G.; Damen, J.; Wouden, J.C. van der; Suijlekom-Smit, L.W.A.; Koes, B.W.

    2005-01-01

    This study aimed to assess the incidence of unintentional injuries presented in general practice, and to identify children at risk from experiencing an unintentional injury. We used the data of all 0–17-yearold children from a representative survey in 96 Dutch general practices in 2001. We computed

  16. Refugee experiences of general practice in countries of resettlement: a literature review.

    Science.gov (United States)

    Cheng, I-Hao; Drillich, Ann; Schattner, Peter

    2015-03-01

    Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

  17. MR imaging in patients with knee injury: an observational study in general practice

    NARCIS (Netherlands)

    S.S. Boks (Simone)

    2007-01-01

    textabstractKnee trauma is often seen in general practice. The availability of magnetic resonance (MR) imaging has improved the diagnostic possibilities after knee trauma. Nevertheless, little is known about the findings on MR imaging after knee trauma in general practice. Especially, there is

  18. The pattern of trauma in private general medical practice set-up Port ...

    African Journals Online (AJOL)

    BACKGROUND: Private general medical practice establishments appear to be treating a significant number of trauma cases including more serious ones. Aim: To find out the extent of such treatment of trauma and what has made this possible. METHODS: All trauma cases treated in a private general medical practice set up ...

  19. Prescribing of pain medication in palliative care: a survey in general practice.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Deliens, L.; Zuurmond, W.W.A.; Schellevis, F.; Willems, D.L.; Wal, G. van der; Eijk, J.T.M. van

    2009-01-01

    PURPOSE: To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. METHODS: In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed

  20. Prescribing of pain medication in palliative care. A survey in general practice

    NARCIS (Netherlands)

    Borgsteede, Sander D.; Deliens, Luc; Zuurmond, Wouter W. A.; Schellevis, François G.; Willems, Dick L.; van der Wal, Gerrit; van Eijk, Jacques Th M.

    2009-01-01

    Purpose To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. Methods In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed

  1. Developing a framework of, and quality indicators for, general practice management in Europe.

    NARCIS (Netherlands)

    Engels, Y.M.P.; Campbell, S.M.; Dautzenberg, M.G.H.; Hombergh, P. van den; Brinkmann, H.; Szecsenyi, J.; Falcoff, H.; Seuntjens, L.; Kuenzi, B.; Grol, R.P.T.M.

    2005-01-01

    OBJECTIVES: To develop a framework for general practice management made up of quality indicators shared by six European countries. METHODS: Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six

  2. Patients with persistent medically unexplained physical symptoms: A descriptive study from Norwegian general practice

    OpenAIRE

    Aamland, Aase; Malterud, Kirsti; Werner, Erik L.

    2014-01-01

    Background: Further research on effective interventions for patients with peristent Medically Unexplained Physical Symptoms (MUPS) in general practice is needed. Prevalence estimates of such patients are conflicting, and other descriptive knowledge is needed for development and evaluation of effective future interventions. In this study, we aimed to estimate the consultation prevalence of patients with persistent MUPS in general practice, including patients’ characteristics and...

  3. Interpreted consultations as ‘business as usual’? : An analysis of organizational routines in general practices

    NARCIS (Netherlands)

    Greenhagh, T.; Voisey, C.J.; Robb, N.

    2007-01-01

    UK general practices operate in an environment of high linguistic diversity, because of recent large-scale immigration and of the NHS's commitment to provide a professional interpreter to any patient if needed. Much activity in general practice is co-ordinated and patterned into organisational

  4. Diagnostic approach to urinary tract infections in male general practice patients: a national surveillance study.

    NARCIS (Netherlands)

    Heijer, C.D.J. den; Dongen, M.C.J.M. van; Donker, G.A.; Stobberingh, E.E.

    2012-01-01

    Background: Diagnostic urinary tract infection (UTI) studies have primarily been performed among female patients. Aim: To create a diagnostic algorithm for male general practice patients suspected of UTI. Design and setting: Surveillance study in the Dutch Sentinel General Practice Network. Method:

  5. Supervision--growing and building a sustainable general practice supervisor system.

    Science.gov (United States)

    Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

    2011-06-06

    This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

  6. Commercial property loan valuations in the UK : implications of current trends in practice and liability

    OpenAIRE

    Crosby, Neil; Lavers, Anthony; Foster , Henry

    1997-01-01

    This paper is the second of two papers which aim to examine the major legal liability implications of changes to the commercial property loan valuation process caused by the recession in the UK property market and to make recommendations to valuers and their professional institutions to improve the quality of the process and the result. The objectives of this paper are to address a number of the practical implications of changes to the loan valuation process within the context of legal liabil...

  7. Leadership and management skills of general practice nurses: experience or education?

    Science.gov (United States)

    Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

    2014-12-01

    A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

  8. Problem drinking - detection and assessment in general practice.

    Science.gov (United States)

    Demirkol, Apo; Haber, Paul; Conigrave, Katherine

    2011-08-01

    Alcohol has long been an integral part of the social life of many Australians. However, alcohol is associated with significant harm to drinkers, and also to nondrinkers. This article explores the role of the general practitioner in the detection and assessment of problem drinking. Excessive alcohol use is a major public health problem and the majority of people who drink excessively go undetected. General practitioners are in a good position to detect excessive alcohol consumption; earlier intervention can help improve outcomes. AUDIT-C is an effective screening tool for the detection of problem drinking. National Health and Medical Research Council guidelines suggest that no more than two standard drinks on each occasion will keep lifetime risk of death from alcohol related disease or injury at a low level. Once an alcohol problem is detected it is important to assess for alcohol dependence, other substance use, motivation to change, psychiatric comorbidities and examination and investigation findings that may be associated with excessive alcohol use. A comprehensive assessment of the impact and risk of harm of the patient's drinking to themselves and others is vital, and may require several consultations.

  9. NONVERBAL TREATMENT OF NEUROSIS—Techniques for General Practice

    Science.gov (United States)

    Batten, Charles T.

    1959-01-01

    “Psychosomatic medicine” does not demand that the general practitioner function as a psychiatrist; rather, it is a psychiatric orientation that can increase the effectiveness of purely medical treatment for such conditions as neuroses. The general practitioner to whom the patient turns may achieve permanent results with nonverbal techniques where formal psychotherapy would be impracticable or unacceptable. The first aim is to relieve pressure so that the patient can regain his mental balance and thereby his self-confidence. Arts, hobbies, sports, and the like can be prescribed rather specifically according to the patient's personality and needs. Nutrition can be improved simply at first by prescribing needed additions to diet rather than imposing restrictions. Vitamin deficiency may by itself be the cause of neurosis or more serious mental disease, whereas psychic stress by itself may create a need for additional vitamin intake. Hormone therapy may be extremely helpful but must be based on clear indication and limited to specific purposes. Since lack of sleep and rest quickly impairs mental function, it is important for neurotic persons to learn relaxation as a necessity for sleep. Sedatives may be used in a crisis but should be abandoned as soon as possible. With all drugs there are problems of excess and habituation. The least, the mildest, the shortest dosage is the ideal. The initial steps of psychotherapy are available to any physician: Establishing rapport, noting how complaints are stated, encouraging ventilation, winning confidence rather than immediate results. PMID:13638823

  10. What Should General Practice Trainees Learn about Atopic Eczema?

    Directory of Open Access Journals (Sweden)

    Deepani Munidasa

    2015-02-01

    Full Text Available Effective atopic eczema (AE control not only improves quality of life but may also prevent the atopic march. The Royal College of General Practitioners’ (RCGP curriculum does not currently provide specific learning outcomes on AE management. We aimed to gain consensus on learning outcomes to inform curriculum development. A modified Delphi method was used with questionnaires distributed to gather the views of a range of health care professionals (HCPs including general practitioners (GPs, dermatologists, dermatology nurses and parents of children with AE attending a dedicated paediatric dermatology clinic. Ninety-one questionnaires were distributed to 61 HCPs and 30 parents; 81 were returned. All agreed that learning should focus on the common clinical features, complications and management of AE and the need to appreciate its psychosocial impact. Areas of divergence included knowledge of alternative therapies. Parents felt GPs should better understand how to identify, manage and refer severe AD and recognized the value of the specialist eczema nurse. Dermatologists and parents highlighted inconsistencies in advice regarding topical steroids. This study identifies important areas for inclusion as learning outcomes on AE management in the RCGP curriculum and highlights the importance of patients and parents as a valuable resource in the development of medical education.

  11. Understanding implementation in complex public organizations – implication for practice

    Directory of Open Access Journals (Sweden)

    Gry Cecilie Høiland

    2016-10-01

    Full Text Available The effective implementation of politically initiated public service innovations to the front-lines of the public service organization, where the innovation is to be applied, is a challenge that both practitioners and researchers struggle to solve. We highlight the importance of analysing contextual factors at several levels of the implementation system, as well as the importance of considering how the practical everyday work situations of the front-line workers influence their application of the innovation in question. We illustrate this by exploring the implementation process of a specific work inclusion measure, looking at its wider context and some of its implementation outcomes at a specific public agency. The intention is to illustrate the significance of considering the contextual complexity influencing implementation work as a reminder for practitioners to take this into account in their planning and practices.

  12. Implications of Automotive and Trucking On-Board Information Systems for General Aviation Cockpit Weather Systems

    Science.gov (United States)

    Sireli, Yesim; Kauffmann, Paul; Gupta, Surabhi; Kachroo, Pushkin

    2002-01-01

    In this study, current characteristics and future developments of Intelligent Transportation Systems (ITS) in the automobile and trucking industry are investigated to identify the possible implications of such systems for General Aviation (GA) cockpit weather systems. First, ITS are explained based on tracing their historical development in various countries. Then, current systems and the enabling communication technologies are discussed. Finally, a market analysis for GA is included.

  13. TEHORIES OF CONNECTIONS – PRACTICAL IMPLICATIONS IN ACQUIRING MOTOR SKILLS

    OpenAIRE

    Zoran Milošević; Nebojša Maksimović; Nada Milošević; Borislav Obradović

    2010-01-01

    Theories of learning which are classified in two broad schools as theories of connections and cognitive theories, differ among themselves according to specific interaction relationships between external stimulus (S), reaction and behavior and organism (R), i.e. particular learner (O). In relation to pedagogical practices, predominance of a certain school is not rare, often without any objective insight into their potentials related to age, sex, learning contents and other determinants. Suppor...

  14. Perspectives on academic misconduct: implications for education and practice.

    Science.gov (United States)

    Klainberg, Marilyn B; McCrink, Andrea; Eckardt, Patricia; Schecter, Rose; Bongiorno, Anne; Sedhom, Laila

    2014-01-01

    From Harvard to high school, concern related to academic misconduct, specifically cheating and its impact on societal issues, has become a great concern for educational communities. While a significant number of studies on ethical behaviors in practice in other professions such as business have been published, little research exists on registered nurses in practice. Even fewer studies have, for registered nurses, addressed if there is an association between perceived academic misconduct as students and perceived unethical behaviors in the workplace. The purpose of this study was to determine the relationship between perceptions of registered professional nurses' (RNs) current workplace behaviors and the RNs' retrospective perceptions of their academic misconduct as students. A convenience sample of 1 66 RNs enrolled in master's degree programs at four university schools of nursing completed questionnaires regarding their beliefs and behaviors. The outcome of this study was significant. Results revealed a strong relationship between unethical behaviors of the RN in practice and their prior academic misconduct when they were students.

  15. Informal Online Learning Practices: Implications for Distance Education

    Directory of Open Access Journals (Sweden)

    Fawn Winterwood

    2010-02-01

    Full Text Available This qualitative ethnographic study examines five American teenagers’ historical and current digitally-mediated multiliteracy practices within digital popular culture. The participants included three male and two female students of a private high school in the Midwestern United States. The study is framed by the notion that literacy is a socially, culturally, and historically situated discursive construct rather than a purely individualized cognitive endeavor. This social constructivist theory of literacy emphasizes the social conditions necessary to navigate the economic, social, and political worlds of the 21st century. The purpose of the study was to explore the students’ multiliteracy practices that they enact through their activities within digital popular culture. Data collection methods included synchronous interviews facilitated by video conferencing tools as well as observation of the participants’ online activities and member checks conducted via email and instant messaging. The analytic strategy employed during this study was informed by Clarke’s (2005 situational analysis method. The study’s findings indicate that literacy practices in which the study participants have engaged through informal learning activities within digital youth culture have had a much greater impact on enabling them to cultivate the multimodal literacies necessary within a postmodern digital era than have their formal educational experiences

  16. What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan.

    Science.gov (United States)

    Ie, Kenya; Murata, Akiko; Tahara, Masao; Komiyama, Manabu; Ichikawa, Shuhei; Takemura, Yousuke C; Onishi, Hirotaka

    2018-01-01

    Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

  17. Factors predicting team climate, and its relationship with quality of care in general practice

    OpenAIRE

    Goh, Teik T; Eccles, Martin P; Steen, Nick

    2009-01-01

    Abstract Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relatio...

  18. Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

    Science.gov (United States)

    Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

    2018-03-01

    Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible

  19. Time to talk, time to see: changing microeconomies of professional practice among nurses and doctors in Australian general practice.

    Science.gov (United States)

    Phillips, Christine; Dwan, Kathryn; Pearce, Christopher; Hall, Sally; Porritt, Julie; Yates, Rachel; Sibbald, Bonnie

    2007-08-01

    In Australia, more nurses are entering general practice, and nurses' work is being funded in increasingly complex ways through Medicare. Little research has explored the ways doctors and nurses realign their priorities and activities when working together in general practice. We undertook rapid, intensive multimethod studies of 25 general practices to explore the ways in which the labour of nurses and doctors was structured, and the implicit decisions made by both professions about the values placed on different ways of working and on their time. Data collected included photographs, floor-plans, interviews with 37 nurses, 24 doctors and 22 practice managers, and 50 hours of structured observation. Nursing time was constructed by both nurses and doctors as being fluid and non-contingent; they were regarded as being 'available' to patients in a way that doctors were not. Compared to medical time, nursing time could be disposed more flexibly, underpinning a valorized attribute of nursing: deep clinical and personal contact with patients. The location of practice nurses' desks in areas of traffic, such as administrative stations, or in the treatment room, underpinned this valuable unstructured contact with patients. Changes to the practice nurse role through direct fee-for-service items for nurses may lead to greater congruence between the microeconomies of nursing and medicine in general practice. In a time of pressure upon a primary care workforce, this is likely to lead to more independent clinical work by nurses, but may also lead to a decrease in flexible contact with patients.

  20. Third universal definition of myocardial infarction. Implications for clinical practice

    International Nuclear Information System (INIS)

    Bazzino, O.

    2013-01-01

    In general, the conceptual meaning of the term myocardial infarction has not changed, although have developed new sensitive diagnostic methods. In this way the clinical diagnosis is based on patient symptoms, electrocardiogram's (ECG) changes and sensitive biochemical markers, as well as the information obtained from various imaging techniques

  1. [Theoretical and practical assessment of Lille general practice and pharmacy students' knowledge about use of inhaler devices for asthma control].

    Science.gov (United States)

    Veylon, P; Rochoy, M; Gautier, S; Wallaert, B; Berkhout, C

    2018-04-01

    Asthma is a potentially serious chronic respiratory disease impacting patients quality of life. Satisfactory control requires proper use of inhaled devices. This study assesses general medical residents and pharmacy students knowledge about proper use of inhaled asthma devices. We evaluated knowledge of 43 general practice students and 43 pharmacy students in Lille for three inhaler devices (metered-dose inhaler, Turbuhaler ® and Diskus ® ) during individual interviews. Students were assessed on 8 proper use criterias for each device. General practice and pharmacy students are unfamiliar with proper use of inhaler devices. However, pharmacy students get better average scores than general practice students for all devices included in this study: 6.3/8 respected criterias against 5/8 for metered-dose inhaler; 5.3/8 against 3.2/8 for Turbuhaler ® ; and 6/8 against 4.3/8 for Diskus ® . Pharmacy students more frequently perform a demonstration of proper use to patients when a device is first prescribed or when a prescription is renewed; general practice students more frequently ask patients themselves to perform a demonstration of proper use. Introducing trainings workshops for inhaler devices to pharmacy and general practice students appears appropriate in order to promote therapeutic patient education, to increase asthma control and better patients life quality. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  2. Identification, assessment and intervention--Implications of an audit on dyslexia policy and practice in Scotland.

    Science.gov (United States)

    Reid, Gavin; Deponio, Pamela; Davidson Petch, Louise

    2005-08-01

    This article reports on research commissioned by the Scottish Executive Education Department (SEED). It aimed to establish the range and extent of policy and provision in the area of specific learning difficulties (SpLD) and dyslexia throughout Scotland. The research was conducted between January and June 2004 by a team from the University of Edinburgh. The information was gathered from a questionnaire sent to all education authorities (100% response rate was achieved). Additional information was also obtained from supplementary interviews and additional materials provided by education authorities. The results indicated that nine education authorities in Scotland (out of 32) have explicit policies on dyslexia and eight authorities have policies on SpLD. It was noted however that most authorities catered for dyslexia and SpLD within a more generic policy framework covering aspects of Special Educational Needs or within documentation on 'effective learning'. In relation to identification thirty-six specific tests, or procedures, were mentioned. Classroom observation, as a procedure was rated high by most authorities. Eleven authorities operated a formal staged process combining identification and intervention. Generally, authorities supported a broader understanding of the role of identification and assessment and the use of standardized tests was only part of a wider assessment process. It was however noted that good practice in identification and intervention was not necessarily dependent on the existence of a dedicated policy on SpLD/dyslexia. Over fifty different intervention strategies/programmes were noted in the responses. Twenty-four authorities indicated that they had developed examples of good practice. The results have implications for teachers and parents as well as those involved in staff development. Pointers are provided for effective practice and the results reflect some of the issues on the current debate on dyslexia particularly relating to early

  3. Medical engagement and organizational characteristics in general practice

    DEFF Research Database (Denmark)

    Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders

    2016-01-01

    BACKGROUND: Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale...... and organizational characteristics. DESIGN AND SETTING: A cross-sectional study using a sampled survey questionnaire and the official register from the Danish General Practitioners' Organization comprising all registered Danish GPs. METHOD: The Danish version of the MES Questionnaire was distributed and the survey...... and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs....

  4. Social capital and frequent attenders in general practice

    DEFF Research Database (Denmark)

    Pasgaard, Alexander A.; Mæhlisen, Maiken H.; Overgaard, Charlotte

    2018-01-01

    weeks. RESULTS: Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79-0.94)] and social network [OR 0.88 (0.79-0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity...... at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148...... and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99-1.11) and OR 1.01 (0.92-1.11) respectively]. None of the associations were statistically significant for men. CONCLUSION: This study suggests that for women, some aspects of social capital are associated...

  5. Regionalisation of general practice training--are we meeting the needs of rural Australia?

    Science.gov (United States)

    Campbell, David G; Greacen, Jane H; Giddings, Patrick H; Skinner, Lesley P

    2011-06-06

    The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.

  6. Case Studies of Mental Health in General practice(28)---HIV and Mood Disturbance

    Institute of Scientific and Technical Information of China (English)

    Fiona Judd; Leon Piterman; Grant Blashki; Hui Yang

    2014-01-01

    The Journal presents the Column of Case Studies of Mental Health in General Practice;with aca-demic support from Australian eXperts in general practice,psychology and psychiatry from Monash University and the University of Mel-bourne. The Columnˊs purpose is to respond to the increasing need for the development of mental health services in China. Through study and analysis of mental health cases,we hope to improve understanding of mental illnesses in Chinese primary health settings,and to build capaci-ty amongst community health professionals in managing mental illnesses and psychological problems in general practice. A patient - centred whole - person approach in general practice is the best way to maintain and improve the physical and mental health of residents. Our hope is that these case studies will lead the new wave of general practice and mental health service development both in practice and research. A num-ber of Australian eXperts from the disciplines of general practice,mental health and psychiatry will contribute to the Column. Professor Blash-ki,Professor Judd and Professor Piterman are authors of the teXt General Practice Psychiatry;the Chinese version of the book to be published in 2014. The Journal cases are helping to prepare for the translation and publication of a Chinese version of the book in China. We believe Chi-nese mental health in primary health care will reach new heights under this international cooperation.

  7. Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine.

    Science.gov (United States)

    Mola, Ernesto; De Bonis, Judith A; Giancane, Raffaele

    2008-01-01

    Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline. The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline. The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline. General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities. "Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.

  8. Intensive versus conventional blood pressure monitoring in a general practice population. The Blood Pressure Reduction in Danish General Practice trial: a randomized controlled parallel group trial

    DEFF Research Database (Denmark)

    Klarskov, Pia; Bang, Lia E; Schultz-Larsen, Peter

    2018-01-01

    To compare the effect of a conventional to an intensive blood pressure monitoring regimen on blood pressure in hypertensive patients in the general practice setting. Randomized controlled parallel group trial with 12-month follow-up. One hundred and ten general practices in all regions of Denmark....... One thousand forty-eight patients with essential hypertension. Conventional blood pressure monitoring ('usual group') continued usual ad hoc blood pressure monitoring by office blood pressure measurements, while intensive blood pressure monitoring ('intensive group') supplemented this with frequent...... a reduction of blood pressure. Clinical Trials NCT00244660....

  9. KNOWLEDGE OF DIVERSE LEARNERS: IMPLICATIONS FOR THE PRACTICE OF TEACHING

    Directory of Open Access Journals (Sweden)

    Fadzilah Abd Rahman

    2010-07-01

    Full Text Available Knowledge of Diverse Learners (KDL is increasingly recognized as an essential component of knowledge base for effective teaching as in today’s schools, teachers must be prepared to teach a diverse population of student (Banks et al. 2005. In other words, teachers need to be aware that their students in a classroom are and always have been different from one another in a variety of ways. KDL refers to an understanding of diversity of students in terms of their abilities and interests and how they respond to diverse situations; an application of different teaching strategies; and how various types of classroom activities might be managed. Although KDL has come to be seen as important, details of its development, depth and quality among pre-service teachers (PSTs has remained something of mystery, as has the capability of PSTs to adapt and employ KDL into their actual teaching. As an effort to develop coherent understanding of the feature of prospective teachers regarding KDL, this paper addresses three questions. First, to what extent are the PSTs prepared for KDL as they are finishing the teacher education programmes? Secondly, how do the PSTs apply the KDL in their teaching practices? Thirdly, how do PSTs reflect on their practice in undertaking the elements of KDL during the teaching practices? This paper illustrates the results of a study involving a sample of 74 PSTs at a university in Malaysia. At the beginning of the study, 74 PSTs were given a questionnaire. 11 PSTs have been observed and interviewed. Result indicates that PSTs were able to develop KDL and show their understanding of it, yet not readily apply such knowledge in modified situations.

  10. [Cultural diversity and stereotyping: implication for the medical practice].

    Science.gov (United States)

    Durieux-Paillard, S; Loutan, L

    2005-09-28

    Increasing number of migrants worldwide brings doctors to treat patients of various origins. Patients' diversity enriches health professionals but also induces a risk of mutual incomprehension, due to cultural and language barriers. Multicultural context stimulates unwittingly stereotyping, based on a simplistic assessment of the patient's culture. Stereotyping is also influenced by the political and media coverage. Studies underscored that universally, minorities patients have an unequal access to health care in host countries. Health professionals should be aware that racial stereotyping exists in medical practice: it is a first step to bridge cultural gap between them and their patients.

  11. Toward an Ontology of Practices in Educational Administration: Theoretical Implications for Research and Practice

    Science.gov (United States)

    Newton, Paul; Riveros, Augusto

    2015-01-01

    In this article, we argue for a study of educational administration centered on an "ontology of practices." This is an initial proposal for thinking about and conceptualizing practices in educational administration. To do this, first, we explore how practices are constituted and how they configure the social realities of practitioners.…

  12. The place of knowledge and evidence in the context of Australian general practice nursing.

    Science.gov (United States)

    Mills, Jane; Field, John; Cant, Robyn

    2009-01-01

    The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.

  13. Current knowledge on radon risk. Implications for practical radiation protection?

    International Nuclear Information System (INIS)

    Mueller, Wolfgang-Ulrich; Giussani, Augusto; Kreuzer, Michaela; Sobotzki, Christina; Ruehm, Werner; Lecomte, Jean-Francois; Harrison, John; Breckow, Joachim

    2016-01-01

    ICRP suggested a strategy based on the distinction between a protection approach for dwellings and one for workplaces in the previous recommendations on radon. Now, the Commission recommends an integrated approach for the protection against radon exposure in all buildings irrespective of their purpose and the status of their occupants. The strategy of protection in buildings, implemented through a national action plan, is based on the application of the optimisation principle below a derived reference level in concentration (maximum 300 Bq m -3 ). A problem, however, arises that due to new epidemiological findings and application of dosimetric models, ICRP 115 (Ann ICRP 40, 2010) presents nominal probability coefficients for radon exposure that are approximately by a factor of 2 larger than in the former recommendations of ICRP 65 (Ann ICRP 23, 1993). On the basis of the so-called epidemiological approach and the dosimetric approach, the doubling of risk per unit exposure is represented by a doubling of the dose coefficients, while the risk coefficient of ICRP 103 (2007) remains unchanged. Thus, an identical given radon exposure situation with the new dose coefficients would result in a doubling of dose compared with the former values. This is of serious conceptual implications. A possible solution of this problem was presented during the workshop. (orig.)

  14. Current knowledge on radon risk. Implications for practical radiation protection?

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Wolfgang-Ulrich [Universitaetsklinikum Essen, Institut fuer Medizinische Strahlenbiologie, Essen (Germany); Giussani, Augusto; Kreuzer, Michaela; Sobotzki, Christina [Federal Office for Radiation Protection, Oberschleissheim (Germany); Ruehm, Werner [German Research Center for Environmental Health, Institute of Radiation Protection, Helmholtz Zentrum Muenchen, Neuherberg (Germany); Lecomte, Jean-Francois [International Affaires Directorate, Institut de Radioprotection et de Surete Nucleaire, P.O. Box 17, Fontenay-aux-Roses (France); Harrison, John [Oxford Brookes University, Faculty of Health and Life Sciences, Oxford (United Kingdom); Breckow, Joachim [THM University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen (Germany)

    2016-08-15

    ICRP suggested a strategy based on the distinction between a protection approach for dwellings and one for workplaces in the previous recommendations on radon. Now, the Commission recommends an integrated approach for the protection against radon exposure in all buildings irrespective of their purpose and the status of their occupants. The strategy of protection in buildings, implemented through a national action plan, is based on the application of the optimisation principle below a derived reference level in concentration (maximum 300 Bq m{sup -3}). A problem, however, arises that due to new epidemiological findings and application of dosimetric models, ICRP 115 (Ann ICRP 40, 2010) presents nominal probability coefficients for radon exposure that are approximately by a factor of 2 larger than in the former recommendations of ICRP 65 (Ann ICRP 23, 1993). On the basis of the so-called epidemiological approach and the dosimetric approach, the doubling of risk per unit exposure is represented by a doubling of the dose coefficients, while the risk coefficient of ICRP 103 (2007) remains unchanged. Thus, an identical given radon exposure situation with the new dose coefficients would result in a doubling of dose compared with the former values. This is of serious conceptual implications. A possible solution of this problem was presented during the workshop. (orig.)

  15. Understanding general practice: a conceptual framework developed from case studies in the UK NHS.

    Science.gov (United States)

    Checkland, Kath

    2007-01-01

    General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Five general practices in England, selected using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and nonparticipant observation, and examination of documents. A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality.

  16. The reported availability of general practitioners and the influence of practice list size.

    OpenAIRE

    Campbell, J L

    1996-01-01

    BACKGROUND: Combined practice list sizes have increased, but larger practice size may be associated with disadvantage to patients. AIM: The aim of the study was to investigate the availability of general practitioners as reported by their patients and the relationship between reported availability and practice list size. METHOD: A one-week questionnaire survey of 8315 patients attending participating practices in West Lothian, Scotland, was conducted. Patients were asked about the arrangement...

  17. Physical activity coaching by Australian Exercise Physiologists is cost effective for patients referred from general practice.

    Science.gov (United States)

    Ewald, Ben; Stacey, Fiona; Johnson, Natalie; Plotnikoff, Ronald C; Holliday, Elizabeth; Brown, Wendy; James, Erica L

    2018-02-01

    Interventions to promote physical activity for sedentary patients seen in general practice may be a way to reduce the burden of chronic disease. Coaching by an exercise physiologist is publicly funded in Australia, but cost effectiveness has not been documented. In a three-arm randomised controlled trial, face-to-face coaching and telephone coaching over 12 weeks were compared with a control group using the outcome of step count for one week at baseline, three months and twelve months. Program costs and time-based costs were considered. Quality of life was measured as a secondary outcome. At 12 months, the intervention groups were more active than controls by 1,002 steps per day (95%CI 244, 1,759). This was achieved at a cost of AUD$245 per person. There was no change in reported quality of life or utility values. Coaching achieved a modest increase in activity equivalent to 10 minutes walking per day, at a cost of AUD$245 per person. Face-to-face and telephone counselling were both effective. Implication for public health: Persistence of increases nine months after the end of coaching suggests it creates long-term change and is a good value health intervention. © 2017 The Authors.

  18. The global financial crisis and Australian general practice.

    Science.gov (United States)

    McRae, Ian S; Paolucci, Francesco

    2011-02-01

    To explore the potential effects of the global financial crisis (GFC) on the market for general practitioner (GP) services in Australia. We estimate the impact of changes in unemployment rates on demand for GP services and the impact of lost asset values on GP retirement plans and work patterns. Combining these supply and demand effects, we estimate the potential effect of the GFC on the market for GP services under various scenarios. If deferral of retirement increases GP availability by 2%, and historic trends to reduce GP working hours are halved, at the current level of ~5.2% unemployment average fees would decline by $0.23 per GP consultation and volumes of GP services would rise by 2.53% with almost no change in average GP gross earnings over what would otherwise have occurred. With 8.5% unemployment, as initially predicted by Treasury, GP fees would increase by $0.91 and GP income by nearly 3%. The GFC is likely to increase activity in the GP market and potentially to reduce fee levels relative to the pre-GFC trends. Net effects on average GP incomes are likely to be small at current unemployment levels.

  19. Asthma control in general practice -- GP and patient perspectives compared.

    Science.gov (United States)

    Henderson, Joan; Hancock, Kerry L; Armour, Carol; Harrison, Christopher; Miller, Graeme

    2013-10-01

    How general practitioners (GPs) and patients perceive asthma control, and concordance between these perceptions, may influence asthma management and medication adherence. The aims of this study were to determine asthma prevalence in adult patients, measure patient asthma control and the correlation between GP and patient perceptions of asthma control or impact. A Supplementary Analysis of Nominated Data (SAND) sub-study of the Bettering the Evaluation and Care of Health (BEACH) program surveyed 2563 patients from 103 GPs. Asthma control was measured using the Asthma Control Questionnaire 5-item version (ACQ-5), and medication adherence by patient self-report. Survey procedures in SAS software and Pearson's correlation statistics were used. Asthma prevalence was 12.7% (95% confidence interval: 10.9-14.5), with good correlation between GP and patient perceptions of asthma control/impact, and with raw ACQ-5 scores. Grouped ACQ-5 scores showed higher levels of uncontrolled asthma. Medication adherence was sub-optimal. The ACQ-5 questions are useful for assessing asthma control, for prompting medication reviews, and for reinforcing benefits of medication compliance to improve long-term asthma control.

  20. The lesser evil? Initiating a benzodiazepine prescription in general practice

    Science.gov (United States)

    Anthierens, Sibyl; Habraken, Hilde; Petrovic, Mirko; Christiaens, Thierry

    2007-01-01

    Objective Chronic benzodiazepine (BZD) use is widespread and linked with adverse effects. There is consensus concerning the importance of initiating BZD as a crucial moment. Nevertheless specific research in this field is lacking. This paper addresses the views of GPs on why they start prescribing BZDs to first-time users. Design Qualitative study with five focus groups analysed using a systematic content analysis. Setting Regions of Ghent and Brussels in Belgium. Subjects A total of 35 general practitioners. Main outcome measure The GPs’ perspective on their initiating of BZD prescribing. Results GPs reported that they are cautious in initiating BZD usage. At the same time, GPs feel overwhelmed by the psychosocial problems of their patients. They show empathy by prescribing. They feel in certain situations there are no other solutions and they experience BZDs as the lesser evil. They admit to resorting to BZDs because of time restraint and lack of alternatives. GPs do not perceive the addictive nature of BZD consumption as a problem with first-time users. GPs do not specifically mention patients’ demand as an element for starting. Conclusion The main concern of GPs is to help the patient. GPs should be aware of the addictive nature of BZD even in low doses and a non-pharmacological approach should be seen as the best first approach. If GPs decide to prescribe a BZD they should make plain to the patient that the medication is only a “temporary” solution with clear agreements with regard to medication withdrawal. PMID:18041658

  1. [Antibiotic prescribing in acute respiratory tract infections in general practice].

    Science.gov (United States)

    Malo, S; Bjerrum, L; Feja, C; Lallana, M J; Poncel, A; Rabanaque, M J

    2015-06-01

    Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  2. General Parenting Strategies: Practical Suggestions for Common Child Behavior Issues.

    Science.gov (United States)

    Kavan, Michael G; Saxena, Shailendra K; Rafiq, Naureen

    2018-05-15

    Parents often seek guidance from physicians on child behavior problems. Questions may range from general parenting strategies to managing specific child behaviors. Physicians and their staff can identify problematic parent-child interactions or behaviors within the office setting and assist parents by providing effective monitoring tools for behavior problems. Effective strategies for influencing a child's behavior include positive reinforcement to increase appropriate behavior, extinction (planned ignoring) for most low-level problematic behaviors, and time-out from reinforcement for more problematic behaviors. Written contracting provides parents the opportunity to communicate with their children about important behaviors and strengthens the commitment of each party to improve behavior. Parents should be cautioned about the use of punishment (e.g., scolding, taking away privileges or possessions) because it suppresses behavior only temporarily. Physicians should discourage physical or corporal punishment because it is related to negative parent-child relationships, increased aggressiveness, antisocial behavior, lower cognitive ability, lower self-esteem, mental health problems, and increased risk of physical abuse.

  3. Caring for self-harming patients in general practice.

    Science.gov (United States)

    Rowe, Joanne; Jaye, Chrystal

    2017-12-01

    INTRODUCTION Intentional self-harm is an international public health issue with high personal, social and financial costs to society. Poor relationship dynamics are known to have a negative influence on the psyche of people who self-harm, and this can increase anxiety and decrease self-esteem, both shown to be significant contributors to self-harm behaviours. Positive and functional social supports have been proposed as a cost-effective and constructive approach in diminishing self-harming behaviours. AIM This qualitative study investigated the aspects of professional, social, familial and romantic relationships that people who have self-harmed identified as having a positive and constructive effect on their self-harm behaviour. METHODS Twelve participants with a history of self-harming behaviours were recruited through free press advertising in primary care and interviewed. The participants ranged in age from 19 to 70 years, and represented New Zealand (NZ) European and Māori from across the Southern region of NZ. RESULTS This study shows that constructive relationships that inhibit self-harm behaviours are characterised by participants' perceptions of authenticity in their relationships, and knowing that other people genuinely care. Feeling cared for within an authentic therapeutic relationship enabled participants to overcome their perception of being damaged selves and gave them the skills and confidence to develop functional relationships within their communities. A relationship-centred care approach may be useful for general practitioners seeking to develop more effective therapeutic relationships with patients who deliberately self-harm.

  4. Practical Implications of Empirically Studying Moral Decision-Making

    Science.gov (United States)

    Heinzelmann, Nora; Ugazio, Giuseppe; Tobler, Philippe N.

    2012-01-01

    This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main problems usually keep us form acting and judging in a morally decent way: firstly, we make mistakes in moral reasoning. Secondly, even when we know how to act and judge, we still fail to meet the requirements due to personal weaknesses. This discussion naturally leads us to another question: can we narrow the gap between what people are morally required to do and what they actually do? We discuss findings from neuroscience, economics, and psychology, considering how we might bring our moral behavior better in line with moral theory. Potentially fruitful means include nudging, training, pharmacological enhancement, and brain stimulation. We conclude by raising the question of whether such methods could and should be implemented. PMID:22783157

  5. Practical implications of empirically studying moral decision-making.

    Science.gov (United States)

    Heinzelmann, Nora; Ugazio, Giuseppe; Tobler, Philippe N

    2012-01-01

    This paper considers the practical question of why people do not behave in the way they ought to behave. This question is a practical one, reaching both into the normative and descriptive domains of morality. That is, it concerns moral norms as well as empirical facts. We argue that two main problems usually keep us form acting and judging in a morally decent way: firstly, we make mistakes in moral reasoning. Secondly, even when we know how to act and judge, we still fail to meet the requirements due to personal weaknesses. This discussion naturally leads us to another question: can we narrow the gap between what people are morally required to do and what they actually do? We discuss findings from neuroscience, economics, and psychology, considering how we might bring our moral behavior better in line with moral theory. Potentially fruitful means include nudging, training, pharmacological enhancement, and brain stimulation. We conclude by raising the question of whether such methods could and should be implemented.

  6. A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

    Science.gov (United States)

    Hampton, Kerry D; Newton, Jennifer M; Parker, Rhian; Mazza, Danielle

    2016-07-01

    To understand the barriers and enablers to fertility-awareness education in general practice. Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. A descriptive exploratory qualitative study using deductive content analysis. General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. © 2016 John Wiley & Sons Ltd.

  7. COPD exacerbations in general practice: variability in oral prednisolone courses

    Directory of Open Access Journals (Sweden)

    de Vries Marianne

    2012-01-01

    Full Text Available Abstract Background The use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs who adjust their treatment according to the presence of diabetic co-morbidity. Methods Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands. Results The response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity. Conclusion Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.

  8. Parents' preferred child health information sources: implications for nursing practice.

    Science.gov (United States)

    Keatinge, Diane

    2006-01-01

    To ascertain parents' preferences in sources of health information concerning their children's general health care needs, and caring for their children when they are sick. Exploratory/descriptive design. A telephone survey secured data for the study and qualitative content analysis and descriptive statistics were used for analysis. Part 2 of a larger study in which Part I evaluated parents' satisfaction with a paediatric telephone triage service. One hundred of the 101 parents who were recruited for Part 1 of the study participated in Part 2, an examination of parents' preferences in information sources relating to their child's health. Parents' preferences in child health information sources varied according to the perceived severity of their child's illness. Parents frequently selected more than one item on a list of health information sources provided. In a non-urgent situation when children were sick a total of 170 selections were made by parents, with 'telephone advice line' the source most frequently selected (58, 34%), followed by general practitioner (27, 15.8%). In an emergency situation the most frequently selected information source was again 'telephone advice line' (74, n=129, 57.4%), followed by 'other' (31, n=129, 24.3%) often identified as relating to dialing '000' (Australia's emergency services number). Finally, when parents required information about the general health care needs of their child, 'other' (most frequently identified as books) was selected on 40 (n=185, 21.6%) occasions, followed by child health clinic (35, n= 185, 18.9%). Parents prefer to receive information about the health care needs of their child from another person rather than a printed or audio-visual source.

  9. Implications of model uncertainty for the practice of risk assessment

    International Nuclear Information System (INIS)

    Laskey, K.B.

    1994-01-01

    A model is a representation of a system that can be used to answer questions about the system's behavior. The term model uncertainty refers to problems in which there is no generally agreed upon, validated model that can be used as a surrogate for the system itself. Model uncertainty affects both the methodology appropriate for building models and how models should be used. This paper discusses representations of model uncertainty, methodologies for exercising and interpreting models in the presence of model uncertainty, and the appropriate use of fallible models for policy making

  10. Empathy Variation in General Practice: A Survey among General Practitioners in Denmark

    DEFF Research Database (Denmark)

    Charles, Justin; Ahnfeldt-Mollerup, Peder; Søndergaard, Jens

    2018-01-01

    Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informe...

  11. Informal Interpreting in General Practice: Comparing the perspectives of General Practitioners, migrant patients and family interpreters.

    NARCIS (Netherlands)

    Zendedel, R.; Schouten, B.C.; van Weert, J.C.M.; van den Putte, B.

    Objective To explore differences in perspectives of general practitioners, Turkish-Dutch migrant patients and family interpreters on interpreters’ role, power dynamics and trust in interpreted GP consultations. Methods 54 semi-structured in-depth interviews were conducted with the three parties

  12. A multidirectional communication model: implications for social marketing practice.

    Science.gov (United States)

    Thackeray, Rosemary; Neiger, Brad L

    2009-04-01

    The landscape of sending and receiving information has changed dramatically in the past 25 years. The communication process is changing from being unidirectional to multidirectional as consumers are becoming active participants by creating, seeking, and sharing information using a variety of channels and devices. The purpose of this article is to describe how this shift in the communication process- where gatekeepers control the creation and content of information and consumers are less active recipients to one that reflects a multidirectional and more dynamic process with participative consumers-will affect the social marketing process. This shift in communication does not represent an option for social marketers so much as a necessity. As professionals respond to this evolving communication model, the practice of social marketing can remain vibrant as a relevant consumer-oriented approach to behavior change.

  13. Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

    Science.gov (United States)

    Kinouani, Shérazade; Boukhors, Gary; Luaces, Baptiste; Durieux, William; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Gay, Bernard

    2016-09-01

    Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

  14. The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation.

    Science.gov (United States)

    Henderson, Emily J; Rubin, Greg P

    2013-05-01

    To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. General practitioners' views, experiences and usage of the system. Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

  15. ["General Practice is a great job anyway" - a qualitative study with vocational trainees].

    Science.gov (United States)

    Steinhäuser, Jost; Paulus, Jan; Roos, Marco; Peters-Klimm, Frank; Ledig, Thomas; Szecsenyi, Joachim; Joos, Stefanie

    2011-01-01

    Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession. Copyright © 2010. Published by Elsevier GmbH.

  16. Management of osteoarthritis in general practice in Australia.

    Science.gov (United States)

    Brand, Caroline A; Harrison, Christopher; Tropea, Joanne; Hinman, Rana S; Britt, Helena; Bennell, Kim

    2014-04-01

    To describe management of osteoarthritis (OA) of the hip (OA-hip) and knee (OA-knee) by Australian general practitioners (GPs). We analyzed data from the Bettering the Evaluation and Care of Health program, from April 1, 2005 to March 31, 2010. Patient and GP characteristics and encounter management data were extracted. Data were classified by the International Classification of Primary Care, version 2, and summarized using descriptive statistics and 95% confidence intervals around point estimates. There were 489,900 GP encounters at which OA was managed (rate of 26.4 per 1,000 encounters). OA-hip was managed at a rate of 2.3 per 1,000 encounters (n = 1,106, 8.6% OA) and OA-knee at a rate of 6.2 per 1,000 (n = 3,058, 23.7% OA). The encounter management rate per 1,000 for OA-hip was higher among non-metropolitan dwellers (2.85 per 1,000 versus 1.97 per 1,000) and lower for non-English-speaking people (1.53 per 1,000 encounters versus 2.39 per 1,000). The rate for OA-knee was higher for non-English-speaking background (8.50 per 1,000 encounters versus 6.24 per 1,000) and lower among indigenous people (3.16 per 1,000 encounters versus 6.46 per 1,000). Referral to an orthopedic surgeon was the most frequently used nonpharmacologic management (OA-knee 17.4 per 100 contacts and OA-hip 17.7 per 100), followed by advice, education, and counselling. As first-line treatment, medication prescription rates (OA-knee 78.7 per 100 contacts and OA-hip 73.2 per 100) were substantially higher than rates of lifestyle management (OA-knee 20.7 per 100 contacts and OA-hip 14.8 per 100). OA-hip and OA-knee encounters and management differ. Nonpharmacologic treatments as first-line management were low compared with pharmacologic management rates, and surgical referral rates were high. However, lack of longitudinal data limits definitive assessment of appropriateness of care. Copyright © 2014 by the American College of Rheumatology.

  17. Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

    Science.gov (United States)

    Sturmberg, Joachim P; Martin, Carmel M; Katerndahl, David A

    2014-01-01

    Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing

  18. Promoting leadership and management in Australian general practice nursing: what will it take?

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Patterson, Elizabeth

    2008-10-01

    This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.

  19. Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study.

    Science.gov (United States)

    Merrett, Alexandra; Jones, Daniel; Sein, Kim; Green, Trish; Macleod, Una

    2017-04-01

    A key element of the NHS is universal access to a GP. Recently, UK general practice has been described as being in crisis, with training places unfilled and multiple practices reporting vacancies or facing closure. The recruitment of GPs continues to be a key focus for both the Royal College of General Practitioners (RCGP) and the government. To understand the attitudes of newly qualified doctors towards a career in general practice, to appreciate potential reasons for the crisis in GP recruitment, and to recommend ways to improve recruitment. A qualitative study comprising five focus groups with 74 Foundation Year 1 (FY1) doctors from one Yorkshire deanery. Audio recordings were transcribed verbatim and thematic analysis undertaken. Foundation Year 1 doctors' thoughts towards a career in general practice were summarised in four themes: quality of life, job satisfaction, uncertainty surrounding the future of general practice, and the lack of respect for GPs among both doctors and the public. Participants felt that general practice could provide a good work-life balance, fair pay, and job stability. Job satisfaction, with the ability to provide care from the cradle to the grave, and to work within a community, was viewed positively. Uncertainties around future training, skill levels, pay, and workload, together with a perceived stigma experienced in medical schools and hospitals, were viewed as a deterrent to a career in general practice. This study has gathered the opinions of doctors at a critical point in their careers, before they choose a future specialty. Findings highlight areas of concern and potential deterrents to a career in general practice, together with recommendations to address these issues. © British Journal of General Practice 2017.

  20. Helmet wearing in Kenya: prevalence, knowledge, attitude, practice and implications.

    Science.gov (United States)

    Bachani, A M; Hung, Y W; Mogere, S; Akunga, D; Nyamari, J; Hyder, A A

    2017-03-01

    In light of the increasing prevalence of motorcycles on Kenyan roads, there is a need to address the safety of individuals using this mode of transport. Helmet use has been proven to be effective in preventing head injuries and fatalities in the event of a crash. This study aims to understand the prevalence of helmet use as well as knowledge, attitudes, and practices in two districts in Kenya over a 5-year period (2010-2014). Observational studies on helmet use at randomly selected locations throughout each district were done every quarter to estimate the prevalence of helmet use. Roadside knowledge, attitude, and practice (KAP) surveys were done two times a year in each district. Helmet use among motorcycle drivers and passengers in Thika and Naivasha was assessed through systematic observations at randomly selected locations in the two districts between August 2010 and December 2014. Roadside KAP surveys were administered in both sites to motorcyclists in areas where they stopped, including motorcycle bays, petrol stations and rest areas near the helmet observation sites. Secondary analysis of trauma registries was also used. Negative binomial regressions were used to assess trends of helmet wearing among motorcyclists over time, and logistic regressions were used to analyze associated risk factors as well as association with health outcomes among those admitted to the four hospitals. A total of 256,851 motorcycles were observed in the two target districts during the study period. Overall, prevalence of helmet use among motorcycle drivers in Thika and Naivasha across all periods was 35.12% (95% confidence interval [CI]: 34.87%-35.38%) and 37.42% (95% CI: 37.15%-37.69%) respectively. Prevalence of helmet wearing remained similar after the passage of a traffic amendment bill. These results were not statistically significant in either Thika or in Naivasha. Data from the KAP survey showed that respondents recognized the life-saving effect of wearing a helmet, but

  1. Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

    2007-08-01

    Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

  2. Semantic web implications for technologies and business practices

    CERN Document Server

    2016-01-01

    This book examines recent developments in semantic systems that can respond to situations and environments and events. The contributors to this book cover how to design, implement, and utilize disruptive technologies from the semantic and Web 3.0 arena. The editor and the contributors discuss two fundamental sets of disruptive technologies: the development of semantic technologies including description logics, ontologies, and agent frameworks; and the development of semantic information rendering including graphical forms of displays of high-density time-sensitive data to improve situational awareness. Beyond practical illustrations of emerging technologies, the goal of this book is to help readers learn about managing information resources in new ways and reinforcing the learning as they read on.   ·         Examines the contrast of competing paradigms and approaches to problem solving and decision-making using technology tools and techniques ·         Covers how to use semantic principle...

  3. The implication of transcultural psychiatry for clinical practice.

    Science.gov (United States)

    Moldavsky, Daniel

    2003-01-01

    This article deals with the main concepts of Transcultural Psychiatry and their applications to everyday psychiatric practice. Transcultural psychiatry has undergone a conceptual reformulation in the last two decades. Having started with a comparative approach, which focused on the diverse manifestations of mental disorders among different societies, it broadened its scope, aiming at present to incorporate social and cultural aspects of illness into the clinical framework. Therefore, transcultural psychiatry now focuses more on what is called the illness experience than on the disease process, the latter understood as illness as it is viewed by health practitioners. Western medicine, of which psychiatry is a part, is grounded in positivist epistemological principles that stress the biological processes of disease. The intention of the paper is to develop an interest in alternative but also complementary ways of thinking. Modern transcultural psychiatry interprets some epidemiological and clinical aspects of major mental disorders (such as schizophrenia and depression) in a different light. However, it also distances itself from the absolute relativism of antipsychiatry, centering on clinical facts and helping clinicians in their primary task of alleviating suffering. An important contribution in addressing this task is the formulation of a cultural axis within the DSM model of multiaxial evaluation. A clinical vignette of a cultural formulation applied to a clinical discussion of a case is described.

  4. Blood specimen labelling errors: Implications for nephrology nursing practice.

    Science.gov (United States)

    Duteau, Jennifer

    2014-01-01

    Patient safety is the foundation of high-quality health care, as recognized both nationally and worldwide. Patient blood specimen identification is critical in ensuring the delivery of safe and appropriate care. The practice of nephrology nursing involves frequent patient blood specimen withdrawals to treat and monitor kidney disease. A critical review of the literature reveals that incorrect patient identification is one of the major causes of blood specimen labelling errors. Misidentified samples create a serious risk to patient safety leading to multiple specimen withdrawals, delay in diagnosis, misdiagnosis, incorrect treatment, transfusion reactions, increased length of stay and other negative patient outcomes. Barcode technology has been identified as a preferred method for positive patient identification leading to a definitive decrease in blood specimen labelling errors by as much as 83% (Askeland, et al., 2008). The use of a root cause analysis followed by an action plan is one approach to decreasing the occurrence of blood specimen labelling errors. This article will present a review of the evidence-based literature surrounding blood specimen labelling errors, followed by author recommendations for completing a root cause analysis and action plan. A failure modes and effects analysis (FMEA) will be presented as one method to determine root cause, followed by the Ottawa Model of Research Use (OMRU) as a framework for implementation of strategies to reduce blood specimen labelling errors.

  5. PRACTICAL IMPLICATIONS OF USING INDUCED TRANSIENTS FOR LEAK DETECTION

    Directory of Open Access Journals (Sweden)

    Marko V. Ivetic

    2007-06-01

    Full Text Available This paper deals with practical problems of leak detection by methods based on hydraulic transient analysis. Controlled and safe transients can be generated and the response of the network, with the relevant information, can be monitored and analysed. Information about leaks, contained in the monitored pressure signal, cannot be easily retrieved, due to reflections, noise etc. On the basis of numerical experiments on a simple network, merits and limitations of several methods for signal analysis (time domain analysis, spectral density function and wavelet transform have been examined. Certain amount of information can be extracted from the time history of the pressure signal, assuming the first reflection of the pressure wave is captured with very high time resolution and accuracy. Only relatively large leaks can be detected using this methodology. As a way to increase the sensitivity of this method it is suggested that transforms in frequency domain and, especially, wavelet transforms, are used. The most promising method for leakage location and quantification seems to be based on wavelet analysis.

  6. PRACTICAL IMPLICATIONS OF USING INDUCED TRANSIENTS FOR LEAK DETECTION

    Directory of Open Access Journals (Sweden)

    Marko V. Ivetic

    2007-01-01

    Full Text Available This paper deals with practical problems of leak detection by methods based on hydraulic transient analysis. Controlled and safe transients can be generated and the response of the network, with the relevant information, can be monitored and analysed. Information about leaks, contained in the monitored pressure signal, cannot be easily retrieved, due to reflections, noise etc. On the basis of numerical experiments on a simple network, merits and limitations of several methods for signal analysis (time domain analysis, spectral density function and wavelet transform have been examined. Certain amount of information can be extracted from the time history of the pressure signal, assuming the first reflection of the pressure wave is captured with very high time resolution and accuracy. Only relatively large leaks can be detected using this methodology. As a way to increase the sensitivity of this method it is suggested that transforms in frequency domain and, especially, wavelet transforms, are used. The most promising method for leakage location and quantification seems to be based on wavelet analysis.

  7. Greek Immigrants in Australia: Implications for Culturally Sensitive Practice.

    Science.gov (United States)

    Georgiades, Savvas Daniel

    2015-10-01

    This exploratory research examined adjustment challenges, resiliencies, attitudes, emotional health, economic stability, criminal involvement, victimization and service experiences, and some cultural propensities of Greek Immigrants (GIs) in Australia using a convenient multi-generational sample (n = 123; response rate = .5). Data were collected via surveys, telephone, and personal-interviews in four major Australian cities. Among other things, the study revealed that Greek identity and cultural customs are often significant to first generation GIs. Adjustment challenges upon entry include primarily language, housing, and transportation difficulties, nostalgia for relatives and the motherland, unfamiliarity with socio-cultural systems, unemployment, money challenges, and lack of friendships. Christian faith, the extended family, family values and traditions, cultural pride for ancient Greek achievements, and a hard 'work ethic' are notable resiliencies that support GIs in their struggles and solidify their pursuit for happiness and success. Financial concerns, aging, and nostalgia for relatives and the motherland were the primary causes of socio-emotional instability. Attitudinal differences in the respondents based on age, gender, and socio-economic status, cross-cultural comparisons, and recommendations for culturally-sensitive practice with GIs are analyzed and methodological limitations illuminated. Future research needs in the field are also highlighted.

  8. Evidence behind FDA alerts for drugs with adverse cardiovascular effects: implications for clinical practice.

    Science.gov (United States)

    Rackham, Daniel M; C Herink, Megan; Stevens, Ian G; Cardoza, Natalie M; Singh, Harleen

    2014-01-01

    The U.S. Food and Drug Administration (FDA) periodically publishes Drug Safety Communications and Drug Alerts notifying health care practitioners and the general public of important information regarding drug therapies following FDA approval. These alerts can result in both positive and negative effects on patient care. Most clinical trials are not designed to detect long-term safety end points, and postmarketing surveillance along with patient reported events are often instrumental in signaling the potential harmful effect of a drug. Recently, many cardiovascular (CV) safety announcements have been released for FDA-approved drugs. Because a premature warning could discourage a much needed treatment or prompt a sudden discontinuation, it is essential to evaluate the evidence supporting these FDA alerts to provide effective patient care and to avoid unwarranted changes in therapy. Conversely, paying attention to these warnings in cases involving high-risk patients can prevent adverse effects and litigation. This article reviews the evidence behind recent FDA alerts for drugs with adverse CV effects and discusses the clinical practice implications. © 2013 Pharmacotherapy Publications, Inc.

  9. Health sciences libraries' subscriptions to journals: expectations of general practice departments and collection-based analysis.

    Science.gov (United States)

    Barreau, David; Bouton, Céline; Renard, Vincent; Fournier, Jean-Pascal

    2018-04-01

    The aims of this study were to (i) assess the expectations of general practice departments regarding health sciences libraries' subscriptions to journals and (ii) describe the current general practice journal collections of health sciences libraries. A cross-sectional survey was distributed electronically to the thirty-five university general practice departments in France. General practice departments were asked to list ten journals to which they expected access via the subscriptions of their health sciences libraries. A ranked reference list of journals was then developed. Access to these journals was assessed through a survey sent to all health sciences libraries in France. Adequacy ratios (access/need) were calculated for each journal. All general practice departments completed the survey. The total reference list included 44 journals. This list was heterogeneous in terms of indexation/impact factor, language of publication, and scope (e.g., patient care, research, or medical education). Among the first 10 journals listed, La Revue Prescrire (96.6%), La Revue du Praticien-Médecine Générale (90.9%), the British Medical Journal (85.0%), Pédagogie Médicale (70.0%), Exercer (69.7%), and the Cochrane Database of Systematic Reviews (62.5%) had the highest adequacy ratios, whereas Family Practice (4.2%), the British Journal of General Practice (16.7%), Médecine (29.4%), and the European Journal of General Practice (33.3%) had the lowest adequacy ratios. General practice departments have heterogeneous expectations in terms of health sciences libraries' subscriptions to journals. It is important for librarians to understand the heterogeneity of these expectations, as well as local priorities, so that journal access meets users' needs.

  10. Validation of an instrument to measure inter-organisational linkages in general practice.

    Science.gov (United States)

    Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

    2007-12-03

    Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high

  11. Youth Work Transitions: A Review with Implications for Counselling and Career Practice

    Science.gov (United States)

    Parada, Filomena; Young, Richard A.

    2013-01-01

    We critically review studies highlighting youth's work transitions and derive some implications for career and counselling theory and practice. We first discuss today's hypermodern world, specifically the meanings being conveyed by today's complex social realities and their impact on individuals' (work) lives. An overview of…

  12. Understanding Parental Grief as a Response to Mental Illness: Implications for Practice

    Science.gov (United States)

    Penzo, Jeanine A.; Harvey, Pat

    2008-01-01

    Parents who are raising children with mental illness struggle with feelings of grief and loss. Kubler-Ross' (1969) stages of grieving (denial, anger, bargaining, depression, and acceptance) are examined as experienced by parents raising children with chronic mental illness. Practice implications for social workers who are working with children and…

  13. "Forest Grove School District v. T.A." Supreme Court Case: Implications for School Psychology Practice

    Science.gov (United States)

    Dixon, Shauna G.; Eusebio, Eleazar C.; Turton, William J.; Wright, Peter W. D.; Hale, James B.

    2011-01-01

    The 2009 "Forest Grove School District v. T.A." United States Supreme Court case could have significant implications for school psychology practice. The Court ruled that the parents of a student with a disability were entitled to private school tuition reimbursement even though T.A. had not been identified with a disability or previously…

  14. Addressing Cross-Cultural Teamwork Barriers: Implications for Industry Practice and Higher Education Curricula

    Science.gov (United States)

    Levitt, Steven R.

    2016-01-01

    This study explores cultural factors affecting international team dynamics and the implications for industry practice and higher education. Despite decades of studying and experience with cultural diversity, international work groups continue to be challenged by ethnocentrism and prejudices. Central to the context is that cultural differences in…

  15. Elder Abuse: Systematic Review and Implications for Practice.

    Science.gov (United States)

    Dong, Xin Qi

    2015-06-01

    This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse. © 2015, Copyright the Author Journal compilation © 2015, The American Geriatrics Society.

  16. Factors predicting team climate, and its relationship with quality of care in general practice

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2009-08-01

    Full Text Available Abstract Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relationship between team climate and quality of care. Methods Cross sectional survey of a convenience sample of 14 general practices and their staff in South Tyneside in the northeast of England. Team climate was measured using the short version of Team Climate Inventory (TCI questionnaire. Practice characteristics were collected during a structured interview with practice managers. Quality was measured using the practice Quality and Outcome Framework (QOF scores. Results General Practitioners (GP had a higher team climate scores compared to other professionals. Individual's gender and tenure, and number of GPs in the practice were significantly predictors of a higher team climate. There was no significant correlation between mean practice team climate scores (or subscales with QOF scores. Conclusion The absence of a relationship between a measure of team climate and quality of care in this exploratory study may be due to a number of methodological problems. Further research is required to explore how to best measure team functioning and its relationship with quality of care.

  17. Factors predicting team climate, and its relationship with quality of care in general practice.

    Science.gov (United States)

    Goh, Teik T; Eccles, Martin P; Steen, Nick

    2009-08-04

    Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relationship between team climate and quality of care. Cross sectional survey of a convenience sample of 14 general practices and their staff in South Tyneside in the northeast of England. Team climate was measured using the short version of Team Climate Inventory (TCI) questionnaire. Practice characteristics were collected during a structured interview with practice managers. Quality was measured using the practice Quality and Outcome Framework (QOF) scores. General Practitioners (GP) had a higher team climate scores compared to other professionals. Individual's gender and tenure, and number of GPs in the practice were significantly predictors of a higher team climate. There was no significant correlation between mean practice team climate scores (or subscales) with QOF scores. The absence of a relationship between a measure of team climate and quality of care in this exploratory study may be due to a number of methodological problems. Further research is required to explore how to best measure team functioning and its relationship with quality of care.

  18. The estimation of patients' views on organizational aspects of a general dental practice by general dental practitioners: a survey study

    Directory of Open Access Journals (Sweden)

    Truin Gert-Jan

    2011-10-01

    Full Text Available Abstract Background Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views. Methods In a survey study, patients and GDPs provided their views on organizational aspects of a general dental practice. In a second, separate survey, GDPs were invited to estimate patients' views on 22 organizational aspects of a general dental practice. Results For 4 of the 22 aspects, patients and GDPs had the same views, and GDPs estimated patients' views reasonably well: 'Dutch-speaking GDP', 'guarantee on treatment', 'treatment by the same GDP', and 'reminder of routine oral examination'. For 2 aspects ('quality assessment' and 'accessibility for disabled patients' patients and GDPs had the same standards, although the GDPs underestimated the patients' standards. Patients had higher standards than GDPs for 7 aspects and lower standards than GDPs for 8 aspects. Conclusion On most aspects GDPs and patient have different views, except for social desirable aspects. Given the increasing assertiveness of patients, it is startling the GDP's estimated only half of the patients' views correctly. The findings of the study can assist GDPs in adapting their organizational services to better meet the preferences of their patients and to improve the communication towards patients.

  19. Selecting for creativity and innovation potential: implications for practice in healthcare education.

    Science.gov (United States)

    Patterson, Fiona; Zibarras, Lara Dawn

    2017-05-01

    The ability to innovate is an important requirement in many organisations. Despite this pressing need, few selection systems in healthcare focus on identifying the potential for creativity and innovation and so this area has been vastly under-researched. As a first step towards understanding how we might select for creativity and innovation, this paper explores the use of a trait-based measure of creativity and innovation potential, and evaluates its efficacy for use in selection for healthcare education. This study uses a sample of 188 postgraduate physicians applying for education and training in UK General Practice. Participants completed two questionnaires (a trait-based measure of creativity and innovation, and a measure of the Big Five personality dimensions) and were also rated by assessors on creative problem solving measured during a selection centre. In exploring the construct validity of the trait-based measure of creativity and innovation, our research clarifies the associations between personality, and creativity and innovation. In particular, our study highlights the importance of motivation in the creativity and innovation process. Results also suggest that Openness to Experience is positively related to creativity and innovation whereas some aspects of Conscientiousness are negatively associated with creativity and innovation. Results broadly support the utility of using a trait-based measure of creativity and innovation in healthcare selection processes, although practically this may be best delivered as part of an interview process, rather than as a screening tool. Findings are discussed in relation to broader implications for placing more priority on creativity and innovation as selection criteria within healthcare education and training in future.

  20. Implications of the new sepsis definition on research and practice.

    Science.gov (United States)

    Peach, Brian C

    2017-04-01

    practice will be essential, to determine if the Sepsis 3 definition, its associated clinical criteria, and the qSOFA need further revision. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Effects of a team-based assessment and intervention on patient safety culture in general practice

    DEFF Research Database (Denmark)

    Hoffmann, B; Müller, V; Rochon, J

    2014-01-01

    Background: The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations....... In this study we assessed the effects of FraTrix on safety culture in general practice. Methods: We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12...... months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management. Results: During the team sessions, practice teams reflected on their safety...

  2. A new approach to child mental health care within general practice.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Dijk, M. van; Walstock, D.; Zwaanswijk, M.

    2015-01-01

    Background: Child and adolescent mental health problems are frequently not identified and properly treated within general practice. Politicians in the Netherlands are promoting more primary healthcare treatment for mental health problems. The current study aims to evaluate an integrated primary

  3. Diagnostic evaluation of dementia in general practice in Denmark. A national survey

    DEFF Research Database (Denmark)

    Waldorff, Frans Boch; Møller, S

    2001-01-01

    OBJECTIVE: To examine GPs' self-reported basic diagnostic evaluation of dementia according to the recommendations in multidisciplinary consensus guidelines and to analyse explanatory factors for GP performance. DESIGN: Postal questionnaire study, spring 1998. SETTING: General practice in Denmark...

  4. General educational disciplines practice-oriented training in intermediate vocational education

    Directory of Open Access Journals (Sweden)

    Liya G. Skorobogatova

    2011-01-01

    Full Text Available The article concerns crucial issues of practice-oriented training in Russia's intermediate vocational education, designates directions of general educational disciplines study in intermediate vocational education.

  5. Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling

    NARCIS (Netherlands)

    Groenier, KH; Winters, JC; Meyboom-de Jong, B

    Objectives: To determine if a classification of shoulder complaints in general practice can be made from variables of medical history and physical examination with nonmetric multidimensional scaling and to investigate the reproducibility of results from an earlier hierarchical cluster analysis.

  6. Clinical accuracy of point-of-care urine culture in general practice

    DEFF Research Database (Denmark)

    Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller

    2017-01-01

    OBJECTIVE: To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. DESIGN: Prospective diagnostic...... uncomplicated, symptomatic UTI. MAIN OUTCOME MEASURES: (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply...... general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci...

  7. Models of clinical reasoning with a focus on general practice: A critical review.

    Science.gov (United States)

    Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

    2017-10-01

    Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

  8. Models of clinical reasoning with a focus on general practice: a critical review

    Directory of Open Access Journals (Sweden)

    SHAHRAM YAZDANI

    2017-10-01

    Full Text Available Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties

  9. Increase in palliative sedation and reasons in cancer patients in Dutch general practice 2005–2014.

    OpenAIRE

    Donker, G.A.; Dijk, C.E. van

    2015-01-01

    Background: Little is known about the quantity and reasons for use of palliative sedation in cancer patients in general practice and the reason to apply palliative sedation when a request for euthanasia was pending. Aim: To gain more insight into the reasons for palliative sedation at the end of life, also when a request for euthanasia was pending in cancer patients in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Met...

  10. Systems and complexity thinking in general practice: part 1 - clinical application.

    Science.gov (United States)

    Sturmberg, Joachim P

    2007-03-01

    Many problems encountered in general practice cannot be sufficiently explained within the Newtonian reductionist paradigm. Systems and complexity thinking - already widely adopted in most nonmedical disciplines - describes and explores the contextual nature of questions posed in medicine, and in general practice in particular. This article briefly describes the framework underpinning systems and complexity sciences. A case study illustrates how systems and complexity thinking can help to better understand the contextual nature of patient presentations, and how different approaches will lead to different outcomes.

  11. Validation of an instrument to measure inter-organisational linkages in general practice

    Directory of Open Access Journals (Sweden)

    Cheryl Amoroso

    2007-11-01

    Full Text Available Purpose: Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice’s linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. Methods: An interview to measure surgery-level (rather than individual clinician-level clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations. Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. Results: The resulting General Practice Clinical Linkages Interview (GP-CLI is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. Conclusions: The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples

  12. Tired, weak, or in need of rest: fatigue among general practice attenders.

    OpenAIRE

    David, A; Pelosi, A; McDonald, E; Stephens, D; Ledger, D; Rathbone, R; Mann, A

    1990-01-01

    OBJECTIVES--To determine the prevalence and associations of symptoms of fatigue. DESIGN--Questionnaire survey. SETTING--London general practice. PARTICIPANTS--611 General practice attenders. MAIN OUTCOME MEASURES--Scores on a fatigue questionnaire and reasons given for fatigue. RESULTS--10.2% Of men (17/167) and 10.6% of women (47/444) had substantial fatigue for one month or more. Age, occupation, and marital status exerted minor effects. Subjects attributed fatigue equally to physical and n...

  13. The EMR-scan: assessing the quality of Electronic Medical Records in general practice.

    NARCIS (Netherlands)

    Verheij, R.; Jabaaij, L.; Njoo, K.; Hoogen, H. van den; Bakker, D. de

    2008-01-01

    Background: The use of electronic medical records (EMR) in general practice has spread rapidly in the last decade (more than 90% today). Traditionally, these records are primarily used for direct patient care and for administrative purposes by the practice involved. In recent years, further

  14. Teaching of Pneumonia on a Cycle of Specialization “General Practice – Family Medicine”

    Directory of Open Access Journals (Sweden)

    Svetlana Sheyko

    2017-03-01

    Conclusion. Further improvement of practical training of interns – general practitioners on the specialty “Pneumonia”, perfection of practical training of a doctor – is a complex process that requires not only organizational measures, improvement and specification of standardized clinical protocols, textbooks, but also continuous improvement of academic, medical diagnostic, educational work, materials and technical support of study.

  15. Food parenting practices and child dietary behavior. Prospective relations and the moderating role of general parenting

    NARCIS (Netherlands)

    Sleddens, E.F.C.; Kremers, S.P.J.; Stafleu, A.; Dagnelie, P.C.; Vries, N.K. de; Thijs, C.

    2014-01-01

    Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened

  16. Practices and health perception of preparation of Brassica vegetables: translating survey data to technological and nutritional implications

    NARCIS (Netherlands)

    Nugrahedi, P.Y.; Hantoro, I.; Verkerk, R.; Dekker, M.; Steenbekkers, L.P.A.

    2015-01-01

    Food preparation practices are known to have large nutritional implications on the final product. This article describes survey data on preparation practices of Brassica vegetables and the translation of these data into technological and nutritional implications using knowledge on the mechanisms of

  17. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach.

    Science.gov (United States)

    Jackson, Ben; Marshall, Michelle; Schofield, Susie

    2017-11-01

    Physician associates (PAs) are described as one solution to workforce capacity in primary care in the UK. Despite new investment in the role, how effective this will be in addressing unmet primary care needs is unclear. To investigate the barriers and facilitators to the integration of PAs into the general practice workforce. A modified grounded theory study in a region unfamiliar with the PA role. No a priori themes were assumed. Themes generated from stakeholder interviews informed a literature review and theoretical framework, and were then tested in focus groups with GPs, advanced nurse practitioners (ANPs), and patients. Recorded data were transcribed verbatim, and organised using NVivo version 10.2.2, with iterative analysis of emergent themes. A reflexive diary and independent verification of coding and analysis were included. There were 51 participants (30 GPs, 11 ANPs, and 10 patients) in eight focus groups. GPs, ANPs, and patients recognised that support for general practice was needed to improve access. GPs expressed concerns regarding PAs around managing medical complexity and supervision burden, non-prescriber status, and medicolegal implications in routine practice. Patients were less concerned about specific competencies as long as there was effective supervision, and were accepting of a PA role. ANPs highlighted their own negative experiences entering advanced clinical practice, and the need for support to counteract stereotypical and prejudicial attitudes CONCLUSION: This study highlights the complex factors that may impede the introduction of PAs into UK primary care. A conceptual model is proposed to help regulators and educationalists support this integration, which has relevance to other proposed new roles in primary care. © British Journal of General Practice 2017.

  18. Why general practitioners and consultants change their clinical practice: a critical incident study.

    OpenAIRE

    Allery, L. A.; Owen, P. A.; Robling, M. R.

    1997-01-01

    OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an av...

  19. General surgery graduates may be ill prepared to enter rural or community surgical practice.

    Science.gov (United States)

    Gillman, Lawrence M; Vergis, Ashley

    2013-06-01

    Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform "classic" general surgery procedures, but they are also often expected to be competent in other surgical disciplines. Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Toward generally accepted forensic assessment practices among clinical neuropsychologists: a survey of professional practice and common test use.

    Science.gov (United States)

    LaDuke, Casey; Barr, William; Brodale, Donald L; Rabin, Laura A

    2018-01-01

    This study investigated professional practice and common test use among clinical neuropsychologists engaging in forensic assessment.  Doctorate-level psychologists active in the practice of neuropsychology and on the INS and NAN membership listings (n = 502) were surveyed about their demographics, professional practice, and common test use. Participants who reported engaging in forensic practice (n = 255) were further surveyed about their forensic practice. Forensic participants were more likely to be male and Caucasian, and reported higher ages, more years of professional experience, and a higher prevalence of board certification. While characteristics of their professional and forensic practice varied, forensic participants reported spending most of their professional time conducting neuropsychological assessments with adult clients in a private or group practice setting, focusing on civil referrals and civil legal questions involving older adult issues, developmental issues, head injury, and psychiatric issues. Common test use across neuropsychological assessment domains is presented for board-certified forensic participants (n = 77). An examination of these results reveals that the current pattern of test use is similar to the results of a more general survey of neuropsychological test use.  The findings provide insight into the practice of forensic neuropsychological assessment, and further establish the admissibility of neuropsychological evidence in the United States legal system. Results will be useful for clinical neuropsychologists, field leaders, and legal professionals hoping to gain insight into the role of clinical neuropsychology in civil and criminal legal decision-making.

  1. Promoting chlamydia screening with posters and leaflets in general practice--a qualitative study.

    Science.gov (United States)

    Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

    2009-10-12

    General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. The NCSP should consider developing a range of more discrete but eye

  2. Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

    Science.gov (United States)

    Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

    2009-01-01

    Background General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion The NCSP should consider developing

  3. Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

    Directory of Open Access Journals (Sweden)

    Ford-Young William

    2009-10-01

    Full Text Available Abstract Background General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP, have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion The NCSP

  4. Redefining the WISC-R: Implications for Professional Practice and Public Policy.

    Science.gov (United States)

    Macmann, Gregg M.; Barnett, David W.

    1992-01-01

    The factor structure of the Wechsler Intelligence Scale for Children (Revised) was examined in the standardization sample using new methods of factor analysis. The substantial overlap across factors was most parsimoniously represented by a single general factor. Implications for public policy regarding the purposes and outcomes of special…

  5. Relational coordination is associated with productivity in general practice: a survey and register based study

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke; Edwards, Kasper; Reventlow, Susanne

    2014-01-01

    In this paper we investigate the association between relational coordination among the practice team in general practice and number of consultations performed in a general practice per staff, i.e. a proxy of productivity. We measured relational coordination using the Relational Coordination Survey...... and combined the results with register data. We found that relational coordination was statistically significant associated with number of consultation per staff per year. We later divided consultations in to three types: Face-to-face, Email and phone consultations. We found a statistically significant...... associating between relational coordination and with number of face-to-face consultation per staff per year....

  6. Probability of causation tables and their possible implications for the practice of diagnostic radiology

    International Nuclear Information System (INIS)

    Gur, D.; Wald, N.

    1986-01-01

    In compliance with requirements in the Orphan Drug Act (97-414) of 1983, tables were recently constructed by an ad hoc committee of the National Institutes of Health (NIH) in which the probabilities that certain specific cancers are caused by previous radiation exposure are estimated. The reports of the NIH committee and a National Academy of Science oversight committee may have broad implications for the future practice of diagnostic radiology. The basis on which the probability of causation tables were established and some of the possible implications for diagnostic radiology are discussed

  7. Ancient Ethical Practices of Dualism and Ethical Implications for Future Paradigms in Nursing.

    Science.gov (United States)

    Milton, Constance L

    2016-07-01

    Paradigms contain theoretical structures to guide scientific disciplines. Since ancient times, Cartesian dualism has been a prominent philosophy incorporated in the practice of medicine. The discipline of nursing has continued the body-mind emphasis with similar paradigmatic thinking and theories of nursing that separate body and mind. Future trends for paradigm and nursing theory development are harkening to former ways of thinking. In this article the author discusses the origins of Cartesian dualism and implications for its current usage. The author shall illuminate what it potentially means to engage in dualism in nursing and discuss possible ethical implications for future paradigm and theory development in nursing. © The Author(s) 2016.

  8. Quality indicators for diagnosis and treatment of respiratory tract infections in general practice:

    DEFF Research Database (Denmark)

    Plejdrup, Malene; Bjerrum, Lars; Gahrn-Hansen, Bente

    Objective: To develop a set of quality indicators focusing on the diagnosis and treatment of respiratory tract infections in general practice.  Material and methods: A modified 2-round Delphi study was conducted from April to July 2008. A panel of 27 experts (13 countries) comprising mainly general...

  9. Personnel planning in general practices: development and testing of a skill mix analysis method.

    NARCIS (Netherlands)

    Eitzen-Strassel, J. von; Vrijhoef, H.J.M.; Derckx, E.W.C.C.; Bakker, D.H. de

    2014-01-01

    Background: General practitioners (GPs) have to match patients’ demands with the mix of their practice staff’s competencies. However, apart from some general principles, there is little guidance on recruiting new staff. The purpose of this study was to develop and test a method which would allow GPs

  10. Personnel planning in general practices : Development and testing of a skill mix analysis method

    NARCIS (Netherlands)

    von Eitzen-Strassel, J.; Vrijhoef, H.J.M.; Derckx, E.W.C.C.; de Bakker, D.H.

    2014-01-01

    Background General practitioners (GPs) have to match patients’ demands with the mix of their practice staff’s competencies. However, apart from some general principles, there is little guidance on recruiting new staff. The purpose of this study was to develop and test a method which would allow GPs

  11. Effect of mailed reminders on the response rate in surveys among patients in general practice

    DEFF Research Database (Denmark)

    Wensing, M; Mainz, Jan; Kramme, O

    1999-01-01

    Randomized trials were performed in Denmark and The Netherlands to determine the effect of mailed reminders on the response rate in surveys among patients in general practice. In both countries, general practitioners handed out questionnaires to 200 adult patients who came to visit them. An inter...

  12. The epidemiology of suicide and attempted suicide in Dutch general practice 1983-2003.

    NARCIS (Netherlands)

    Marquet, R.L.; Bartelds, A.I.M.; Kerkhof, A.J.F.M.; Schellevis, F.G.; Zee, J. van der

    2005-01-01

    BACKGROUND: Many patients attempting or committing suicide consult their general practitioner (GP) in the preceding period, indicating that GPs might play an important role in prevention. The aim of the present study was to analyse the epidemiology of suicidal behaviour in Dutch general practice in

  13. Organisational determinants of production and efficiency in general practice: a population-based study

    DEFF Research Database (Denmark)

    Rose Olsen, Kim; Gyrd-Hansen, Dorte; Sørensen, Torben Højmark

    2013-01-01

    Shortage of general practitioners (GPs) and an increased political focus on primary care have enforced the interest in efficiency analysis in the Danish primary care sector. This paper assesses the association between organisational factors of general practices and production and efficiency. We a...

  14. Consultations for mental problems in general practices with and without mental health nurses.

    NARCIS (Netherlands)

    Magnée, T.; Beurs, D. de; Verhaak, P.

    2016-01-01

    Background & Aim: It seems cost-effective to provide mental health care to patient with mild mental problems in general practices instead of in specialized care, but general practitioners (GPs) often lack time or expertise. Since 2008, Dutch GPs have been collaborating with nurses with mental health

  15. Child and adolescent mental health care in Dutch general practice: time trend analyses.

    NARCIS (Netherlands)

    Zwaanswijk, M.; Dijk, C.E. van; Verheij, R.A.

    2011-01-01

    Background: Because most children and adolescents visit their general practitioner (GP) regularly, general practice is a useful setting in which child and adolescent mental health problems can be identified, treated or referred to specialised care. Measures to strengthen Dutch primary mental health

  16. Mental health care in general practice in the context of a system reform.

    NARCIS (Netherlands)

    Magnée, T.

    2017-01-01

    The aim of this thesis was to monitor mental health care in Dutch general practices in recent years. In 2014, a reform of the Dutch mental health care system was introduced. Since this reform, general practitioners (GPs) are expected to only refer patients with a (suspected) psychiatric disorder or

  17. The pattern of mental disorders in private general practice: A six ...

    African Journals Online (AJOL)

    To determine the pattern of mental disorders in a private (general) practice in a selected Nigerian community, a cross- sectional, descriptive study was conducted. Two hundred and nine patients seen by a general practitioner (GP), and 291 patients (total 500) seen by a psychiatrist were retrospectively and prospectively ...

  18. Generalization of Tactics in Tag Rugby from Practice to Games in Middle School Physical Education

    Science.gov (United States)

    Lee, Myung-Ah; Ward, Phillip

    2009-01-01

    Background: Many of the issues relating to game performance of students found in the physical education literature can be considered a failure of generalization from practices to games, and from games to games. However, no study in secondary physical education has examined generalization effects as a result of effective game pedagogy in the…

  19. Quality aspects of Dutch general practice based data : A conceptual approach

    NARCIS (Netherlands)

    van den Dungen, C.; Hoeymans, N.; Schellevis, F.G.; van Oers, J.A.M.

    2013-01-01

    Background. General practice–based data, collected within general practice registration networks (GPRNs), are widely used in research. The quality of the data is important but the recording criteria about what type of information is collected and how this information should be recorded differ

  20. Rising workload or rising work pressure in general practice in the Netherlands.

    NARCIS (Netherlands)

    Bakker, D.H. de; Hutten, J.B.F.; Steultjens, M.; Schellevis, F.

    2002-01-01

    Background: General practice in the Netherlands seems to be in a crisis. Worries about shortages of GP's, the first strike of general practitioners in 2001 and the rapid increase of triage systems in out of hours care are signs that work pressure and/or workload are rising. But systematic evidence

  1. Urinary tract infection in male general practice patients: uropathogens and antibiotic susceptibility.

    NARCIS (Netherlands)

    Koeijers, J.J.; Verbon, A.; Kessels, A.G.H.; Bartelds, A.; Donker, G.; Nys, S.; Stobberingh, E.E.

    2010-01-01

    Objectives: To evaluate uropathogens and their antibiotic susceptibility in male general practitioner (GP) patients presenting with an uncomplicated urinary tract infection (UTI). Material and Methods: A population-based study was conducted among males, 18 years and older, general practice patients,

  2. Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

    Science.gov (United States)

    Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

    2003-12-01

    Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

  3. Managing patient demand: a qualitative study of appointment making in general practice.

    Science.gov (United States)

    Gallagher, M; Pearson, P; Drinkwater, C; Guy, J

    2001-04-01

    Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments. To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations. A qualitative study using participant observation. Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice. Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists. Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments. Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.

  4. Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2007-09-01

    Full Text Available Abstract Background In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis, described its management by Dutch general practitioners, and then compared these findings with the recommendations made in the guideline. Methods In 2001, over a 12-month period, data from all patient contacts with 195 general practitioners were taken from electronic medical records. Registration was episode-oriented; all consultations dealing with the same health problem were grouped into disease episodes. Data concerning all episodes of infectious conjunctivitis (ICPC-code F70 and sub codes were analysed. Results Over one year, 5,213 new and recurrent episodes of infectious conjunctivitis were presented to general practitioners from a population of N = 375,899, resulting in an overall incidence rate of 13.9 per 1000 person-years, varying from more than 80/1000 py in children up to one-year old, to less than 12/1000 py in children over the age of 4. Topical ophthalmic ointments were prescribed in 87% of the episodes, of which 80% was antibiotic treatment. Fusidic acid gel was most frequently prescribed (69%. In most episodes general practitioners did not adhere to the guideline. Conclusion In 2001, the management of infectious conjunctivitis by Dutch general practitioners was not in accordance with the recommendations of the consensus-based guideline published five years previously, despite its wide distribution. In 2006 this guideline was revised. Its successful implementation requires more than distribution alone. Probably the most effective way to achieve this is by following a model for systemic implementation.

  5. Deriving a clinical prediction rule to target sexual healthcare to women attending British General Practices.

    Science.gov (United States)

    Edelman, N L; Cassell, J A; Mercer, C H; Bremner, S A; Jones, C I; Gersten, A; deVisser, R O

    2018-07-01

    Some women attending General Practices (GPs) are at higher risk of unintended pregnancy (RUIP) and sexually transmitted infections (STI) than others. A clinical prediction rule (CPR) may help target resources using psychosocial questions as an acceptable, effective means of assessment. The aim was to derive a CPR that discriminates women who would benefit from sexual health discussion and intervention. Participants were recruited to a cross-sectional survey from six GPs in a city in South-East England in 2016. On arrival, female patients aged 16-44 years were invited to complete a questionnaire that addressed psychosocial factors, and the following self-reported outcomes: 2+ sexual partners in the last year (2PP) and RUIP. For each sexual risk, psychosocial questions were retained from logistic regression modelling which best discriminated women at risk using the C-statistic. Sensitivity and specificity were established in consultation with GP staff. The final sample comprised N = 1238 women. 2PP was predicted by 11 questions including age, binge-drinking weekly, ever having a partner who insulted you often, current smoking, and not cohabiting (C-statistic = 0.83, sensitivity = 73% and specificity = 77%). RUIP was predicted by 5 questions including sexual debut years, and emergency contraception use in the last 6 months (C-statistic = 0.70, sensitivity = 69% and specificity = 57%). 2PP was better discriminated than RUIP but neither to a clinically-useful degree. The finding that different psychosocial factors predicted each outcome has implications for prevention strategies. Further research should investigate causal links between psychosocial factors and sexual risk. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Benefits and harms of general health checks- lifelong learning in general practice: how to read and use scientific literature

    DEFF Research Database (Denmark)

    Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Nielsen, Kirsten Lykke

    the paper using the method of critical appraisal. Session content The didactic method used in the workshop is mostly small group activities with eight participants and two tutors in each group. The participants will receive two scientific papers: the BMJ-version of the Cochrane review about general health......Abstract title: Benefits and harms of general health checks - lifelong learning in general practice: how to read and use scientific literature Objectives After this workshop the participants will know the basics of how to read a systematic literature review and interpret a meta-analysis and be able......, assesses, and implements methods of diagnosis and treatment on the basis of the best available current research, clinical expertise, and combines this with the needs and preferences of the patient, is termed evidence-based medicine. By learning and practising the principles of evidence-based medicine, GPs...

  7. The importance of gender of patients and general practitioners in relation to treatment practices for overweight

    DEFF Research Database (Denmark)

    Rohde, Jeanett Friis; Hessner, Marie Vik; Lous, Jørgen

    2014-01-01

    BACKGROUND: Several studies suggest that men and women are treated differently for similar disease including diabetes and cardiovascular disease. Differences in attitudes and treatment practices towards men and women with obesity are not well recognized. OBJECTIVE: To investigate the attitudes...... and treatment practices among Danish general practitioners (GPs), in relation to treatment of overweight, while taking gender of both the patients and practitioners into account. DESIGN: Questionnaire inventory covertly examining attitudes and practices among Danish general practitioners towards treatment......: Among general practitioners in Denmark, treatment for weight loss is more often practiced for overweight male than overweight female patients presenting with same symptoms. In addition, hyperlipidemia among overweight males is also more often treated with lipid lowering medicine than hyperlipidemia...

  8. Variation in examination and treatment offers to patients with allergic diseases in general practice

    DEFF Research Database (Denmark)

    Hansen, Dorte Gilså; Jarbøl, Dorte Ejg; Munck, Anders Peter

    2010-01-01

    in general practice to patients with allergic diseases, and to evaluate guideline compliance with respect to anaphylaxis emergency treatment kits. DESIGN: A questionnaire-based survey among general practitioners (GPs) about examination and treatment procedures offered in the surgery to patients with allergic...... recommendations for preparedness for anaphylactic shock in connection with allergy vaccine therapy were not fully implemented. CONCLUSION: General practice is substantially involved in the examination and treatment of patients with allergic diseases. There is room for further involvement of staff members...

  9. Quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Saust, Laura Trolle; Bjerrum, Lars; Arpi, Magnus

    2017-01-01

    Objective: To develop quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections, tailored to the Danish general practice setting. Design: A RAND/UCLA Appropriateness Method was used. Setting: General practice. Subjects: A panel of nine experts, mainly...... general practitioners, was asked to rate the relevance of 64 quality indicators for the diagnosis and antibiotic treatment of acute respiratory tract infections based on guidelines. Subsequently, a face-to-face meeting was held to resolve misinterpretations and to achieve consensus. Main outcome measures...

  10. Long-term prognosis of acute low back pain in patients seen in general practice

    DEFF Research Database (Denmark)

    Schiøttz-Christensen, Berit; Nielsen, G L; Hansen, V K

    1999-01-01

    OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general...... to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict...

  11. New graduate nurses as knowledge brokers in general practice in New Zealand: a constructivist grounded theory.

    Science.gov (United States)

    Hoare, Karen J; Mills, Jane; Francis, Karen

    2013-07-01

    Practice nursing in New Zealand is not well described in the literature. One survey illustrated that most of the New Zealand practice nurses sampled did not know of the country's two premier evidence-based health websites. A recent review compared general practice in the UK, New Zealand and Australia and found that whereas there had been significant developments in empowering the practice nurse workforce to run nurse-led clinics in the UK, New Zealand and Australia lagged behind. The aim of this reported constructivist grounded theory study was to investigate practice nurses' use of information. Conducted in Auckland, New Zealand, data were collected through ethnographic techniques in one general practice between September 2009 and January 2010 to enhance theoretical sensitivity to the area of information use. Subsequently, six experienced practice nurses (one twice after moving jobs) and five new graduate nurses from five different general practices were interviewed, using open-ended questions, between January 2010 and August 2011. Concurrent data collection and analysis occurred throughout the study period. The use of memos, the constant comparative method, data categorisation and finally, data abstraction resulted in the final theory of reciprocal role modelling. Experienced practice nurses role modelled clinical skills to new graduate nurses. Unexpectedly, new graduate nurses were unconscious experts at sourcing information and role modelled this skill to experienced practice nurses. Once this attribute was acknowledged by the experienced practice nurse, mutual learning occurred that enabled both groups of nurses to become better practitioners. Graduate nurses of the millennial generation were identified as a resource for experienced practice nurses who belong to the baby boomer generation and generation X. © 2013 John Wiley & Sons Ltd.

  12. The new era of postgraduate certified general practice training in Japan.

    Science.gov (United States)

    Takamura, Akiteru

    2016-09-01

    This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.

  13. The process of patient enablement in general practice nurse consultations: a grounded theory study.

    Science.gov (United States)

    Desborough, Jane; Banfield, Michelle; Phillips, Christine; Mills, Jane

    2017-05-01

    The aim of this study was to gain insight into the process of patient enablement in general practice nursing consultations. Enhanced roles for general practice nurses may benefit patients through a range of mechanisms, one of which may be increasing patient enablement. In studies with general practitioners enhanced patient enablement has been associated with increases in self-efficacy and skill development. This study used a constructivist grounded theory design. In-depth interviews were conducted with 16 general practice nurses and 23 patients from 21 general practices between September 2013 - March 2014. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling focussing on the process and outcomes of patient enablement. Use of the storyline technique supported theoretical coding and integration of the data into a theoretical model. A clearly defined social process that fostered and optimised patient enablement was constructed. The theory of 'developing enabling healthcare partnerships between nurses and patients in general practice' incorporates three stages: triggering enabling healthcare partnerships, tailoring care and the manifestation of patient enablement. Patient enablement was evidenced through: 1. Patients' understanding of their unique healthcare requirements informing their health seeking behaviours and choices; 2. Patients taking an increased lead in their partnership with a nurse and seeking choices in their care and 3. Patients getting health care that reflected their needs, preferences and goals. This theoretical model is in line with a patient-centred model of health care and is particularly suited to patients with chronic disease. © 2016 John Wiley & Sons Ltd.

  14. Integrating a pharmacist into the general practice environment: opinions of pharmacist’s, general practitioner’s, health care consumer’s, and practice manager’s

    Directory of Open Access Journals (Sweden)

    Freeman Christopher

    2012-08-01

    Full Text Available Abstract Background Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment. Methods A sample of general practitioners, health care consumers, pharmacists and practice managers in South-East Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses. Results A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models. Conclusions These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.

  15. General practice-based clinical trials in Germany - a problem analysis

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2012-11-01

    Full Text Available Abstract Background In Germany, clinical trials and comparative effectiveness studies in primary care are still very rare, while their usefulness has been recognised in many other countries. A network of researchers from German academic general practice has explored the reasons for this discrepancy. Methods Based on a comprehensive literature review and expert group discussions, problem analyses as well as structural and procedural prerequisites for a better implementation of clinical trials in German primary care are presented. Results In Germany, basic biomedical science and technology is more reputed than clinical or health services research. Clinical trials are funded by industry or a single national programme, which is highly competitive, specialist-dominated, exclusive of pilot studies, and usually favours innovation rather than comparative effectiveness studies. Academic general practice is still not fully implemented, and existing departments are small. Most general practitioners (GPs work in a market-based, competitive setting of small private practices, with a high case load. They have no protected time or funding for research, and mostly no research training or experience. Good Clinical Practice (GCP training is compulsory for participation in clinical trials. The group defined three work packages to be addressed regarding clinical trials in German general practice: (1 problem analysis, and definition of (2 structural prerequisites and (3 procedural prerequisites. Structural prerequisites comprise specific support facilities for general practice-based research networks that could provide practices with a point of contact. Procedural prerequisites consist, for example, of a summary of specific relevant key measures, for example on a web platform. The platform should contain standard operating procedures (SOPs, templates, checklists and other supporting materials for researchers. Conclusion All in all, our problem analyses revealed that

  16. Towards vertical integration in general practice education: literature review and discussion paper.

    Science.gov (United States)

    O'Regan, A; Culhane, A; Dunne, C; Griffin, M; Meagher, D; McGrath, D; O'Dwyer, P; Cullen, W

    2013-09-01

    Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

  17. Patient and professional attitudes towards research in general practice: the RepR qualitative study.

    Science.gov (United States)

    Cadwallader, Jean-Sébastien; Lebeau, Jean-Pierre; Lasserre, Evelyne; Letrilliart, Laurent

    2014-07-21

    Since the 1990s, professional institutions worldwide have emphasised the need to develop research in general practice to improve the health of the population. The recent creation of professorships in general practice in French Universities should foster research in this field. Our aim was to explore the views of patients and relevant professionals on research in general practice. Qualitative study, using the grounded theory approach according to Strauss and Corbin, conducted in 2010 in three French regions. Nine focus groups were run to data saturation, and included 57 participants in four different categories: patients, non-academic GPs, academic GPs, academics in other disciplines. Most of the participants in the four categories described research in general practice as specific to the population managed and relevant for health care. They considered that its grounding in day-to-day practice enabled pragmatic approaches. The influence of the pharmaceutical industry, rivalries between university disciplines and a possible gap between research and practice were considered as pitfalls. The barriers identified were representations of the medical researcher as a "laboratory worker", the lack of awareness of any research in the discipline, and lack of time and training. While the views of patients and non-academic GPs are mostly focused on professional issues and the views of academics other than GPs on technical issues, academic GPs are in a position to play a role of interface between the universities and general practices. Although the role of GPs in research is perceived differently by the various protagonists, research in general practice has an undisputed legitimacy in France. Solutions for overcoming the identified barriers include research networks with appropriate resources and training and scientifically sound collaborative research projects, as already implemented in leading countries.

  18. Patients' evaluations of patient safety in English general practices: a cross-sectional study.

    Science.gov (United States)

    Ricci-Cabello, Ignacio; Marsden, Kate S; Avery, Anthony J; Bell, Brian G; Kadam, Umesh T; Reeves, David; Slight, Sarah P; Perryman, Katherine; Barnett, Jane; Litchfield, Ian; Thomas, Sally; Campbell, Stephen M; Doos, Lucy; Esmail, Aneez; Valderas, Jose M

    2017-07-01

    Description of safety problems and harm in general practices has previously relied on information from health professionals, with scarce attention paid to experiences of patients. To examine patient-reported experiences and outcomes of patient safety in primary care. Cross-sectional study in 45 general practices across five regions in the north, centre, and south of England. A version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6736 patients. Main outcome measures included 'practice activation' (what a practice does to create a safe environment); 'patient activation' (how proactive are patients in ensuring safe healthcare delivery); 'experiences of safety events' (safety errors); 'outcomes of safety' (harm); and 'overall perception of safety' (how safe patients rate their practice). Questionnaires were returned by 1244 patients (18.4%). Scores were high for 'practice activation' (mean [standard error] = 80.4 out of 100 [2.0]) and low for 'patient activation' (26.3 out of 100 [2.6]). Of the patients, 45% reported experiencing at least one safety problem in the previous 12 months, mostly related to appointments (33%), diagnosis (17%), patient provider communication (15%), and coordination between providers (14%). Twenty-three per cent of the responders reported some degree of harm in the previous 12 months. The overall assessment of level of safety of practices was generally high (86.0 out of 100 [16.8]). Priority areas for patient safety improvement in general practices in England include appointments, diagnosis, communication, coordination, and patient activation. © British Journal of General Practice 2017.

  19. Seminar program for postgraduate specialty training in general practice: proposal for a 5-year thematic catalogue

    Directory of Open Access Journals (Sweden)

    Sommer, Susanne

    2017-11-01

    Full Text Available Introduction: In different German regions, seminar programs have been conducted for General practice residents. In each region, selection and teaching of learning content is conducted in a different manner. So far, no structured, standardized curriculum has been implemented nationwide. We have investigated, if the development of a common 5-year program of learning topics is conceivable between the different university departments of General practice in Germany.Method: The seminar program working group of the DEGAM (German College of General Practitioners and Family Physicians has conducted an online survey based on information gathered via preliminary telephone conference (n=7; physicians with postgraduate teaching experience among all German university departments of General Practice and two non-university teaching institutions, identified via the internet. 884 topics were extracted from 14 Seminar programs. The topics were entered in a database, discussed and categorized: Practice management/practice work flow/standardized documentation forms/quality management (n=33 topics, common acute and chronic diseases, including disease management programs (n=29 topics, communication, neurological, psychological and psychiatric consultations (n=24 topics, common medical problems, including eye, ear, nose, throat, skin and pediatric problems (n=99 Topics family physicians general approach, including epidemiology, shared decision making, test of time (n=42 Topics. These topics have been rated for priority and desirable number of teaching-units.Results: A catalogue of 111 topics was designed, encompassing 160 teaching units. There is a suggestion of wide topics collections plus an add-on catalogue.Conclusion: A proposal for a 5-year-thematic catalogue for postgraduate training of general practice residents in Germany has been developed. This newly developed curriculum has the potential to improve knowledge and skills that have not been covered during in

  20. Association between general practice characteristics and use of out-of-hours GP cooperatives.

    Science.gov (United States)

    Smits, Marleen; Peters, Yvonne; Broers, Sanne; Keizer, Ellen; Wensing, Michel; Giesen, Paul

    2015-05-01

    The use of out-of-hours healthcare services for non-urgent health problems is believed to be related to the organisation of daytime primary care but insight into underlying mechanisms is limited. Our objective was to examine the association between daytime general practice characteristics and the use of out-of-hours care GP cooperatives. A cross-sectional observational study in 100 general practices in the Netherlands, connected to five GP cooperatives. In each GP cooperative, we took a purposeful sample of the 10 general practices with the highest use of out-of-hours care and the 10 practices with the lowest use. Practice and population characteristics were obtained by questionnaires, interviews, data extraction from patient registration systems and telephone accessibility measurements. To examine which aspects of practice organisation were associated with patients' use of out-of-hours care, we performed logistic regression analyses (low versus high out-of-hours care use), correcting for population characteristics. The mean out-of-hours care use in the high use group of general practices was 1.8 times higher than in the low use group. Day time primary care practices with more young children and foreigners in their patient populations and with a shorter distance to the GP cooperative had higher out-of-hours primary care use. In addition, longer telephone waiting times and lower personal availability for palliative patients in daily practice were associated with higher use of out-of-hours care. Moreover, out-of-hours care use was higher when practices performed more diagnostic tests and therapeutic procedures and had more assistant employment hours per 1000 patients. Several other aspects of practice management showed some non-significant trends: high utilising general practices tended to have longer waiting times for non-urgent appointments, lower availability of a telephone consulting hour, lower availability for consultations after 5 p.m., and less frequent