A Study of Community Guides: Lessons for Professionals Practicing with and in Communities

Science.gov (United States)

Ungar, Michael; Manuel, Susan; Mealey, Stephanie; Thomas, Golda; Campbell, Carolyn

2004-01-01

A study of 35 nonprofessional helpers, identified as community "guides," focused on the contribution each made to helping marginalized individuals and families become a part of their communities. The lessons learned through these lay helpers can inform a postmodern social work practice that promotes the use of indigenous practice principles…

The Use of Lesson Study Combined with Content Representation in the Planning of Physics Lessons During Field Practice to Develop Pedagogical Content Knowledge

Science.gov (United States)

Juhler, Martin Vogt

2016-08-01

Recent research, both internationally and in Norway, has clearly expressed concerns about missing connections between subject-matter knowledge, pedagogical competence and real-life practice in schools. This study addresses this problem within the domain of field practice in teacher education, studying pre-service teachers' planning of a Physics lesson. Two means of intervention were introduced. The first was lesson study, which is a method for planning, carrying out and reflecting on a research lesson in detail with a learner and content-centered focus. This was used in combination with a second means, content representations, which is a systematic tool that connects overall teaching aims with pedagogical prompts. Changes in teaching were assessed through the construct of pedagogical content knowledge (PCK). A deductive coding analysis was carried out for this purpose. Transcripts of pre-service teachers' planning of a Physics lesson were coded into four main PCK categories, which were thereafter divided into 16 PCK sub-categories. The results showed that the intervention affected the pre-service teachers' potential to start developing PCK. First, they focused much more on categories concerning the learners. Second, they focused far more uniformly in all of the four main categories comprising PCK. Consequently, these differences could affect their potential to start developing PCK.

Human Systems Integration in Practice: Constellation Lessons Learned

Science.gov (United States)

Zumbado, Jennifer Rochlis

2012-01-01

NASA's Constellation program provided a unique testbed for Human Systems Integration (HSI) as a fundamental element of the Systems Engineering process. Constellation was the first major program to have HSI mandated by NASA's Human Rating document. Proper HSI is critical to the success of any project that relies on humans to function as operators, maintainers, or controllers of a system. HSI improves mission, system and human performance, significantly reduces lifecycle costs, lowers risk and minimizes re-design. Successful HSI begins with sufficient project schedule dedicated to the generation of human systems requirements, but is by no means solely a requirements management process. A top-down systems engineering process that recognizes throughout the organization, human factors as a technical discipline equal to traditional engineering disciplines with authority for the overall system. This partners with a bottoms-up mechanism for human-centered design and technical issue resolution. The Constellation Human Systems Integration Group (HSIG) was a part of the Systems Engineering and Integration (SE&I) organization within the program office, and existed alongside similar groups such as Flight Performance, Environments & Constraints, and Integrated Loads, Structures and Mechanisms. While the HSIG successfully managed, via influence leadership, a down-and-in Community of Practice to facilitate technical integration and issue resolution, it lacked parallel top-down authority to drive integrated design. This presentation will discuss how HSI was applied to Constellation, the lessons learned and best practices it revealed, and recommendations to future NASA program and project managers. This presentation will discuss how Human Systems Integration (HSI) was applied to NASA's Constellation program, the lessons learned and best practices it revealed, and recommendations to future NASA program and project managers on how to accomplish this critical function.

General Mechanical Repair. Minor Automotive Maintenance, Small Engine [Repair, and] Welding: Curriculum Guide and Lesson Plans.

Science.gov (United States)

Hamlin, Larry

This document contains a curriculum guide and lesson plans for a general mechanical repair course with three sections: minor automotive maintenance, small engine repair, and welding. The curriculum guide begins with a matrix that relates the lesson plans to essential elements of math, science, language arts, and social studies and to Texas…

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.

Development and early experience from an intervention to facilitate teamwork between general practices and allied health providers: the Team-link study.

Science.gov (United States)

Harris, Mark F; Chan, Bibiana C; Daniel, Christopher; Wan, Qing; Zwar, Nick; Davies, Gawaine Powell

2010-04-27

This paper describes the development and implementation of an intervention to facilitate teamwork between general practice and outside allied and community health services and providers. A review of organizational theory and a qualitative study of 9 practices was used to design an intervention which was applied in four Divisions of General Practice and 26 urban practices. Clinical record review and qualitative interviews with participants were used to determine the key lessons from its implementation. Facilitating teamwork across organizational boundaries was very challenging. The quality of the relationship between professionals was of key importance. This was enabled by joint education and direct communication between providers. Practice nurses were key links between general practices and allied and community health services. Current arrangements for Team Care planning provide increased opportunities for access to allied health. However the current paper based system is insufficient to build relationships or effectively share roles as part of a patient care team. Facilitation is feasible but constrained by barriers to communication and trust.

Deploying Serious Games for Management in Higher Education: lessons learned and good practices

NARCIS (Netherlands)

Baalsrud Hauge, Jannicke; Bellotti, Francesco; Nadolski, Rob; Kickmeier-Rust, Michael; Berta, Riccardo; Carvalho, Maria B.

2013-01-01

Baalsrud Hauge, J., Bellotti, F., Nadolski, R. J., Kickmeier-Rust, M., Berta, R., & Carvalho, M. B. (2013, 4 October). Deploying Serious Games for Management in Higher Education: lessons learned and good practices. Presentation at ECGBL 2013, Porto, Portugal.

Breathing Life into Engineering: A Lesson Study Life Science Lesson

Science.gov (United States)

Lawrence, Maria; Yang, Li-Ling; Briggs, May; Hession, Alicia; Koussa, Anita; Wagoner, Lisa

2016-01-01

A fifth grade life science lesson was implemented through a lesson study approach in two fifth grade classrooms. The research lesson was designed by a team of four elementary school teachers with the goal of emphasizing engineering practices consistent with the "Next Generation Science Standards" (NGSS) (Achieve Inc. 2013). The fifth…

Space reactor safety, 1985--1995 lessons learned

International Nuclear Information System (INIS)

Marshall, A.C.

1995-01-01

Space reactor safety activities and decisions have evolved over the last decade. Important safety decisions have been made in the SP-100, Space Exploration Initiative, NEPSTP, SNTP, and Bimodal Space Reactor programs. In addition, international guidance on space reactor safety has been instituted. Space reactor safety decisions and practices have developed in the areas of inadvertent criticality, reentry, radiological release, orbital operation, programmatic, and policy. In general, the lessons learned point out the importance of carefully reviewing previous safety practices for appropriateness to space nuclear programs in general and to the specific mission under consideration

Space reactor safety, 1985--1995 lessons learned

Energy Technology Data Exchange (ETDEWEB)

Marshall, A.C.

1995-12-31

Space reactor safety activities and decisions have evolved over the last decade. Important safety decisions have been made in the SP-100, Space Exploration Initiative, NEPSTP, SNTP, and Bimodal Space Reactor programs. In addition, international guidance on space reactor safety has been instituted. Space reactor safety decisions and practices have developed in the areas of inadvertent criticality, reentry, radiological release, orbital operation, programmatic, and policy. In general, the lessons learned point out the importance of carefully reviewing previous safety practices for appropriateness to space nuclear programs in general and to the specific mission under consideration.

A Harvest of Practical Insights : Lessons Learned in Agriculture, Agribusiness, Sustainable Rural Development, and Climate Change

OpenAIRE

International Finance Corporation

2012-01-01

This IFC SmartBook is a compilation of sixteen IFC SmartLessons that presents practical lessons learned by staff from across the IFC and the World Bank on approaches for engaging in agriculture that have led to success. Agribusiness is a crucial economic sector, for food security of course, for managing water stress and ecosystem services, but also as a source of employment in emerging mar...

Musical Practices and Methods in Music Lessons: A Comparative Study of Estonian and Finnish General Music Education

Science.gov (United States)

Sepp, Anu; Ruokonen, Inkeri; Ruismäki, Heikki

2015-01-01

This article reveals the results of a comparative study of Estonian and Finnish general music education. The aim was to find out what music teaching practices and approaches/methods were mostly used, what music education perspectives supported those practices. The data were collected using questionnaires and the results of 107 Estonian and 50…

Implementing the Mental Health Act 2007 in British general practice: Lessons from Ireland.

Science.gov (United States)

Jabbar, Faraz; Doherty, Anne M; Aziz, Muniba; Kelly, Brendan D

2011-01-01

Changes in mental health legislation (e.g. Mental Health Act 2007 in England and Wales, Mental Health Act 2001 in Ireland) have generally improved adherence to international human rights standards, but also present challenges to primary care providers. When mental health legislation was substantially reformed in Ireland, 62.9% of general practitioners (GPs) felt the new legislation was not user-friendly. Majorities of GPs who felt the legislation affected their practice reported increased workloads (85%) and various other difficulties (53%). GPs who had received training about the legislation were more likely to find it user-friendly (43% versus 30.9%), and informal training (e.g. from colleagues) was just as likely as formal training to be associated with a GP finding it user-friendly. With similar changes to mental health legislation being introduced in England and Wales, it is significant that informal training is just as good as formal training in helping GPs work with new mental health legislation. Copyright © 2011 Elsevier Ltd. All rights reserved.

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...

Narratives in Teaching Practice: Matti Raekallio as Narrator in His Piano Lessons

Science.gov (United States)

Hyry-Beihammer, Eeva Kaisa

2011-01-01

The present article considers the narratives told in piano lessons, studied as both a teacher's "way of knowing" and as echoes of "masters' voices" in classical music. The main character is a well known Finnish music pedagogue and artist, Matti Raekallio, and the study focuses on his knowledge of teaching practice; that is, his…

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.

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 ...

Lesson Learning at JPL

Science.gov (United States)

Oberhettinger, David

2011-01-01

A lessons learned system is a hallmark of a mature engineering organization A formal lessons learned process can help assure that valuable lessons get written and published, that they are well-written, and that the essential information is "infused" into institutional practice. Requires high-level institutional commitment, and everyone's participation in gathering, disseminating, and using the lessons

Deploying Serious Games for Management in Higher Education: lessons learned and good practices

NARCIS (Netherlands)

Baalsrud Hauge, Jannicke; Bellotti, Francesco; Nadolski, Rob; Kickmeier-Rust, Michael; Berta, Riccardo; Carvalho, Maria B.

2013-01-01

Baalsrud Hauge, J., Bellotti, F., Nadolski, R. J., Kickmeier-Rust, M., Berta, R., & Carvalho, M. B. (2013). Deploying Serious Games for Management in Higher Education: lessons learned and good practices. In C. Vaz de Carvalho, & P. Escudeiro (Eds.), Proceedings of the 7th European Conference on

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.

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...

Unintended Learning in Primary School Practical Science Lessons from Polanyi's Perspective of Intellectual Passion

Science.gov (United States)

Park, Jisun; Song, Jinwoong; Abrahams, Ian

2016-01-01

This study explored, from the perspective of intellectual passion developed by Michael Polanyi, the unintended learning that occurred in primary practical science lessons. We use the term "unintended" learning to distinguish it from "intended" learning that appears in teachers' learning objectives. Data were collected using…

ELPSA AS A LESSON DESIGN FRAMEWORK

Directory of Open Access Journals (Sweden)

Tom Lowrie

2015-07-01

Full Text Available This paper offers a framework for mathematics lesson design that is consistent with the way we learn about, and discover, most things in life. In addition, the framework provides a structure for identifying how mathematical concepts and understanding are acquired and developed. This framework is called ELPSA and represents five learning components, namely: Experience, Language, Pictorial, Symbolic and Applications. This framework has been used in developing lessons and teacher professional programs in Indonesia since 2012 in cooperation with the World Bank. This paper describes the theory that underlines the framework in general and in relation to each inter-connected component. Two explicit learning sequences for classroom practice are described, associated with Pythagoras theorem and probability. This paper then concludes with recommendations for using ELPSA in various institutional contexts.Keywords: ELPSA, lesson design framework, Pythagoras theorem, probability DOI: dx.doi.org/10.22342/jme.62.77

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.

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...

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.

Analysing the Integration of Engineering in Science Lessons with the Engineering-Infused Lesson Rubric

Science.gov (United States)

Peterman, Karen; Daugherty, Jenny L.; Custer, Rodney L.; Ross, Julia M.

2017-01-01

Science teachers are being called on to incorporate engineering practices into their classrooms. This study explores whether the Engineering-Infused Lesson Rubric, a new rubric designed to target best practices in engineering education, could be used to evaluate the extent to which engineering is infused into online science lessons. Eighty lessons…

Improving Mathematics Teaching as Deliberate Practice through Chinese Lesson Study

Science.gov (United States)

Huang, Rongjin; Prince, Kyle M.; Barlow, Angela T.

2017-01-01

This study examined how a ninth grade teacher improved an Algebra I lesson through a lesson study approach. We used multiple data sources to investigate the improvement of the lesson towards student-centered mathematics instruction, perceived benefits of the teacher, and factors associated with the improvement of teaching. The lesson group…

Deployment of Wind Turbines in the Built Environment: Risks, Lessons, and Recommended Practices

Energy Technology Data Exchange (ETDEWEB)

Fields, Jason [National Renewable Energy Lab. (NREL), Golden, CO (United States); Oteri, Frank [National Renewable Energy Lab. (NREL), Golden, CO (United States); Preus, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States); Baring-Gould, Ian [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2016-06-01

Built-environment wind turbine (BEWT) projects are wind energy projects that are constructed on, in, or near buildings. These projects present an opportunity for distributed, low-carbon generation combined with highly visible statements on sustainability, but the BEWT niche of the wind industry is still developing and is relatively less mature than the utility-scale wind or traditional distributed wind sectors. The findings from this report cannot be extended to wind energy deployments in general because of the large difference in application and technology maturity. This paper investigates the current state of the BEWT industry by reviewing available literature on BEWT projects as well as interviewing project owners on their experiences deploying and operating the technology. The authors generated a series of case studies that outline the pertinent project details, project outcomes, and lessons learned. This paper integrates those information sources into recommended practices that can be utilized by future stakeholders to evaluate the feasibility of BEWTs for their unique applications and sites.

Creating a Community of Practice: Lessons Learned from the Center for Astronomy Education (Invited)

Science.gov (United States)

Brissenden, G.

2009-12-01

The Center for Astronomy Education (CAE) is devoted to improving teaching and learning in Astro 101. To accomplish this, a vital part of CAE is our broader community of practice which includes over 1000 instructors, graduate and undergraduate students, and postdocs. It is this greater community of practice that supports each other, helps, and learns from each other beyond what would be possible without it. As our community of practice has grown, we at CAE have learned many lessons about how different facets of CAE can best be used to promote and support our community both as a whole and for individual members. We will discuss the various facets of CAE, such as our online discussion group Astrolrner@CAE (http://astronomy101.jpl.nasa.gov/discussion) and its Guest Moderator program, our CAE Regional Teaching Exchange Coordinator program, our CAE Workshop Presenter Apprenticeship Training program, our online This Month’s Teaching Strategy, monthly newsletters, and various types of socializing and networking sessions we hold at national meetings. But more importantly, we will discuss the lessons we’ve learned about what does and does not work in building community within each of these facets.

Development practices and lessons learned in developing SimPEG

Science.gov (United States)

Cockett, R.; Heagy, L. J.; Kang, S.; Rosenkjaer, G. K.

2015-12-01

Inverse modelling provides a mathematical framework for constructing a model of physical property distributions in the subsurface that are consistent with the data collected in geophysical surveys. The geosciences are increasingly moving towards the integration of geological, geophysical, and hydrological information to better characterize the subsurface. This integration must span disciplines and is not only challenging scientifically, but additionally the inconsistencies between conventions often makes implementations complicated, non­ reproducible, or inefficient. SimPEG is an open-source, multi-university effort aimed at providing a generalized framework for solving forward and inverse problems. SimPEG includes finite volume discretizations on structured and unstructured meshes, interfaces to standard numerical solver packages, convex optimization algorithms, model parameterizations, and visualization routines. The SimPEG package (http://simpeg.xyz) supports an ecosystem of forward and inverse modelling applications, including electromagnetics, vadose zone flow, seismic, and potential­ fields, that are all written with a common interface and toolbox. The goal of SimPEG is to support a community of researchers with well-tested, extensible tools, and encourage transparency and reproducibility both of the SimPEG software and the geoscientific research it is applied to. In this presentation, we will share some of the lessons we have learned in designing the modular infrastructure, testing and development practices of SimPEG. We will discuss our use of version control, extensive unit-testing, continuous integration, documentation, issue tracking, and resources that facilitate communication between existing team members and allows new researchers to get involved. These practices have enabled the use of SimPEG in research, industry, and education as well as the ability to support a growing number of dependent repositories and applications. We hope that sharing our

The Effects of Variations in Lesson Control and Practice on Learning from Interactive Video.

Science.gov (United States)

Hannafin, Michael J.; Colamaio, MaryAnne E.

1987-01-01

Discussion of the effects of variations in lesson control and practice on the learning of facts, procedures, and problem-solving skills during interactive video instruction focuses on a study of graduates and advanced level undergraduates learning cardiopulmonary resuscitation (CPR). Embedded questioning methods and posttests used are described.…

Learning Lessons from TMI to Fukushima and Other Industrial Accidents: Keys for Assessing Safety Management Practices

International Nuclear Information System (INIS)

Dechy, N.; Rousseau, J.-M.; Dien, Y.; Montmayeul, R.; Llory, M.

2016-01-01

The main objective of the paper is to discuss and to argue about transfer, from an industrial sector to another industrial sector, of lessons learnt from accidents. It will be achieved through the discussion of some theoretical foundations and through the illustration of examples of application cases in assessment of safety management practices in Nuclear Power Plant (NPP). The nuclear energy production industry has faced three big ones in 30 years (TMI, Chernobyl, Fukushima) involving three different reactor technologies operated in three quite different cultural, organizational and regulatory contexts. Each of those accident has been the origin of questions, but also generator of lessons, some changing the worldview (see Wilpert and Fahlbruch, 1998) of what does cause an accident in addition to the engineering view about the importance of technical failures (human error, safety culture, sociotechnical interactions). Some of their main lessons were implemented such as improvements of human-machine interfaces ergonomics, recast of some emergency operating procedures, severe accident mitigation strategies and crisis management. Some lessons did not really provide deep changes. It is the case for organizational lessons such as, organizational complexity, management of production pressures, regulatory capture, and failure to learn, etc.

Lesson Planning the Kodaly Way.

Science.gov (United States)

Boshkoff, Ruth

1991-01-01

Discusses the contribution of Zoltan Kodaly to music lesson planning. Emphasizes preparation, presentation, and practice as the three important strategies in teaching concepts and skills to be included in a lesson plan. Includes a sample lesson plan covering a semester and advice on choosing song material. (DK)

Rewiew of history lessons during 2001-2012 academic year by the external assessors

OpenAIRE

Survutaitė, Dalia; Vaičekauskienė, Snieguolė

2012-01-01

Recently a lot of attention has been paid to the search of education innovation and modernization. However in the educational environment empirical data analysis and evaluation of subjects of general education of educational practice are rarely found. This article analyzes quality characteristics of history lessons for years 5-12 in the educational practice, reports of external evaluation of the quality of the activities of country's different general education schools were used. Data interpr...

Formation of community-based hypertension practice networks: success, obstacles, and lessons learned.

Science.gov (United States)

Dart, Richard A; Egan, Brent M

2014-06-01

Community-based practice networks for research and improving the quality of care are growing in size and number but have variable success rates. In this paper, the authors review recent efforts to initiate a community-based hypertension network modeled after the successful Outpatient Quality Improvement Network (O'QUIN) project, located at the Medical University of South Carolina. Key lessons learned and new directions to be explored are highlighted. ©2014 Wiley Periodicals, Inc.

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.

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...

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

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.

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.

Uptake of critical knowledge in nursing practice: lessons learned from a knowledge translation study.

Science.gov (United States)

Anderson, Joan M; Browne, Annette J; Reimer-Kirkham, Sheryl; Lynam, M Judith; Rodney, Paddy; Varcoe, Colleen; Wong, Sabrina; Tan, Elsie; Smye, Victoria; McDonald, Heather; Baumbusch, Jennifer; Khan, Koushambhi Basu; Reimer, Joanne; Peltonen, Adrienne; Brar, Anureet

2010-09-01

This article is based on a knowledge translation (KT) study of the transition of patients from hospital to home. It focuses on the lessons learned about the challenges of translating research-derived critical knowledge in practice settings. The authors situate the article in current discourses about KT; discuss their understanding of the nature of critical knowledge; and present themes from their body of research, which comprises the knowledge that was translated. The findings have the potential to guide future KT research that focuses on the uptake of critical knowledge in nursing practice.

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?

ELPSA as A Lesson Design Framework

Directory of Open Access Journals (Sweden)

Tom Lowrie

2015-07-01

Full Text Available This paper offers a framework for mathematics lesson design that is consistent with the way we learn about, and discover, most things in life. In addition, the framework provides a structure for identifying how mathematical concepts and understanding are acquired and developed. This framework is called ELPSA and represents five learning components, namely: Experience, Language, Pictorial, Symbolic and Applications. This framework has been used in developing lessons and teacher professional programs in Indonesia since 2012 in cooperation with the World Bank. This paper describes the theory that underlines the framework in general and in relation to each inter-connected component. Two explicit learning sequences for classroom practice are described, associated with Pythagoras theorem and probability. This paper then concludes with recommendations for using ELPSA in various institutional contexts.

Differentiation practices in grade 2 and 3 : Variations in teacher behavior in mathematics and reading comprehension lessons

NARCIS (Netherlands)

Ritzema, Evelien S.; Deunk, Marjolein I.; Bosker, Roel J.

2016-01-01

This study focused on the differentiation practices of second- and third-grade teachers in mathematics and reading comprehension lessons. Preconditions for differentiation, classroom organization, and how teachers dealt with students of different ability levels were investigated through

Lessons learned bulletin

International Nuclear Information System (INIS)

1994-05-01

During the past four years, the Department of Energy -- Savannah River Operations Office and the Westinghouse Savannah River Company (WSRC) Environmental Restoration (ER) Program completed various activities ranging from waste site investigations to closure and post closure projects. Critiques for lessons learned regarding project activities are performed at the completion of each project milestone, and this critique interval allows for frequent recognition of lessons learned. In addition to project related lessons learned, ER also performs lessons learned critiques. T'he Savannah River Site (SRS) also obtains lessons learned information from general industry, commercial nuclear industry, naval nuclear programs, and other DOE sites within the complex. Procedures are approved to administer the lessons learned program, and a database is available to catalog applicable lessons learned regarding environmental remediation, restoration, and administrative activities. ER will continue to use this database as a source of information available to SRS personnel

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.

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...

Unintended Learning in Primary School Practical Science Lessons from Polanyi's Perspective of Intellectual Passion

Science.gov (United States)

Park, Jisun; Song, Jinwoong; Abrahams, Ian

2016-03-01

This study explored, from the perspective of intellectual passion developed by Michael Polanyi, the unintended learning that occurred in primary practical science lessons. We use the term `unintended' learning to distinguish it from `intended' learning that appears in teachers' learning objectives. Data were collected using video and audio recordings of a sample of twenty-four whole class practical science lessons, taught by five teachers, in Korean primary schools with 10- to 12-year-old students. In addition, video and audio recordings were made for each small group of students working together in order to capture their activities and intra-group discourse. Pre-lesson interviews with the teachers were undertaken and audio-recorded to ascertain their intended learning objectives. Selected key vignettes, including unintended learning, were analysed from the perspective of intellectual passion developed by Polanyi. What we found in this study is that unintended learning could occur when students got interested in something in the first place and could maintain their interest. In addition, students could get conceptual knowledge when they tried to connect their experience to their related prior knowledge. It was also found that the processes of intended learning and of unintended learning were different. Intended learning was characterized by having been planned by the teacher who then sought to generate students' interest in it. In contrast, unintended learning originated from students' spontaneous interest and curiosity as a result of unplanned opportunities. Whilst teachers' persuasive passion comes first in the process of intended learning, students' heuristic passion comes first in the process of unintended learning. Based on these findings, we argue that teachers need to be more aware that unintended learning, on the part of individual students, can occur during their lesson and to be able to better use this opportunity so that this unintended learning can be

Lessons learned related to packaging and transportation

International Nuclear Information System (INIS)

Wallen, C.

1995-01-01

The use of lessons learned as a tool for learning from past experiences is well established, especially by many organizations within the nuclear industry. Every person has, at some time, used the principles of lessons learned to adopt good work practices based on their own experiences or the experiences of others. Lessons learned can also help to avoid the recurrence of adverse practices, which is often an area that most lessons-learned programs tend to focus on. This paper will discuss how lessons learned relate to packaging and transportation issues and events experienced at Department of Energy (DOE) facilities. It will also discuss the role performed by the Office of Nuclear and Facility Safety's Office of Operating Experience Analysis and Feedback in disseminating lessons learned and operating experience feedback to the DOE complex. The central concept of lessons learned is that any organization should be able to learn from its own experiences and events. In addition, organizations should implement methodologies to scan external environments for lessons learned, to analyze and determine the relevance of lessons learned, and to bring about the necessary changes learned from these experiences. With increased concerns toward facility safety, the importance of utilizing the lessons-learned principles and the establishment of lessons-learned programs can not be overstated

Lessons that Bear Repeating and Repeating that Bears Lessons: An Interdisciplinary Unit on Principles of Minimalism in Modern Music, Art, and Poetry (Grades 4-8)

Science.gov (United States)

Smigel, Eric; McDonald, Nan L.

2012-01-01

This theory-to-practice article focuses on interdisciplinary classroom activities based on principles of minimalism in modern music, art, and poetry. A lesson sequence was designed for an inner-city Grades 4 and 5 general classroom of English language learners, where the unit was taught, assessed, and documented by the authors. Included in the…

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.

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 ...

Satellite-instrument system engineering best practices and lessons

Science.gov (United States)

Schueler, Carl F.

2009-08-01

This paper focuses on system engineering development issues driving satellite remote sensing instrumentation cost and schedule. A key best practice is early assessment of mission and instrumentation requirements priorities driving performance trades among major instrumentation measurements: Radiometry, spatial field of view and image quality, and spectral performance. Key lessons include attention to technology availability and applicability to prioritized requirements, care in applying heritage, approaching fixed-price and cost-plus contracts with appropriate attention to risk, and assessing design options with attention to customer preference as well as design performance, and development cost and schedule. A key element of success either in contract competition or execution is team experience. Perhaps the most crucial aspect of success, however, is thorough requirements analysis and flowdown to specifications driving design performance with sufficient parameter margin to allow for mistakes or oversights - the province of system engineering from design inception to development, test and delivery.

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.

Theory and Practice in In-Service Teacher Learning: Teachers' Reconceptualisation of Curriculum in History Lessons

Science.gov (United States)

Moyo, Nathan; Modiba, Maropeng

2014-01-01

This paper reports on the findings of a qualitative interpretive study that was undertaken to determine how in-service teachers at Great Zimbabwe University were able (or not) to translate a theory that they were exposed to into practice during history lessons. Drawing on a range of data, the study explored how the teachers, who were purposively…

Lessons learned from accidents investigations

Energy Technology Data Exchange (ETDEWEB)

Zuniga-Bello, P. [Consejo Nacional de Ciencia y Tecnologia (CONACYT), Mexico City (Mexico); Croft, J. [National Radiological Protection Board (United Kingdom); Glenn, J

1997-12-31

Accidents from three main practices: medical applications, industrial radiography and industrial irradiators are used to illustrate some common causes of accidents and the main lessons to be learned. A brief description of some of these accidents is given. Lessons learned from the described accidents are approached by subjects covering: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

Lessons learned from accident investigations

International Nuclear Information System (INIS)

Zuniga-Bello, P.; Croft, J.R.; Glenn, J.

1998-01-01

Accidents in three main practices - medical applications, industrial radiography and industrial irradiators - are used to illustrate some common causes of accidents and the main lessons to be learned from them. A brief description of some of these accidents is given. Lessons learned from the accidents described are approached bearing in mind: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

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.

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.

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

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

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.

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.

Most Effective Practices in Lesson Planning

Science.gov (United States)

Womack, Sid T.; Pepper, Stephanie; Hanna, Shellie L.; Bell, Columbus David

2015-01-01

In a previous study with 130 undergraduate teacher candidates from all licensure levels, data on candidate effectiveness were examined using factor analysis. Four factors were found in effective teaching, those being lesson planning, teacher and student reflection, safe school environment, and teacher professionalism. The present study followed…

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.

Perceptions of primary care staff on a regional data quality intervention in Australian general practice: a qualitative study.

Science.gov (United States)

Ghosh, Abhijeet; McCarthy, Sandra; Halcomb, Elizabeth

2016-04-26

Technological advances in clinical data capturing and storage systems have led to recent attempts at disease surveillance and region specific population health planning through regularly collected primary care administrative clinical data. However the accuracy and comprehensiveness of primary care health records remain questionable. We aimed to explore the perceptions and experiences of general practice staff in maintaining accurate patient health data within clinical software used in primary care settings of regional NSW. Focus groups were conducted with general practitioners, practice nurses and practice administrative staff from 17 practices in the Illawarra-Shoalhaven region of the state of New South Wales (NSW) in Australia that had participated in the Sentinel Practices Data Sourcing (SPDS) project - a general practice based chronic disease surveillance and data quality improvement study. A total of 25 respondents that included 12 general practitioners (GPs) and 13 practice staff participated in the 6 focus groups. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis of the data was undertaken. Five key themes emerged from the data. Firstly, the theme of resourcing data management raised issues of time constraints, the lack of a dedicated data management role and the importance of multidisciplinary involvement, including a data champion. The need for incentives was identified as being important to motivate ongoing commitment to maintaining data quality. However, quality of software packages, including coding issues and software limitations and information technology skills were seen as key barriers. The final theme provided insight into the lessons learnt from the project and the increased awareness of the importance of data quality amongst practice staff. The move towards electronic methods of maintaining general practice patient records offers significant potential benefits in terms of both patient care and monitoring of health

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.

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...

Cost-effective facility disposition planning with safety and health lessons learned and good practices from the Oak Ridge Decontamination and Decommissioning Program

International Nuclear Information System (INIS)

1998-05-01

An emphasis on transition and safe disposition of DOE excess facilities has brought about significant challenges to managing worker, public, and environmental risks. The transition and disposition activities involve a diverse range of hazardous facilities that are old, poorly maintained, and contain radioactive and hazardous substances, the extent of which may be unknown. In addition, many excess facilities do not have historical facility documents such as operating records, plant and instrumentation diagrams, and incident records. The purpose of this report is to present an overview of the Oak Ridge Decontamination and Decommissioning (D and D) Program, its safety performance, and associated safety and health lessons learned and good practices. Illustrative examples of these lessons learned and good practices are also provided. The primary focus of this report is on the safety and health activities and implications associated with the planning phase of Oak Ridge facility disposition projects. Section 1.0 of this report provides the background and purpose of the report. Section 2.0 presents an overview of the facility disposition activities from which the lessons learned and good practices discussed in Section 3.0 were derived

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.

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.

From resilience thinking to Resilience Planning: Lessons from practice.

Science.gov (United States)

Sellberg, M M; Ryan, P; Borgström, S T; Norström, A V; Peterson, G D

2018-07-01

Resilience thinking has frequently been proposed as an alternative to conventional natural resource management, but there are few studies of its applications in real-world settings. To address this gap, we synthesized experiences from practitioners that have applied a resilience thinking approach to strategic planning, called Resilience Planning, in regional natural resource management organizations in Australia. This case represents one of the most extensive and long-term applications of resilience thinking in the world today. We conducted semi-structured interviews with Resilience Planning practitioners from nine organizations and reviewed strategic planning documents to investigate: 1) the key contributions of the approach to their existing strategic planning, and 2) what enabled and hindered the practitioners in applying and embedding the new approach in their organizations. Our results reveal that Resilience Planning contributed to developing a social-ecological systems perspective, more adaptive and collaborative approaches to planning, and that it clarified management goals of desirable resource conditions. Applying Resilience Planning required translating resilience thinking to practice in each unique circumstance, while simultaneously creating support among staff, and engaging external actors. Embedding Resilience Planning within organizations implied starting and maintaining longer-term change processes that required sustained multi-level organizational support. We conclude by identifying four lessons for successfully applying and embedding resilience practice in an organization: 1) to connect internal "entrepreneurs" to "interpreters" and "networkers" who work across organizations, 2) to assess the opportunity context for resilience practice, 3) to ensure that resilience practice is a learning process that engages internal and external actors, and 4) to develop reflective strategies for managing complexity and uncertainty. Copyright © 2018 The Authors

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

International Best Practice Basis for Assessing Recovery Operations. Annex II of Technical Volume 5

International Nuclear Information System (INIS)

2015-01-01

This volume seeks to identify lessons learned related to post-accident recovery that may further improve preparedness worldwide. This objective assessment of the recovery programme is made according to international best practice. In the practice and assessment of radiation and nuclear safety, international best practice is a process or technique that is likely to consistently produce superior results. An important principle is that a ‘best’ practice can evolve to become better as improvements are discovered and lessons are learned from past experience. The lessons to be learned from the recovery programme as it unfolds in Japan will feed back into improving international best practice in post-accident recovery worldwide. Best practice is used to maintain quality and is a component of quality management systems and standards, such as ISO 9000. It is generally regarded as being the most efficient and effective way to accomplish desired outcomes. The body of best practice is used as a benchmark and for self assessment

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 ...

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.

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.

Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

Science.gov (United States)

Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess

2010-01-01

Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

Medical Students’ View about the Effects of Practical Courses on Learning the General Theoretical Concepts of Basic Medical Sciences

Directory of Open Access Journals (Sweden)

Leila Roshangar

2014-05-01

Full Text Available Introduction: The basic medical sciences section requires 2.5 years in the medical education curriculum. Practical courses complement theoretical knowledge in this period to improve their appreciation. Despite spending lots of disbursement and time, this period’s efficacy is not clearly known. Methods: One hundred thirty-three General Practitioner (GP students have been included in this descriptive cross-sectional study and were asked by questionnaire about the positive impact of practical courses on learning theoretical knowledge. Data were analyzed by descriptive statistics. Result: The agreement in “Practical Head and Neck Anatomy” was 40.91% ± 29.45, in “Practical Trunk Anatomy” was 63.62% ± 2.32 and in “Practical Anatomy of Extremities” was 56.16% ± 2.57. In “Practical Histology”, agreement was 69.50%±2.19; “Practical Biophysics” was 45.97%±2.25, “Practical Physiology” 61.75%±2.17; “Practical Biochemistry” 36.28%±2.42; “Practical Pathology” 59.80%±2.53; “Practical Immunology” 56.25%±26.40; “Practical Microbiology and Virology” 60.39%±2.27 and “Practical Mycology and Parasitology” 68.2%± 2.16.Conclusion: GP students in Tabriz University of Medical Sciences are not optimistic about the applicability of practical courses of basic medical sciences lessons.

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

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.

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

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....

Students’ motivation in a disc golf-lesson and a soccer-lesson: An experimental study in the Physical Education setting

Directory of Open Access Journals (Sweden)

Kristian Vernegaard

2017-09-01

Full Text Available One of the purposes of physical education (PE in both Norway and Denmark is that PE should inspire to a lifelong active lifestyle. Based on the self-determination theory, the aim of the present study was to compare students’ intrinsic motivation, extrinsic motivation, and perceived competence in a lifestyle sport inspired PE-lesson (disc golf to a traditional PE-lesson (soccer and general PE. In addition, we aimed to investigate whether differences in motivation and perceived competence were conditional of the students’ relative attitude toward PE. The result of the study revealed that perceived competence was higher in the disc golf-lesson compared to the soccer-lesson and general PE. No overall differences in intrinsic motivation were found. However, when investigating differences in intrinsic motivation according to the students’ relative attitude toward PE, the results indicated that the students with a negative attitude toward PE was significantly more intrinsically motivated in disc golf-lesson compared to soccer-lesson and general PE. The findings may be seen as further recommendations to physical educators to vary the activity choices in physical education classes.

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...

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.

Local Governments Supporting Local Energy Initiatives: Lessons from the Best Practices of Saerbeck (Germany) and Lochem (The Netherlands)

NARCIS (Netherlands)

Hoppe, Thomas; Graf, Antonia; Warbroek, Wynzen Douwe Beau; Lammers, Imke; Lepping, Isabella

2015-01-01

The social dimension of the transition to a low carbon economy is a key challenge to cities. The establishment of local energy initiatives (LEIs) has recently been attracting attention. It is of great importance to draw lessons from best practices when LEIs have been facilitated by local governments

[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.

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

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.

PROFESSIONAL PREPARATION OF INTERACTIVE MINI-LESSONS USING MULTIMEDIA PRESENTATIONS FOR TEACHERS - PARTICIPANTS OF PEDAGOGICAL MASTERY WORKSHOP BASED ON PRACTICAL SKILLS AND VALUE EXPERIENCE

Directory of Open Access Journals (Sweden)

Alla V. Semenova

2015-04-01

Full Text Available The article deals with the preparation of interactive mini-lessons using multimedia presentations for teachers – participants of the seminar based on practical skills and value experience, which is considered in the unity of intellectual and emotional-volitional personality characteristics. The article covers the theoretical, methodological and practical approaches to creating presentations using MS PowerPoint in preparing and conducting interactive lessons by teachers based on andragogy approach. The proposed approach takes into account the personal aspects of teachers - participants of the seminar, as well as presents an appropriate planning cycle. That helps turn into reality the idea of vocational training throughout life "teacher to teacher".

Inductive & Deductive Science Thinking: A Model for Lesson Development

Science.gov (United States)

Bilica, Kim; Flores, Margaret

2009-01-01

Middle school students make great learning gains when they participate in lessons that invite them to practice their developing scientific reasoning skills; however, designing developmentally appropriate, clear, and structured lessons about scientific thinking and reasoning can be difficult. This challenge can be met through lessons that teach…

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.

Craft Lessons: Teaching Writing K-8. Second Edition

Science.gov (United States)

Fletcher, Ralph; Portalupi, JoAnn

2007-01-01

Since its publication in 1998 Craft Lessons has become a mainstay of writing teachers, both new and experienced. Practical lessons--each printed on one page--and the instructional language geared to three grade-level groupings: K-2, 3-4, and 5-8 are contained in this book. In the decade since Craft Lessons' publication the world has changed in…

Errors in veterinary practice: preliminary lessons for building better veterinary teams.

Science.gov (United States)

Kinnison, T; Guile, D; May, S A

2015-11-14

Case studies in two typical UK veterinary practices were undertaken to explore teamwork, including interprofessional working. Each study involved one week of whole team observation based on practice locations (reception, operating theatre), one week of shadowing six focus individuals (veterinary surgeons, veterinary nurses and administrators) and a final week consisting of semistructured interviews regarding teamwork. Errors emerged as a finding of the study. The definition of errors was inclusive, pertaining to inputs or omitted actions with potential adverse outcomes for patients, clients or the practice. The 40 identified instances could be grouped into clinical errors (dosing/drugs, surgical preparation, lack of follow-up), lost item errors, and most frequently, communication errors (records, procedures, missing face-to-face communication, mistakes within face-to-face communication). The qualitative nature of the study allowed the underlying cause of the errors to be explored. In addition to some individual mistakes, system faults were identified as a major cause of errors. Observed examples and interviews demonstrated several challenges to interprofessional teamworking which may cause errors, including: lack of time, part-time staff leading to frequent handovers, branch differences and individual veterinary surgeon work preferences. Lessons are drawn for building better veterinary teams and implications for Disciplinary Proceedings considered. British Veterinary Association.

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.

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.

[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

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.

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,

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....

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

Sharing lessons learned and best practices in deactivation and decommissioning techniques among U.S. Department of Energy contractors

International Nuclear Information System (INIS)

Lackey, Michael B.; Waisley, Sandra L.; Dusek, Lansing G.

2007-01-01

Approximately $153.2 billion of work currently remains in the United States Department of Energy's (DOE's) Office of Environmental Management (EM) life cycle budget for United States projects. Contractors who manage facilities for the DOE have been challenged to identify transformational changes to reduce the life cycle costs and develop a knowledge management system that identifies, disseminates, and tracks the implementation of lessons learned and best practices. At the request of the DOE's EM Office of Engineering and Technology, the Energy Facility Contractors Group (EFCOG) responded to the challenge with formation of the Deactivation and Decommissioning (D and D) and Facility Engineering (DD/FE) Working Group. Since October 2006, members have already made significant progress in realizing their goals: adding new D and D best practices to the existing EFCOG Best Practices database; participating in lessons learned forums; and contributing to a DOE initiative on identifying technology needs. The group is also participating in a DOE project management initiative to develop implementation guidelines, as well as a DOE radiation protection initiative to institute a more predictable and standardized approach to approving authorized limits and independently verifying cleanup completion at EM sites. Finally, a D and D hotline to provide real-time solutions to D and D challenges is also being launched. (authors)

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...

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...

Didactic Contracts in Realistic Mathematics Education Teaching Practice in Indonesia: A lesson on addition

DEFF Research Database (Denmark)

Putra, Zetra Hainul

combinations that make ten based on a Palembang traditional food, pempek, and tablets of medicine. The result shows that some features such as formulation and validation appear during the teaching and learning process. The students are able to produce combinations that make ten individually and collectively......This paper aims to investigate characterize features of didactic contracts in realistic mathematics education teaching practice in Indonesia in the case of a lesson on addition. We just focus on some episodes of 26 first grade students and a female teacher from SDN 197 Palembang learning...

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

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

The individual teacher in lesson study collaboration

DEFF Research Database (Denmark)

Skott, Charlotte Krog; Møller, Hanne

2017-01-01

used in lesson study research. Design/methodology/approach The authors use collective case studies. By being participant observers the authors provide detailed descriptions of two selected teachers’ lived experiences of lesson study collaboration. In addition to gain first-hand insights, the authors...... in the participation of each of the two teachers during a two-year lesson study project. By comparing these shifts the authors identify significant conditions for their individual learning. Research limitations/implications Although the study is small scale, both the insights into the different ways in which teachers...... participated and the theoretical insights might be valuable for other lesson study research approaches. Practical implications This paper provides valuable insights into conditions that might influence teachers’ participation in lesson study activities, especially in cultures with little experience of lesson...

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.

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.

Deploying Serious Games for Management in Higher Education: lessons learned and good practices

Directory of Open Access Journals (Sweden)

Jannicke Baalsrud Hauge

2014-08-01

Full Text Available Deployment of serious games (SGs and their insertion in higher education (HE curricula is still low. The lacks papers describing deployment of SGs in HE critically showing educational benefits and providing guidelines and good practices for their use. With the present work, we intend to make a first step in this direction, by reporting our experience in using state of the art managerial SGs in MSc engineering/business courses in four different European universities. In order to describe and analyse the educational characteristics and effectiveness of each game, we propose to use two models that we have straightforwardly extracted from two major pedagogical paradigms: the Bloom’s revised cognitive learning goals taxonomy and the Kolb’s experiential learning cycle. Based on our experience, we also propose a set of lessons and good practices to incentivize and better support deployment of SGs in HE courses.

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...

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

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.

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.

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,.

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.

Lessons Learned in Preparation and Review of Safety Analysis Report of PUSPATI TRIGA Reactor in Malaysia

Energy Technology Data Exchange (ETDEWEB)

Maskin, Mazleha [Korea Advanced Institute for Science and Technology, Daejeon (Korea, Republic of); Choi, Kwang Sik [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

2010-05-15

PUSPATI TRIGA Reactor (RTP) is the one and only research reactor in Malaysia. Since the day it was supplied by General Atomic (GA) in 1983, periodic safety reviews were carried out but not published in the form of a complete SAR. In fact, the original SAR (SAR 1983) document was provided by GA as soon as GA was selected as the supplier of RTP. The focus of this report is on the lessons learned from the preparation of SAR. The lessons learned were to address the preparation and regulatory review of the second SAR (SAR 2006). Realizing that safety is important as RTP is aging, the experiences and lessons learned from SAR development and updating processes are of great value for all parties involved. The purpose of this report is to consolidate and organize the lessons learned and suggest the best practice for the next SAR development both in preparation and regulatory review

Lessons Learned in Preparation and Review of Safety Analysis Report of PUSPATI TRIGA Reactor in Malaysia

International Nuclear Information System (INIS)

Maskin, Mazleha; Choi, Kwang Sik

2010-01-01

PUSPATI TRIGA Reactor (RTP) is the one and only research reactor in Malaysia. Since the day it was supplied by General Atomic (GA) in 1983, periodic safety reviews were carried out but not published in the form of a complete SAR. In fact, the original SAR (SAR 1983) document was provided by GA as soon as GA was selected as the supplier of RTP. The focus of this report is on the lessons learned from the preparation of SAR. The lessons learned were to address the preparation and regulatory review of the second SAR (SAR 2006). Realizing that safety is important as RTP is aging, the experiences and lessons learned from SAR development and updating processes are of great value for all parties involved. The purpose of this report is to consolidate and organize the lessons learned and suggest the best practice for the next SAR development both in preparation and regulatory review

Local Governments Supporting Local Energy Initiatives: Lessons from the Best Practices of Saerbeck (Germany and Lochem (The Netherlands

Directory of Open Access Journals (Sweden)

Thomas Hoppe

2015-02-01

Full Text Available The social dimension of the transition to a low carbon economy is a key challenge to cities. The establishment of local energy initiatives (LEIs has recently been attracting attention. It is of great importance to draw lessons from best practices when LEIs have been facilitated by local governments and made a substantial contribution to greening local energy systems. The main research questions in this paper are: What lessons can be drawn from successful local low carbon energy transition cases, and which strategies proved successful to support LEIs? We have used analytical notions from the Strategic Niche Management (SNM and grassroots innovation literature to analyze two best-practice cases: Saerbeck (Germany and Lochem (The Netherlands. Data collection involved a set of fourteen in-depth interviews and secondary data. The results show that three key factors from SNM (building networks, managing expectations, and facilitation of learning are of great importance. However, to a great degree it is also strategic, community serving, responsive, reflexive leadership and proper process management by public officials that spurred success, which would not have been possible without close interaction and mutual trust between local government and representatives of the local communities.

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

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.

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.

Lessons Learned: Public Health Nurses Practice in Safeguarding Children in the Republic of Ireland.

Science.gov (United States)

Phelan, Amanda; Davis, Michaela

2015-01-01

The public health nurses' scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child's parent(s)/guardian(s) and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

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...

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...

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...

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...

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,

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

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.

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...

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

Lessons learned from case studies of inhalation exposures of workers to radioactive aerosols

Energy Technology Data Exchange (ETDEWEB)

Hoover, M.D.; Fencl, A.F.; Newton, G.J. [and others

1995-12-01

Various Department of Energy requirements, rules, and orders mandate that lessons learned be identified, evaluated, shared, and incorporated into current practices. The recently issued, nonmandatory DOE standard for Development of DOE Lessons Learned Program states that a DOE-wide lessons learned program will {open_quotes}help to prevent recurrences of negative experiences, highlight best practices, and spotlight innovative ways to solve problems or perform work more safely, efficiently, and cost effectively.{close_quotes} Additional information about the lessons learned program is contained in the recently issued DOE handbook on Implementing U.S. Department of Energy Lessons Learned Programs and in October 1995 DOE SAfety Notice on Lessons Learned Programs. This report summarizes work in progress at ITRI to identify lessons learned for worker exposures to radioactive aerosols, and describes how this work will be incorporated into the DOE lessons learned program, including a new technical guide for measuring, modeling, and mitigating airborne radioactive particles. Follow-on work is focusing on preparation of {open_quotes}lessons learned{close_quotes} training materials for facility designers, managers, health protection professionals, line supervisors, and workers.

Lessons learned from case studies of inhalation exposures of workers to radioactive aerosols

International Nuclear Information System (INIS)

Hoover, M.D.; Fencl, A.F.; Newton, G.J.

1995-01-01

Various Department of Energy requirements, rules, and orders mandate that lessons learned be identified, evaluated, shared, and incorporated into current practices. The recently issued, nonmandatory DOE standard for Development of DOE Lessons Learned Program states that a DOE-wide lessons learned program will open-quotes help to prevent recurrences of negative experiences, highlight best practices, and spotlight innovative ways to solve problems or perform work more safely, efficiently, and cost effectively.close quotes Additional information about the lessons learned program is contained in the recently issued DOE handbook on Implementing U.S. Department of Energy Lessons Learned Programs and in October 1995 DOE SAfety Notice on Lessons Learned Programs. This report summarizes work in progress at ITRI to identify lessons learned for worker exposures to radioactive aerosols, and describes how this work will be incorporated into the DOE lessons learned program, including a new technical guide for measuring, modeling, and mitigating airborne radioactive particles. Follow-on work is focusing on preparation of open-quotes lessons learnedclose quotes training materials for facility designers, managers, health protection professionals, line supervisors, and workers

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.

[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

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...

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...

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.

Free Trade and Tariffs: Level III, Unit 2, Lesson 1; Capitalism, Communism, Socialism: Lesson 2; Nationalism vs. Internationalism: Lesson 3. Advanced General Education Program. A High School Self-Study Program.

Science.gov (United States)

Manpower Administration (DOL), Washington, DC. Job Corps.

This self-study program for high-school level contains lessons on: Free Trade and Tariffs; Capitalism, Communism, Socialism; and Nationalism vs. Internationalism. Each of the lessons concludes with a Mastery Test to be completed by the student. (DB)

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

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…

Periodontal Emergencies in General Practice.

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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.

The Employed Neurosurgeon: Essential Lessons.

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Benzil, Deborah L; Zusman, Edie E

2017-04-01

Neurosurgeons are highly specialized surgeons whose pride is mastery of the complexity of form and function that is the nervous system and then knowing when and how these require surgical intervention. Following years of arduous postgraduate education, neurosurgeons enter the world of practice that is not only daunting in its intricacies of regulations, mandates, and unknown business practices, but also changing at a meteoric pace. Overwhelmingly, graduating residents and fellows are choosing to practice as employed physicians, a trend that is new in its magnitude and also changed because of the rapid evolution of large health systems. Case studies of challenges other employed surgical specialists have faced can provide critical and important education for any neurosurgeon in this arena. As with the lessons of all case studies, the teachings are remarkably universal, but how those lessons apply to an individual's specific situation will require personalized adaptation. Copyright © 2016 by the Congress of Neurological Surgeons.

Sustaining Lesson Study: Resources and Factors that Support and Constrain Mathematics Teachers' Ability to Continue After the Grant Ends

Science.gov (United States)

Druken, Bridget Kinsella

Lesson study, a teacher-led vehicle for inquiring into teacher practice through creating, enacting, and reflecting on collaboratively designed research lessons, has been shown to improve mathematics teacher practice in the United States, such as improving knowledge about mathematics, changing teacher practice, and developing communities of teachers. Though it has been described as a sustainable form of professional development, little research exists on what might support teachers in continuing to engage in lesson study after a grant ends. This qualitative and multi-case study investigates the sustainability of lesson study as mathematics teachers engage in a district scale-up lesson study professional experience after participating in a three-year California Mathematics Science Partnership (CaMSP) grant to improve algebraic instruction. To do so, I first provide a description of material (e.g. curricular materials and time), human (attending district trainings and interacting with mathematics coaches), and social (qualities like trust, shared values, common goals, and expectations developed through relationships with others) resources present in the context of two school districts as reported by participants. I then describe practices of lesson study reported to have continued. I also report on teachers' conceptions of what it means to engage in lesson study. I conclude by describing how these results suggest factors that supported and constrained teachers' in continuing lesson study. To accomplish this work, I used qualitative methods of grounded theory informed by a modified sustainability framework on interview, survey, and case study data about teachers, principals, and Teachers on Special Assignment (TOSAs). Four cases were selected to show the varying levels of lesson study practices that continued past the conclusion of the grant. Analyses reveal varying levels of integration, linkage, and synergy among both formally and informally arranged groups of

Landfill gas operation and maintenance manual of practice

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-03-01

This manual has the following objectives: (1) compile and present key portions of the general body of knowledge about operating and maintaining LFG control systems; (2) present information in an easy to understand format useful for hands-on practical use in the field; (3) present accepted practices and procedures for LFG control practices; (4) highlight key points, common mistakes and lessons learned from more than 20 years of industry experience, point out areas of controversy and indicate alternative practices where applicable; (5) compile key reference information; and (6) provide theory and discussion needed to develop a deeper understanding of LFG control and recovery.

Towards the system-wide implementation of the International Classification of Functioning, Disability and Health in routine practice: Lessons from a pilot study in China.

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Li, Jianan; Prodinger, Birgit; Reinhardt, Jan D; Stucki, Gerold

2016-06-13

In 2011 the Chinese leadership in rehabilitation, in collaboration with the International Classification of Functioning, Disability and Health (ICF) Research Branch, embarked on an effort towards the system-wide implementation of the ICF in the healthcare system in China. We report here on the lessons learned from the pilot phase of testing the ICF Generic Set, a parsimonious set of 7 ICF categories, which have been shown to best describe functioning across the general population and people with various health conditions, for use in routine clinical practice in China. The paper discusses whether classification and measurement are compatible, what number of ICF categories should be included in data collection in routine practice, and the usefulness of a functioning profile and functioning score in clinical practice and health research planning. In addition, the paper reflects on the use of ICF qualifiers in a rating scale and the particularities of certain ICF categories contained in the ICF Generic Set when used as items in the context of Chinese rehabilitation and healthcare. Finally, the steps required to enhance the utility of system-wide implementation of the ICF in rehabilitation and healthcare services are set out.

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.

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Little, Paul; Lewith, George; Webley, Fran; Evans, Maggie; Beattie, Angela; Middleton, Karen; Barnett, Jane; Ballard, Kathleen; Oxford, Frances; Smith, Peter; Yardley, Lucy; Hollinghurst, Sandra; Sharp, Debbie

2008-08-19

To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. Factorial randomised trial. 64 general practices in England. 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription. Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling. Roland Morris disability score (number of activities impaired by pain) and number of days in pain. Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported. One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons. National Research Register N0028108728.

The Finishing Touch: Anatomy of Expert Lesson Closures

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Webster, Collin A.; Connolly, Graeme; Schempp, Paul G.

2009-01-01

Background: Based on the idea that students remember best what is presented last, the lesson closure is commonly identified as an important component of effective teaching and has recently surfaced as a routine practice of expert teachers in sport. Despite its link to both effective and expert instruction, the lesson closure has seen scarce…

Preservice teachers' use of lesson study in teaching nature of science

Science.gov (United States)

McDowell, Amy Virginia

The purpose of this study was to explore preservice teachers' lived experiences in a lesson study focused on teaching and learning nature of science (NOS). The body of knowledge about shifting pre- and in-service novice NOS understandings is substantial. The focus of science education research is now exploring ways to move these informed NOS understandings into classroom practice (Abd-El-Khalick & Lederman, 2000b). The research questions guiding the study were (a) how do preservice teachers' understandings of NOS shift as a result of the lesson study experience?, and (b) how does the reflective practice that occurs in lesson study influence preservice teachers' transition of NOS tenets into classroom practice? The participants in this study represented a sample of graduate preservice teachers, who were part of a middle and secondary science teaching alternative certification program in a southeastern university. In the first summer semester of this certification program, the participants were immersed in reform based science instruction; a section of which included NOS teachings (INTASC, 2002). In the following semester, participants were placed in a practicum setting; where the exploration of the preservice teachers' teaching of NOS was supported through the modified lesson study framework. Data sources included the Views on Nature of Science-Form B (VNOS-b), interviews, and lesson study portfolios. Analysis of NOS understandings was guided by instruments found in literature associated with the VNOS-b (Lederman et al., 2002) and reflection (Ward & McCotter, 2004). Results showed successful transfer of NOS into classroom practice using the modified lesson study framework, with less success in the deepening of participants' NOS understandings. Of particular significance was that results indicated a deepening of NOS pedagogical content knowledge for those participants functioning at higher levels of reflection. The study's results contributes to two knowledge bases

Recycling Lesson Plan

Science.gov (United States)

Okaz, Abeer Ali

2013-01-01

This lesson plan designed for grade 2 students has the goal of teaching students about the environmental practice of recycling. Children will learn language words related to recycling such as: "we can recycle"/"we can't recycle" and how to avoid littering with such words as: "recycle paper" and/or "don't throw…

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

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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.

A Text Mining Approach for Extracting Lessons Learned from Project Documentation: An Illustrative Case Study

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Benjamin Matthies

2017-12-01

Full Text Available Lessons learned are important building blocks for continuous learning in project-based organisations. Nonetheless, the practical reality is that lessons learned are often not consistently reused for organisational learning. Two problems are commonly described in this context: the information overload and the lack of procedures and methods for the assessment and implementation of lessons learned. This paper addresses these problems, and appropriate solutions are combined in a systematic lesson learned process. Latent Dirichlet Allocation is presented to solve the first problem. Regarding the second problem, established risk management methods are adapted. The entire lessons learned process will be demonstrated in a practical case study

Practical experiences of, and lessons learnt from, Internet technologies in higher education

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Simon Polovina

1999-01-01

Full Text Available The paper addresses how the Internet as computer-mediated communication is affecting teaching and learning in higher education institutions, particularly as these institutions face increasing competition due to the emergence of Web-based collaboration and assessment technologies. London’s South Bank University (SBU, a typical modern-day higher education institution is thereby in the process of integrating Internet technologies into its conventional and distance learning programmes. From its practical experiences so far SBU has learnt a variety of valuable lessons. In particular the technical and social aspects that determine the choice and use of the most appropriate software tools were identified, as well as a new approach towards online (Internet / Web subject reference sources was outlined. From SBU’s anecdotal experiences, useful recommendations are made for the effective use of Internet technologies that applies to many higher educational institutions.

Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts

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Steven Simon

2008-07-01

Conclusion MAeHC is implementing EHRs and health information exchange among communities with physicians and practices that appear generally representative of Massachusetts. The lessons learned from this pilot project should be applicable statewide and to other states with large numbers of physicians in small office practices.

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...

The effectiveness of Concept Mapping Content Representation Lesson Study (ComCoReLS) model to improve skills of Creating Physics Lesson Plan (CPLP) for pre-service physics teacher

Science.gov (United States)

Purwaningsih, E.; Suyatno; Wasis; Prahani, B. K.

2018-03-01

This research is aimed to analyse the effectiveness of ComCoReLS (Concept Mapping Content Representation Lesson Study) model towards the improvement skills of Creating Physics Lesson Plan (CPLP) for pre-service physics teacher. This research used one group pre-test and post-test design on 12 pre-service physics teacher at University of Malang State (Indonesia) in academic year 2016/2017. Data collection was conducted through test and interview. Skills of creating physics lesson plan for pre-service physics teacher measurement were conducted through Physics Lesson Plan Evaluation Sheet (PLPES). The data analysis technique was done by using paired t-test and n-gain. The CoMCoReLS model consists of 5 phases, including (1) Preparation, (2) Coaching, (3) Guided Practice, (4) Independent Practice, and (5) Evaluation. In the first, second, third and fifth phases are done at University of Malang State, while the fourth phase (Independent Practice) is done in SMAN 1 Singosari, SMAN 2 Malang, SMA Lab UM, MAN 3 Malang. The results showed that there was a significant increase in skills of creating physics lesson plan for pre-service physics teacher at α = 5% and n-gain average of high category. Thus, the ComCoReLS model is effective for improving skills of creating physics lesson plan for pre-service physics teacher.

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...

[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.

The new era of postgraduate certified general practice training in Japan.

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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.

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

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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.

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...

Climate adaptation policy, science and practice - Lessons for communication

Science.gov (United States)

Wolf, Johanna

2017-04-01

In climate change adaptation research, policy, and practice, institutional culture produces distinct conceptualizations of adaptation, which in turn affect how adaptation work is undertaken. This study examines institutional culture as the four domains of norms, values, knowledge, and beliefs that are held by adaptation scientists, policy- and decision-makers, and practitioners in Western Canada. Based on 31 semi-structured interviews, this article traces the ways in which these four domains interact, intersect, converge, and diverge among scientists, policy- and decision-makers, and practitioners. By exploring the knowledge, backgrounds, goals, approaches, assumptions, and behaviours of people working in adaptation, these interviews map the ways in which institutional culture shapes adaptation work being carried out by local, provincial, and federal governments, nongovernmental organizations, and an international community of scientists (including Canadian scientists). Findings suggest that institutional culture both limits and enables adaptation actions for these actors in important ways, significantly influencing how climate change adaptation is being planned for, and carried out on the ground. As a result, this paper asserts that there is an urgent need to better understand the role that institutional culture plays in order to advance climate change adaptation, both now and in the future. Important lessons for communicating about climate science, climate impacts and adaptation will be presented.

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...

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

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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

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.

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.

Supporting near-peer teaching in general practice: a national survey.

Science.gov (United States)

van de Mortel, Thea F; Silberberg, Peter L; Ahern, Christine M; Pit, Sabrina W

2016-05-12

Training bodies see teaching by junior doctors and vocational trainees in general practice (family medicine) as integral to a doctor's role. While there is a body of literature on teacher training programs, and on peer and near-peer teaching in hospitals and universities, there has been little examination of near-peer teaching in general practice. Near-peer teaching is teaching to those close to oneself but not at the same level in the training continuum. This study investigated the perceptions of key stakeholders on near-peer teaching in general practice, their current near-peer teaching activities, and methods of recruitment and support. A national anonymous online survey was used to obtain data on Australian stakeholders' perceptions of, and processes related to, near-peer teaching in general practice. Recruitment occurred via electronic invitations sent by training providers and stakeholder associations. Separate questionnaires, which were validated via several cycles of review and piloting, were developed for supervisors and learners. The survey included both fixed response and open response questions. Responses (n = 1,122) were obtained from 269 general practitioner supervisors, 221 general practice registrars, 319 prevocational trainees, and 313 medical students. All stakeholder groups agreed that registrars should teach learners in general practice, and 72% of registrars, 68% of prevocational trainees, and 33% of medical students reported having done some teaching in this setting. Three-quarters of supervisors allowed learners to teach. Having another learner observe their consultations was the most common form of teaching for registrars and prevocational trainees. Eight percent of registrars received some remuneration for teaching. The approach used to determine teaching readiness and quality varied greatly between supervisors. Near-peer teaching was supported by the majority of stakeholders, but is underutilised and has poor structural support

Mathematics Teachers' Views of Accountability Testing Revealed through Lesson Study

Science.gov (United States)

Yarema, Connie H.

2010-01-01

The practice of lesson study, a professional development model originating in Japan, aligns well with recommendations from research for teacher professional development. Lesson study is also an inductive research method that uncovers student thinking and, in parallel, grants teacher-educators the opportunity to study teachers' thinking about…

Nigerian Journal of General Practice: About this journal

African Journals Online (AJOL)

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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.

The impact of curricula and lesson planning in the teaching process

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Majlinda Lika

2017-03-01

Full Text Available Lesson planning is at the core of teaching. It allows teachers to create an orientation path in the process of teaching, taking into consideration, many elements such as, students’ styles of learning, previous knowledge, types of intelligences, interests etc. Effective curricula plans are characterized by principles of coherence, flexibility, integration of knowledge etc. Effective lesson plans strongly rely on previous information gathered through different forms of assessment, and provide inclusive opportunities for every student. This paper will show how planning affects teaching and the quality of learning. First, a review of the literature will represent the importance of flexible planning and incorporation of differentiated elements of planning that ensure inclusive opportunities of learning for all students. Second, there will be a detailed analysis of findings taken by 25 full school inspections practices on the field of “lesson planning”. This part of the study will specify the planning difficulties the teachers face and how this affects the process of teaching and learning. Third, benefits of lesson plans that rely on good assessment practices and integrate differentiated instruction according to students' needs will be discussed as ways of helping teachers adjust lesson plans to overcome their planning difficulties. Findings indicate that teachers design lesson plans that do not rely on good assessment practices. Lesson plans are not flexible enough to respond and satisfy the needs of all categories of students, impacting that way the quality of instruction and learning. The paper will serve teachers to review their planning approaches and integrate elements of differentiated instruction as an organic part of the process, responding to traits and uniqueness students represent.

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

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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.

Implementing Evidence-Based Practices for People With Schizophrenia

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Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

2009-01-01

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

Considerations for implementing an organizational lessons learned process.

Energy Technology Data Exchange (ETDEWEB)

Fosshage, Erik D

2013-05-01

This report examines the lessons learned process by a review of the literature in a variety of disciplines, and is intended as a guidepost for organizations that are considering the implementation of their own closed-loop learning process. Lessons learned definitions are provided within the broader context of knowledge management and the framework of a learning organization. Shortcomings of existing practices are summarized in an attempt to identify common pitfalls that can be avoided by organizations with fledgling experiences of their own. Lessons learned are then examined through a dual construct of both process and mechanism, with emphasis on integrating into organizational processes and promoting lesson reuse through data attributes that contribute toward changed behaviors. The report concludes with recommended steps for follow-on efforts.

General practice-based clinical trials in Germany - a problem analysis

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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

Promoting Mental Health and Preventing Mental Illness in General Practice.

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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.

An Assessment of Need for Instructional Professional Development for Middle School Science Teachers Using Interactive Lessons

Science.gov (United States)

Burton, Amanda

Numerous studies on the impact of interactive lessons on student learning have been conducted, but there has been a lack of professional development (PD) programs at a middle school focusing on ways to incorporate interactive lessons into the science classroom setting. The purpose of this case study was to examine the instructional practices of science teachers to determine whether the need for an interactive lessons approach to teaching students exists. This qualitative case study focused on teachers' perceptions and pedagogy to determine whether the need to use interactive lessons to meet the needs of all students is present. The research question focused on identifying current practices and determining whether a need for interactive lessons is present. Qualitative data were gathered from science teachers at the school through interviews, lesson plans, and observations, all of which were subsequently coded using an interpretative analysis. The results indicated the need for a professional development (PD) program centered on interactive science lessons. Upon completion of the qualitative study, a detailed PD program has been proposed to increase the instructional practices of science teachers to incorporate interactive lessons within the science classroom. Implications for positive social change include improved teaching strategies and lessons that are more student-centered resulting in better understanding and comprehension, as well as performance on state-mandated tests.

Characteristics and lessons learned from practice-based research networks (PBRNs in the United States

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Keller S

2012-09-01

Full Text Available Melinda M Davis,1,2 Sara Keller,1 Jennifer E DeVoe,1,3 Deborah J Cohen11Department of Family Medicine, 2Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA; 3OCHIN Practice-based Research Network, Portland, OR, USAAbstract: Practice-based research networks (PBRNs are organizations that involve practicing clinicians in asking and answering clinically relevant research questions. This review explores the origins, characteristics, funding, and lessons learned through practice-based research in the United States. Primary care PBRNs emerged in the USA in the 1970s. Early studies explored the etiology of common problems encountered in primary care practices (eg, headache, miscarriage, demonstrating the gap between research conducted in controlled specialty settings and real-world practices. Over time, national initiatives and an evolving funding climate have shaped PBRN development, contributing to larger networks, a push for shared electronic health records, and the use of a broad range of research methodologies (eg, observational studies, pragmatic randomized controlled trials, continuous quality improvement, participatory methods. Today, there are over 160 active networks registered with the Agency for Healthcare Research and Quality's PBRN Resource Center that engage primary care clinicians, pharmacists, dentists, and other health care professionals in research and quality-improvement initiatives. PBRNs provide an important laboratory for encouraging collaborative research partnerships between academicians and practices or communities to improve population health, conduct comparative effectiveness and patient-centered outcomes research, and study health policy reform. PBRNs continue to face critical challenges that include: (1 adapting to a changing landscape; (2 recruiting and retaining membership; (3 securing infrastructure support; (4 straddling two worlds (academia and community and managing

Parental Involvement in Children's Independent Music Lessons

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Upitis, Rena; Abrami, Philip C.; Brook, Julia; King, Matthew

2017-01-01

The purpose of the study was to examine types of parental involvement associated with independent music lessons. A self-report survey was designed to explore parent characteristics, parental goals, students' musical progress, the teacher-student relationship, the practice environment, and parent behaviours during practice sessions. The extent to…

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

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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

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

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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.

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

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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

"O Mundo da Lingua Portuguesa," a Supplementary Cultural Lesson.

Science.gov (United States)

Kennedy, James H.

The text of a classroom lesson on the distribution and use of the Portuguese language in African countries, written in Portuguese and containing an explanation of and practice in using the definite article with African place names, is presented. The lesson is accompanied by vocabulary notes in the margin, a list of questions on the text, and a mpa…

Evaluation of World Wide Web-based Lessons for a First Year Dental Biochemistry Course

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Dr. Alan E. Levine

2002-11-01

Full Text Available First year dental students at The University of Texas Dental Branch at Houston (Dental Branch are required to take a basic biochemistry course. To facilitate learning and allow student self-assessment of their progress, WWW-based lessons covering intermediary metabolism were developed as a supplement to traditional lectures. Lesson design combined text, graphics, and animations and included learner control, links to other learning resources, and practice exercises and exams with immediate feedback. Results from an on-line questionnaire completed by students in two different classes showed that they completed 50% of the lessons and spent an average of 4 hrs. on-line. A majority of the students either agreed or strongly agreed that practice exercises were helpful, that the ability to control the pace of the lessons was important, that the lesson structure and presentation was easy to follow, that the illustrations, animations, and hyperlinks were helpful, and that the lessons were effective as a review. The very positive response to the WWW-based lessons indicates the usefulness of this approach as a study aid for dental students.

Science and Technology awareness for preschool children: Practical lessons and experiences

CSIR Research Space (South Africa)

Van Deventer, A

2007-04-01

Full Text Available the “success” = enjoyed the class. Before each lesson started each child were asked to choose a face on the paper and write his/her name below their choice. The choices were: Are you happy, tired sick or sad? After each lesson the children had... to try again, are not happy with the first attempt etc.) • Observations can be captured by making use of drawings of the results of an experiment or of what they built. At first they might not want to because it is a skill that they still need...

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

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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

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...

Validation of an instrument to measure inter-organisational linkages in general practice.

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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

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

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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.

Transport practices in Amish communities

OpenAIRE

Warren, James; Enoch, Marcus

2014-01-01

Car ownership is growing in many countries.While beneficial to individuals in many cases, this trend has often resulted in significant economic, social, and environmental costs to society more generally. In researching possible solutions, one approach is to look at particular areas or communities that exhibit less reliance on the car or are even ‘car free’ to some extent, in order to see if lessons can be learned. Accordingly, this study seeks to define and characterize transport practices in...

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...

Blogging as Community of Practice: Lessons for Academic Development?

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Guerin, Cally; Carter, Susan; Aitchison, Claire

2015-01-01

As practices and expectations around doctoral writing continue to change, so too do the demands on academic developers and learning advisors. Social media is increasingly playing a role in doctoral education, just as it is in higher education more generally. This paper explores a blog initiated in 2012 to inform and support doctoral writing; since…

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 ...

METHODOLOGY OF ORGANIZATION OF INTEGRATED LESSONS OF NATURAL-SCIENCE CYCLE (ON THE EXAMPLE OF TEACHING SPE STUDENTS

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Alsou Raufovna Kamaleeva

2015-09-01

Full Text Available In the process of transition of Russian organizations of secondary professional education to educational standards of the third generation educational process is reduced to formation of students’ competences. This article presents methodology of creating integrated lessons of natural-science cycle (for example, in physics and informatics. These lessons are constructed on the basis of interdisciplinary integration and focused on task solution. The main purpose is to teach students how to solve particular tasks in physics with the use of informatics, in particular on the basis of algorithmization and programming (Pascal language. Didactic conditions, which are the basis of the algorithm of designing corresponding tasks, are described in this article. Structural components of the integrated lessons created on the traditional principle are marked out. During the research we observed that realization of all stages of the corresponding lessons in practice allows the teacher to create educational process over the borders of disciplinary basis. This approach helps to form generalization of knowledge. Being one of the most optimal forms of education, an integrated lesson allows students to solve various educational and professional problems in non-standard situations and stimulates their cognitive activity and their involvement in the process of education and their responsibility for the result which promotes an intensification of educational process.

Regionalisation of general practice training--are we meeting the needs of rural Australia?

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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.

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

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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

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

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Sturgiss, Elizabeth; van Boven, Kees

2018-06-04

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not

WHC significant lessons learned 1993--1995

Energy Technology Data Exchange (ETDEWEB)

Bickford, J.C.

1997-12-12

A lesson learned as defined in DOE-STD-7501-95, Development of DOE Lessons Learned Programs, is: A ``good work practice`` or innovative approach that is captured and shared to promote repeat applications or an adverse work practice or experience that is captured and shared to avoid a recurrence. The key word in both parts of this definition is ``shared``. This document was published to share a wide variety of recent Hanford experiences with other DOE sites. It also provides a valuable tool to be used in new employee and continuing training programs at Hanford facilities and at other DOE locations. This manual is divided into sections to facilitate extracting appropriate subject material when developing training modules. Many of the bulletins could be categorized into more than one section, however, so examination of other related sections is encouraged.

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

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

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.

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...

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

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.

Biology Teachers Designing Context-Based Lessons for Their Classroom Practice--The Importance of Rules-of-Thumb

Science.gov (United States)

Wieringa, Nienke; Janssen, Fred J. J. M.; Van Driel, Jan H.

2011-01-01

In science education in the Netherlands new, context-based, curricula are being developed. As in any innovation, the outcome will largely depend on the teachers who design and implement lessons. Central to the study presented here is the idea that teachers, when designing lessons, use rules-of-thumb: notions of what a lesson should look like if…

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

General medicine advanced training: lessons from the John Hunter training programme.

Science.gov (United States)

Jackel, D; Attia, J; Pickles, R

2014-03-01

Recent years have seen a rapid growth in the number of advanced trainees pursuing general medicine as a specialty. This reflects an awareness of the need for broader training experiences to equip future consultant physicians with the skills to manage the healthcare challenges arising from the demographic trends of ageing and increasing comorbidity. The John Hunter Hospital training programme in general medicine has several characteristics that have led to the success in producing general physicians prepared for these challenges. These include support from a core group of committed general physicians, an appropriate and sustainable funding model, flexibility with a focus on genuine training and developing awareness of a systems approach, and strong links with rural practice. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

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...

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...

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.

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.

GPs' job satisfaction: doctors who chose general practice early or late.

Science.gov (United States)

Lambert, Trevor; Smith, Fay; Goldacre, Michael

2013-11-01

In the UK many practising GPs did not choose general practice as their first choice of career when they originally graduated as doctors. To compare job satisfaction of GPs who chose general practice early or later in their career. Questionnaires were sent to all UK-trained doctors who graduated in selected years between 1993 and 2000. Questionnaires were sent to the doctors 1, 3, 7 and 10 years after graduation. Of all 3082 responders working in general practice in years 7 and 10, 38% had first specified general practice as their preferred career when responding 1 year after graduation, 19% by year 3, 21% by year 5, and 22% after year 5. Job satisfaction was high and, generally, there was little difference between the first three groups (although, when different, the most positive responses were from the earliest choosers); but there were slightly lower levels of job satisfaction in the 'more than 5 years' group. For example, in response to the statement 'I find enjoyment in my current post', the percentages agreeing in the four groups, respectively, were 91.5%, 91.1%, 91.0% and 88.2%. In response to 'I am doing interesting and challenging work' the respective percentages were 90.2%, 88.0%, 86.6% and 82.6%. Job satisfaction levels were generally high among the late choosers as well as the early choosers. On this evidence, most doctors who turn to general practice, after preferring another specialty in their early career, are likely to have a satisfying career.

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...

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.

Best practices for effective partnerships with Aboriginal groups : lessons learned from major Canadian projects in mining and forestry

Energy Technology Data Exchange (ETDEWEB)

Andersen, C. [Labrador Inuit Association, NF (Canada)

2004-07-01

This PowerPoint presentation provided an update on effective partnerships and best practices reported in Canadian mining, forestry and energy projects. The forestry and mining industries have provided most of the models and best practices for natural resource projects. This presentation described the approach to negotiations for the Voisey's Bay Nickel Project and future steps for commercial success. The lessons learned were also discussed with particular reference to corporate agendas that help advance Aboriginal participation. The presentation outlined the expected results from Voisey's Bay Nickel Company Impact Benefit Agreement with the Labrador Inuit Association and the Innu Nation. The issue of responsible environmental management was also discussed along with long-term opportunities for jobs, education and business opportunities for Newfoundland and Labrador residents. figs.

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.

["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.

Best Practices and Lessons Learned In LANL Approaches to Transportation Security

Energy Technology Data Exchange (ETDEWEB)

Drypolcher, Katherine Carr [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-10-24

Presentation includes slides on Physical Protection of Material in Transit; Graded Approach for Implementation Controls; Security Requirements; LANL Lessons Learned; Shipping Violation; Unmonitored Shipment; Foreign shipment; and the Conclusion.

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.

General Motors' R&D: Managing Innovation Globally

Science.gov (United States)

Taub, Alan

2006-03-01

The rapid pace of technology development and the globalization of the automobile industry are major forces driving General Motors to devise new ways to innovate faster and more efficiently. In response, GM has developed a global R&D network that has transformed GM's research and development organization from a U.S.-based enterprise to one that is over 30 percent leveraged with collaboration in 16 countries. This talk will focus on the challenges faced as well as the lessons learned and best practices developed in building this network.

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...

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

Anticipating students' reasoning and planning prompts in structured problem-solving lessons

Science.gov (United States)

Vale, Colleen; Widjaja, Wanty; Doig, Brian; Groves, Susie

2018-02-01

Structured problem-solving lessons are used to explore mathematical concepts such as pattern and relationships in early algebra, and regularly used in Japanese Lesson Study research lessons. However, enactment of structured problem-solving lessons which involves detailed planning, anticipation of student solutions and orchestration of whole-class discussion of solutions is an ongoing challenge for many teachers. Moreover, primary teachers have limited experience in teaching early algebra or mathematical reasoning actions such as generalising. In this study, the critical factors of enacting the structured problem-solving lessons used in Japanese Lesson Study to elicit and develop primary students' capacity to generalise are explored. Teachers from three primary schools participated in two Japanese Lesson Study teams for this study. The lesson plans and video recordings of teaching and post-lesson discussion of the two research lessons along with students' responses and learning are compared to identify critical factors. The anticipation of students' reasoning together with preparation of supporting and challenging prompts was critical for scaffolding students' capacity to grasp and communicate generality.

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...

Experiences of using email for general practice consultations: a qualitative study.

Science.gov (United States)

Atherton, Helen; Pappas, Yannis; Heneghan, Carl; Murray, Elizabeth

2013-11-01

Reports suggest approximately 21-23% of GPs in the UK have consulted with patients using email, but little is known about the nature of this use and what it means for clinicians and patients in general practice. To understand the use of email consultation in general practice by investigating the experiences of existing users and views of experts. A qualitative study conducted in 2010 using purposive sampling and semi-structured interviews in general practice and community settings in some London boroughs. A maximum variation sample of GPs and patients who had used email for consultation in general practice were recruited, as were policy and/or implementation experts. Interviews continued until saturation was achieved. In total 10 GPs, 14 patients, and six experts were interviewed. Consultation by email was often triggered by logistic or practical issues; motivators for ongoing use were the benefits, such as convenience, for GPs and patients. Both GPs and patients reported concerns about safety and lack of guidance about the 'rules of engagement' in email consultations, with GPs also concerned about workload. In response, both groups attempted to introduce their own rules, although this only went some way to addressing uncertainty. Long term, participants felt there was a need for regulation and guidance. Consultations by email in general practice occur in an unregulated and unstructured way. Current UK policy is to promote consultations by email, making it crucial to consider the responsibility and workload faced by clinicians, and the changes required to ensure safe use; not doing so may risk safety breaches and result in suboptimal care for patients.

[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.

[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.

Lessons From Watershed-Based Climate Smart Agricultural Practices In Jogo-Gudedo Watershed Ethiopia

Directory of Open Access Journals (Sweden)

Abera Assefa

2015-08-01

Full Text Available Abstract Land degradation is the most chronic problem in the Ethiopia. Soil erosion and denudation of vegetation covers are tending to enlarge the area of degraded and west land in semi-arid watersheds. It is therefore watershed management is believed as a holistic approach to create a climate smart landscape that integrate forestry agriculture pasture and soil water management with an objective of sustainable management of natural resources to improve livelihood. This approach pursues to promote interactions among multiple stakeholders and their interests within and between the upstream and downstream locations of a watershed. Melkassa Agricultural Research Centre MARC has been implementing integrated watershed management research project in the Jogo-gudedo watershed from 2010-2014 and lessons from Jogo-gudedo watershed are presented in this research report. Participatory action research PAR was implemented on Soil and Water Conservation SWC area enclosure Agroforestry AF Conservation Tillage CT energy saving stove drought resistance crop varieties in the Jogo-gudedo watershed. Empirical research and action research at plot level and evaluation of introduced technologies with farmers through experimental learning approach and documentation were employed. The participatory evaluation and collective action of SWC and improved practices brought high degree of acceptance of the practices and technologies. This had been ratified by the implementation of comprehensive watershed management action research which in turn enabled to taste and exploit benefits of climate-smart agricultural practices. Eventually significant reduction on soil loss and fuel wood consumption improvements on vegetation cover and crop production were quantitatively recorded as a good indicator and success. Field visit meetings trainings and frequent dialogues between practitioners and communities at watershed level have had a help in promoting the climate smart agriculture

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

Defining a risk-informed framework for whole-of-government lessons learned: A Canadian perspective.

Science.gov (United States)

Friesen, Shaye K; Kelsey, Shelley; Legere, J A Jim

Lessons learned play an important role in emergency management (EM) and organizational agility. Virtually all aspects of EM can derive benefit from a lessons learned program. From major security events to exercises, exploiting and applying lessons learned and "best practices" is critical to organizational resilience and adaptiveness. A robust lessons learned process and methodology provides an evidence base with which to inform decisions, guide plans, strengthen mitigation strategies, and assist in developing tools for operations. The Canadian Safety and Security Program recently supported a project to define a comprehensive framework that would allow public safety and security partners to regularly share event response best practices, and prioritize recommendations originating from after action reviews. This framework consists of several inter-locking elements: a comprehensive literature review/environmental scan of international programs; a survey to collect data from end users and management; the development of a taxonomy for organizing and structuring information; a risk-informed methodology for selecting, prioritizing, and following through on recommendations; and standardized templates and tools for tracking recommendations and ensuring implementation. This article discusses the efforts of the project team, which provided "best practice" advice and analytical support to ensure that a systematic approach to lessons learned was taken by the federal community to improve prevention, preparedness, and response activities. It posits an approach by which one might design a systematic process for information sharing and event response coordination-an approach that will assist federal departments to institutionalize a cross-government lessons learned program.

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,

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.

Changing Work Practices in Design

DEFF Research Database (Denmark)

Bødker, Keld; Kensing, F.; Simonsen, Jesper

2000-01-01

The paper presents lessons learned in relation to changing work practices in design. We describe method dissemination activities in three IT-organisations in relation to introducing a method for design in an organisational context. From the activities a number of lessons are drawn....

"Lesson Study" as Professional Culture in Japanese Schools: An Historical Perspective on Elementary Classroom Practices

Science.gov (United States)

Arani, Mohammad Reza Sarkar; Keisuke, Fukaya; Lassegard, James P.

2010-01-01

This research examines "lesson study" as a traditional model of creating professional knowledge in schools. "Lesson study," typically defined as teachers' classroom based collaborative research, has a long history in Japan as a shared professional culture with potential for enhancing learning, enriching classroom activities and…

Patient satisfaction surveys as a market research tool for general practices.

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Khayat, K; Salter, B

1994-05-01

Recent policy developments, embracing the notions of consumer choice, quality of care, and increased general practitioner control over practice budgets have resulted in a new competitive environment in primary care. General practitioners must now be more aware of how their patients feel about the services they receive, and patient satisfaction surveys can be an effective tool for general practices. A survey was undertaken to investigate the use of a patient satisfaction survey and whether aspects of patient satisfaction varied according to sociodemographic characteristics such as age, sex, social class, housing tenure and length of time in education. A sample of 2173 adults living in Medway District Health Authority were surveyed by postal questionnaire in September 1991 in order to elicit their views on general practice services. Levels of satisfaction varied with age, with younger people being consistently less satisfied with general practice services than older people. Women, those in social classes 1-3N, home owners and those who left school aged 17 years or older were more critical of primary care services than men, those in social classes 3M-5, tenants and those who left school before the age of 17 years. Surveys and analyses of this kind, if conducted for a single practice, can form the basis of a marketing strategy aimed at optimizing list size, list composition, and service quality. Satisfaction surveys can be readily incorporated into medical audit and financial management.

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

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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.

Linking research and practice through teacher communities: A place where formal and practical knowledge meet?

NARCIS (Netherlands)

Pareja Roblin, Natalie; Ormel, Bart; McKenney, Susan; Voogt, Joke; Pieters, Jules

2015-01-01

This study characterizes the links between research and practice across twelve projects concerned with the collaborative design of lesson plans by teacher communities. Analyses focused on sources of knowledge used to inform lesson design, participants’ roles, and knowledge generated by the teacher

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

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

Benchmarking on Inspection Practices. First Triennial Report of the Working Group on Inspection Practices

International Nuclear Information System (INIS)

2017-01-01

The WGIP Nuclear Power Plant (NPP) Observed Inspection Practices Program is intended to promote co-operation and learning among member countries and to collect and provide them with information for improving the effectiveness of existing regulatory inspection practices. This is accomplished by observing how inspections are carried out by other member countries and issuing a WGIP observed inspection report that includes observations (e.g. inspection techniques, obstacles encountered), lessons learnt and potential commendable practices that could be used by a regulatory body. This first triennial report documents the results of a consistency check performed between all six WGIP observed inspection reports and ratifies certain observations, lessons learnt and potential commendable practices identified by WGIP observed inspection participants

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.

Teachers of the Alexander Technique in the UK and the people who take their lessons: A national cross-sectional survey.

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Eldred, J; Hopton, A; Donnison, E; Woodman, J; MacPherson, H

2015-06-01

Given the rising profile of the Alexander Technique in the UK, there is a need for a comprehensive description of its teachers and of those who currently take lessons. In a national survey of Alexander teachers, we set out to address this information gap. A cross-sectional survey of 871 UK members of three main Alexander Technique teachers' professional associations was conducted. A questionnaire requested information about their professional background, teaching practice and methods, and about the people who attend lessons and their reasons for seeking help. With an overall response rate of 61%, 534 teachers responded; 74% were female with median age of 58 years, 60% had a higher education qualification, and 95% were self-employed, many with additional non-Alexander paid employment. The majority (87%) offered lessons on their own premises or in a privately rented room, and 19% provided home visits; both individual and group lessons were provided. People who took lessons were predominantly female (66%) with a median age of 48 years, and 91% paid for their lessons privately. Nearly two-thirds (62%) began lessons for reasons related to musculoskeletal conditions, including back symptoms, posture, neck pain, and shoulder pain. Other reasons were general (18%, including well-being), performance-related (10%, including voice-, music-, and sport-related), psychological (5%) and neurological (3%). We estimate that Alexander teachers in the UK provide approximately 400,000 lessons per year. This study provides an overview of Alexander Technique teaching in the UK today and data that may be useful when planning future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

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

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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.

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

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally

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.

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

Distributing learning over time: the spacing effect in children's acquisition and generalization of science concepts.

Science.gov (United States)

Vlach, Haley A; Sandhofer, Catherine M

2012-01-01

The spacing effect describes the robust finding that long-term learning is promoted when learning events are spaced out in time rather than presented in immediate succession. Studies of the spacing effect have focused on memory processes rather than for other types of learning, such as the acquisition and generalization of new concepts. In this study, early elementary school children (5- to 7-year-olds; N = 36) were presented with science lessons on 1 of 3 schedules: massed, clumped, and spaced. The results revealed that spacing lessons out in time resulted in higher generalization performance for both simple and complex concepts. Spaced learning schedules promote several types of learning, strengthening the implications of the spacing effect for educational practices and curriculum. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Lessons in Contingent, Recursive Humility

Science.gov (United States)

Vagle, Mark D.

2011-01-01

In this article, the author argues that critical work in teacher education should begin with teacher educators turning a critical eye on their own practices. The author uses Lesko's conception of contingent, recursive growth and change to analyze a lesson he observed as part of a phenomenological study aimed at understanding more about what it is…

Teamwork - general practitioners and practice nurses working together in New Zealand.

Science.gov (United States)

Finlayson, Mary P; Raymont, Antony

2012-06-01

Teamwork in primary health care has been encouraged in New Zealand and in the international literature. It may improve work satisfaction for staff, and satisfaction and outcomes for patients. Teamwork may be classified as being multi-, inter- or transdisciplinary and is likely to be influenced by the nature of the work and the organisational context. To describe and analyse teamwork between general practitioners and practice nurses in New Zealand. Data were drawn from a survey of general practices and from interviews with primary health care staff and management. Doctors and nurses in general practice in New Zealand see themselves as a team. Evidence suggests that the nature of the work and the business context most often leads to a multidisciplinary style of teamwork. Some providers have adopted a more intense teamwork approach, often when serving more disadvantaged populations or in caring for those with chronic illnesses. Concepts of teamwork differ. This article provides a classification of teams and suggests that most general practice teams are multidisciplinary. It is hoped that this will help personnel to communicate their expectations of a team and encourage progressive team development where it would be of value.

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.

Does general surgery residency prepare surgeons for community practice in British Columbia?

Science.gov (United States)

Hwang, Hamish

2009-01-01

Background Preparing surgeons for clinical practice is a challenging task for postgraduate training programs across Canada. The purpose of this study was to examine whether a single surgeon entering practice was adequately prepared by comparing the type and volume of surgical procedures experienced in the last 3 years of training with that in the first year of clinical practice. Methods During the last 3 years of general surgery training, I logged all procedures. In practice, the Medical Services Plan (MSP) of British Columbia tracks all procedures. Using MSP remittance reports, I compiled the procedures performed in my first year of practice. I totaled the number of procedures and broke them down into categories (general, colorectal, laparoscopic, endoscopic, hepatobiliary, oncologic, pediatric, thoracic, vascular and other). I then compared residency training with community practice. Results I logged a total of 1170 procedures in the last 3 years of residency. Of these, 452 were performed during community rotations. The procedures during residency could be broken down as follows: 392 general, 18 colorectal, 242 laparoscopic, 103 endoscopic, 85 hepatobiliary, 142 oncologic, 1 pediatric, 78 thoracic, 92 vascular and 17 other. I performed a total of 1440 procedures in the first year of practice. In practice the break down was 398 general, 15 colorectal, 101 laparoscopic, 654 endoscopic, 2 hepatobiliary, 77 oncologic, 10 pediatric, 0 thoracic, 70 vascular and 113 other. Conclusion On the whole, residency provided excellent preparation for clinical practice based on my experience. Areas of potential improvement included endoscopy, pediatric surgery and “other,” which comprised mostly hand surgery. PMID:19503663

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

"Getting Fit Basically Just Means, Like, Nonfat": Children's Lessons in Fitness and Fatness

Science.gov (United States)

Powell, Darren; Fitzpatrick, Katie

2015-01-01

Current concerns about a childhood obesity crisis and children's physical activity levels have combined to justify fitness lessons as a physical education practice in New Zealand primary (elementary) schools. Researchers focused on children's understandings of fitness lessons argue that they construct fitness as a quest for an "ideal"…

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...

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.

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.

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.

The art of co-production of knowledge in environmental sciences and management: lessons from international practice

Science.gov (United States)

Djenontin, Ida Nadia S.; Meadow, Alison M.

2018-06-01

This review paper addresses the challenging question of "how to" design and implement co-production of knowledge in climate science and other environmental and agricultural sciences. Based on a grounded theory review of nine (9) published case studies of transdisciplinary and collaborative research projects, the paper offers a set of common themes regarding specific components and processes for the design, implementation, and achievement of co-production of knowledge work, which represent the "Modus Operandi" of knowledge co-production. The analysis focuses on practical methodological guidance based on lessons from how different research teams have approached the challenges of complex collaborative research. We begin by identifying broad factors or actions that inhibit or facilitate the process, then highlight specific practices associated with co-production of knowledge and necessary competencies for undertaking co-production. We provide insights on issues such as the integration of social and professional cultures, gender and social equity, and power dynamics, and illustrate the different ways in which researchers have addressed these issues. By exploring the specific practices involved in knowledge co-production, this paper provides guidance to researchers on how to navigate different possibilities of the process of conducting transdisciplinary and co-production of knowledge research projects that best fit their research context, stakeholder needs, and research team capacities.

Direct observation of the nutrition care practices of Australian general practitioners

Directory of Open Access Journals (Sweden)

Ball LE

2014-06-01

Full Text Available INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients. AIM: The aim of this study was to describe the practices of a sample of Australian general practitioners (GPs when providing nutrition care to adult patients. METHODS: Eighteen GPs (13 male, 5 female were observed by fourth-year medical students during their general practice rotation. Each GP was observed for five consultations that included nutrition care, totalling 90 observed consultations. In each consultation, students completed a 31-item nutrition care checklist of nutrition care practices that could feasibly occur in a standard consultation. Each practice was marked with either a ‘yes’ (completed, ‘no’ (did not complete or ‘completed by practice nurse prior to or after the consultation’. RESULTS: Twenty-eight nutrition care practices were observed at least once. The most frequently observed practices were measuring and discussing blood pressure (76.7%; n=69, followed by general questions about current diet (74.4%; n=67. Approximately half of the consultations included a statement of a nutrition-related problem (52.2%; n=47, and the provision of nutrition advice that focused on a nutrient (45.6%; n=41 or food group (52.2%; n=47. Consultations with male GPs, as well as GPs with more than 25 years of experience, were associated with an increased number of nutrition care practices per consultation. DISCUSSION: The GPs performed nutrition care practices in varying frequencies. Further research is required to identify the most effective GP nutrition care practices to improve the nutrition behaviour of patients.

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.

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

Workplace bullying--what's it got to do with general practice?

Science.gov (United States)

Askew, Deborah A; Schluter, Philip J; Dick, Marie-Louise

2013-04-01

Workplace bullying is repeated systematic, interpersonal abusive behaviours that negatively affect the targeted individual and the organisation in which they work. It is generally the result of actual or perceived power imbalances between perpetrator and victim, and includes behaviours that intimidate, offend, degrade or humiliate a worker. It is illegal, and bullied employees can take legal action against their employers for a breach of implied duty of trust and confidence. Despite this, workplace bullying occurs in many Australian workplaces, including Australian general practices. This article explores the issue of workplace bullying with particular reference to bullying within general practice and provides a framework for managing these situations. All general practices need organisation-wide anti-bullying policies that are endorsed by senior management, clearly define workplace bullying, and provide a safe procedure for reporting bullying behaviours. General practitioners should investigate whether workplace issues are a potential contributor to patients who present with depression and/or anxiety and assess the mental health of patients who do disclose that they are victims of workplace bullying, Importantly, the GP should reassure their patient that bullying is unacceptable and illegal, and that everyone has the right to a safe workplace free from violence, harassment and bullying. The time has come for all workplaces to acknowledge that workplace bullying is unacceptable and intolerable.

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.

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

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.

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.

Creating comics in physics lessons: an educational practice

Science.gov (United States)

Albrecht, Evonir; Voelzke, Marcos Rincon

2012-06-01

This article presents the results from an intervention program with 119 students during physics and astronomy lessons. This program has taken place in the public school "Colônia dos Pescadores" in the City of Caraguatatuba, State of São Paulo. The goal is to show the importance and possibility of learning with support materials, either in the classroom or at home,created by the learners themselves. The results show that students can demonstrate their creativity while building up their own knowledge related to Astronomy as they are able to produce comic strips about the theme afterwards.

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.

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.

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.

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 ...

[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.

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

Serving online customers lessons for libraries from the business world

CERN Document Server

Barclay, Donald A

2014-01-01

To compete in the digital age, libraries must provide outstanding customer service to their virtual users. Serving Online Customers: Lessons for Libraries from the Business World is a practical guide to help libraries adopt and adapt the best practices of e-business for their own online operations.

Update in outpatient general internal medicine: practice-changing evidence published in 2014.

Science.gov (United States)

Sundsted, Karna K; Wieland, Mark L; Szostek, Jason H; Post, Jason A; Mauck, Karen F

2015-10-01

The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Beyond the specific child. What is 'a child's case' in general practice?

Science.gov (United States)

Hølge-Hazelton, Bibi; Tulinius, Charlotte

2010-01-01

Too many abused and neglected children are being overlooked by GPs and other professionals who are in contact with the families. Some suggestions for a definition of 'a child in need' have been given, but the functionality of these definitions has not been tested in general practice. To describe the problems presented by GPs as cases with children in need during supervision, and from here to suggest an empirically-based definition of a child in need in general practice. A mixed-method evaluation design was used. Twenty-one GPs, in Denmark, participated in supervision groups concerning cases with children in need in general practice. The data were analysed via field notes and video recordings; case categorisation into sex, ethnicity, and developmental stages; thematically using the GPs' own descriptions; and a theoretically supported style. Analysis of the data led to the suggested definition of a case concerning 'a child in need' in general practice as one that directly or indirectly involves problems with a specific child, an as-yet unborn child, or one or both parents of a family currently or potentially threatening the wellbeing of the family or the child. Based on this analysis, one suggestion as to why some abused and neglected children are overlooked in general practice is that GPs often have to navigate in difficult indirect consultations, where there is a high risk of losing the overview.

Linking Research and Practice through Teacher Communities: A Place Where Formal and Practical Knowledge Meet?

Science.gov (United States)

Pareja Roblin, Natalie N.; Ormel, Bart J. B.; McKenney, Susan E.; Voogt, Joke M.; Pieters, Jules M.

2014-01-01

This study characterises the links between research and practice across 12 projects concerned with the collaborative design of lesson plans by teacher communities (TCs). Analyses focused on sources of knowledge used to inform lesson design, participants' roles and knowledge generated by the teacher community. Three patterns emerged pertaining…

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

Case studies in teaching evolution: The intersection of dilemmas in practice

Science.gov (United States)

Fisher, Rachel

Despite recent science education reform documents citing evolution as a core concept to be taught in grades K-12, research shows problems with how it is currently taught. Evolution is often avoided, teachers minimize its importance within biology, infuse misconceptions, and/or interject non-scientific ideologies into lessons. My research focused on how teachers in two geographically and culturally distinct school districts in the southwestern U.S. negotiate dilemmas during an evolution unit. One school district was rural and had a large population of Mormon students, while the other district was urban, with a large majority Mexican/Mexican-American students. Using a case study approach, I observed three biology teachers during their evolution lessons, interviewed them throughout the unit, co-planned lessons with them, and collected artifacts from this unit, including anonymous student work. I also included data from four genetics lessons for each teacher to determine if the issues that arose during the evolution unit were a result of the general practice of the teacher, or if they were unique to evolution. Findings showed teachers' backgrounds and comfort levels with evolution, in addition to their perceptions of community context, affected how they negotiated pedagogical, conceptual, political, and cultural dilemmas. This study's findings will inform in-service teachers' future practice and professional development tools to aid with their teaching---this may include methods to negotiate some of the political (e.g. state standards) or cultural (e.g. religious resistance) issues inherent to teaching evolution.

The hospital component of general practice vocational training--the Irish experience.

Science.gov (United States)

Murphy, A W

1992-12-01

All second and third year general practice vocational trainees in the Irish Republic in 1991 were invited to complete a questionnaire concerning the hospital component of their training. The questionnaire was based on specific recommendations published by the I.C.G.P. regarding hospital training posts. Replies were received from 39 trainees constituting 70% of the total number of eligible trainees. In general, hospital posts were perceived to be of relevance and to offer adequate exposure to outpatient management and to the development of useful practical skills. More than 70% of the trainees were free to attend at least 75% of the study release course. Everyone entitled to study leave for examination purposes obtained it. However, 95% of trainees found their hospital teachers unfamiliar with the aims and objectives of Vocational Training. Two-thirds of trainees received less than two hours a week of formal or informal teaching. More than two-thirds did not participate in an introductory general practice period and less than a quarter had their individual needs assessed early on. Substantial realisation of the guidelines issued by the ICGP has been achieved. Further work is necessary in the areas of individual needs assessment, relevant structured teaching and general practice liaison. Three specific recommendations are made to achieve these aims.

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.

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.

Characterizing Mathematics Teaching Research Specialists' Mentoring in the Context of Chinese Lesson Study

Science.gov (United States)

Gu, Feishi; Gu, Lingyuan

2016-01-01

This study examines how mathematics teaching research specialists mentor practicing teachers during post-lesson debriefs of a lesson study in China. Based on a systematic, fine-grained analysis of 107 h of videotaped mentoring meetings of 20 groups of teachers and teaching research specialists from different elementary schools, this study reveals…

Early detection of COPD: a case finding study in general practice.

Science.gov (United States)

Vandevoorde, Jan; Verbanck, Sylvia; Gijssels, Lieve; Schuermans, Daniel; Devroey, Dirk; De Backer, Joan; Kartounian, Jan; Vincken, Walter

2007-03-01

To estimate the prevalence of undiagnosed chronic obstructive pulmonary disease (COPD) in a population of general practice patients at risk for developing COPD. A further aim was to evaluate the presence of respiratory symptoms as a predictor for the diagnosis of COPD. This study was conducted by eight general practitioners (GP) in six semi-rural general practices. During two consecutive months all patients attending their GP were included if they met the following criteria: current smokers between 40 and 70 yr of age, and a smoking history of at least 15 pack-years. A questionnaire regarding smoking history, respiratory symptoms, exposure to dust or chemical fumes, and history of respiratory diseases was completed for all patients. Subjects without known COPD were invited for spirometric testing. Off the 146 general practice patients included, 17.1% already had an established COPD diagnosis. Screening by spirometry revealed a 46.6% prevalence of COPD. Underdiagnosis of COPD was more frequent in the younger age categories (40-49 Yr; 50-59 Yr). Objective wheezing was the only sign that was significantly more frequent in COPD patients than in non-COPD patients (Pfatigue than newly detected patients. Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

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...

Implementation of evidence-based knowledge in general practice.

Science.gov (United States)

Le, Jette Videbæk

2017-12-01

Background Keeping up with the evidence and implementing it into the daily care for patients are fundamental prerequisites for delivering a high quality of care in general practice. However, despite many years of research into dissemination and implementation of evidence-based recommendations, significant challenges remain. In recent years, organisational factors have become widely acknowledged as vitally important for ensuring successful implementation. Further knowledge is needed to understand more about which factors affect the seeking and implementation of evidence-based knowledge in general practice. Aim The overall aim was to investigate how evidence-based knowledge is sought and implemented in general practice and to analyse associations with GP characteristics and quality of care. Three separate studies, each covering a specific part of the overall aim, were undertaken: I. To examine how GPs implement clinical practice guidelines in everyday clinical practice, and how implementation approaches differ between practices. II. To assess GPs’ information seeking behaviour with regard to the use and perceived importance of scientific medical information sources and to investigate associations with GP characteristics. III. To investigate if there are associations between specific formalised implementation activities within general practice and quality of care – exemplified by the use of spirometry testing among first-time users of medication against obstructive lung diseases. Methods The study was designed as a mixed methods study combining qualitative interviews, questionnaire and register data. Study I was a qualitative interview study that involved purposefully selected GPs representing seven different practices. The interviews were analysed using systematic text condensation, and results were used to qualify the development of a national survey of general practitioners regarding their seeking and implementation of evidence-based knowledge. This survey was

Lesson Study-Building Communities of Learning Among Pre-Service Science Teachers

Science.gov (United States)

Hamzeh, Fouada

Lesson Study is a widely used pedagogical approach that has been used for decades in its country of origin, Japan. It is a teacher-led form of professional development that involves the collaborative efforts of teachers in co-planning and observing the teaching of a lesson within a unit for evidence that the teaching practices used help the learning process (Lewis, 2002a). The purpose of this research was to investigate if Lesson Study enables pre-service teachers to improve their own teaching in the area of science inquiry-based approaches. Also explored are the self-efficacy beliefs of one group of science pre-service teachers related to their experiences in Lesson Study. The research investigated four questions: 1) Does Lesson Study influence teacher preparation for inquiry-based instruction? 2) Does Lesson Study improve teacher efficacy? 3) Does Lesson Study impact teachers' aspiration to collaborate with colleagues? 4) What are the attitudes and perceptions of pre-service teachers to the Lesson Study idea in Science? The 12 participants completed two pre- and post-study surveys: STEBI- B, Science Teaching Efficacy Belief Instrument (Enochs & Riggs, 1990) and ASTQ, Attitude towards Science Teaching. Data sources included student teaching lesson observations, lesson debriefing notes and focus group interviews. Results from the STEBI-B show that all participants measured an increase in efficacy throughout the study. This study added to the body of research on teaching learning communities, professional development programs and teacher empowerment.

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.

Knowledge degradation within routine operation practices in TRR - Lessons learned

International Nuclear Information System (INIS)

Gharib, M.

2004-01-01

Human factors play a major role in almost all sorts of knowledge management. Even in cases such as a nuclear incident, still the human part is prominent. It is showed that how general knowledge is eroded within routine practices and end up to disastrous consequences in abnormal conditions. Therefore relevant organizations should be aware of this natural tendency and find ways to confront it. (author)

The influence of experiential learning on medical equipment adoption in general practices.

Science.gov (United States)

Bourke, Jane; Roper, Stephen

2014-10-01

The benefits of the availability and use of medical equipment for medical outcomes are understood by physicians and policymakers alike. However, there is limited understanding of the decision-making processes involved in adopting and using new technologies in health care organisations. Our study focuses on the adoption of medical equipment in Irish general practices which are marked by considerable autonomy in terms of commercial practice and the range of medical services they provide. We examine the adoption of six items of medical equipment taking into account commercial, informational and experiential stimuli. Our analysis is based on primary survey data collected from a sample of 601 general practices in Ireland on practice characteristics and medical equipment use. We use a multivariate Probit to identify commonalities in the determinants of the adoption. Many factors, such as GP and practice characteristics, influence medical equipment adoption. In addition, we find significant and consistent evidence of the influence of learning-by-using effects on the adoption of medical equipment in a general practice setting. Knowledge generated by experiential or applied learning can have commercial, organisational and health care provision benefits in small health care organisations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Designing an Earthquake-Proof Art Museum: An Arts- and Engineering-Integrated Science Lesson

Science.gov (United States)

Carignan, Anastasia; Hussain, Mahjabeen

2016-01-01

In this practical arts-integrated science and engineering lesson, an inquiry-based approach was adopted to teach a class of fourth graders in a Midwest elementary school about the scientific concepts of plate tectonics and earthquakes. Lessons were prepared following the 5 E instructional model. Next Generation Science Standards (4-ESS3-2) and the…

Qualitative methods in PhD theses from general practice in Scandinavia.

Science.gov (United States)

Malterud, Kirsti; Hamberg, Katarina; Reventlow, Susanne

2017-12-01

Qualitative methodology is gaining increasing attention and esteem in medical research, with general practice research taking a lead. With these methods, human and social interaction and meaning can be explored and shared by systematic interpretation of text from talk, observation or video. Qualitative studies are often included in Ph.D. theses from general practice in Scandinavia. Still, the Ph.D. programs across nations and institutions offer only limited training in qualitative methods. In this opinion article, we draw upon our observations and experiences, unpacking and reflecting upon values and challenges at stake when qualitative studies are included in Ph.D. theses. Hypotheses to explain these observations are presented, followed by suggestions for standards of evaluation and improvement of Ph.D. programs. The authors conclude that multimethod Ph.D. theses should be encouraged in general practice research, in order to offer future researchers an appropriate toolbox.

[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.

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

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

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.

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.

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.

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.

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.

Enhancing mathematics teachers' quality through Lesson Study.

Science.gov (United States)

Lomibao, Laila S

2016-01-01

The efficiency and effectivity of the learning experience is dependent on the teacher quality, thus, enhancing teacher's quality is vital in improving the students learning outcome. Since, the usual top-down one-shot cascading model practice for teachers' professional development in Philippines has been observed to have much information dilution, and the Southeast Asian Ministers of Education Organization demanded the need to develop mathematics teachers' quality standards through the Southeast Asia Regional Standards for Mathematics Teachers (SEARS-MT), thus, an intensive, ongoing professional development model should be provided to teachers. This study was undertaken to determine the impact of Lesson Study on Bulua National High School mathematics teachers' quality level in terms of SEARS-MT dimensions. A mixed method of quantitative-qualitative research design was employed. Results of the analysis revealed that Lesson Study effectively enhanced mathematics teachers' quality and promoted teachers professional development. Teachers positively perceived Lesson Study to be beneficial for them to become a better mathematics teacher.

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.

Improving IT Project Portfolio Management: Lessons Learned

DEFF Research Database (Denmark)

Pedersen, Keld

2013-01-01

The IT PPM improvement process is not well understood, and our knowledge about what makes IT PPM improvement succeed or fail is not well developed. This article presents lessons learned from organizations trying to improve their IT PPM practice. Based on this research IT PPM practitioners are adv...

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.

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....

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

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

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

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.

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,

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.

Changing hearts and minds: examining student nurses' experiences and perceptions of a general practice placement through a 'community of practice' lens.

Science.gov (United States)

Lewis, Robin; Kelly, Shona

2018-04-05

The recent UK Government paper 'Five year forward view' describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students' perceptions of general practice as a placement and a potential career option post-graduation. Data were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout. Using the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: 'Myths and misunderstandings' outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a 'good' placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. 'Changing hearts and minds' referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students' perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation. The CoP that is emerging through the ATPS placements appear to be

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.

Assessing the Impact of Lesson Study on the Teaching Practice of Middle School Science Teachers

Science.gov (United States)

Grove, Michael C.

Despite wave after wave of educational reform in the United States our students continue to lag behind their peers in other industrialized countries on virtually all measures of academic achievement. Effective professional development (PD) is seen as a key to improving instructional practice and therefore student learning, but traditional forms of PD have been wholly unsuccessful in changing teaching practice. Over the last two decades an emerging body of research has identified some key features of effective PD that seem to create meaningful change and improvement in instructional practice. Some of this research highlights the promise of adapting Japanese lesson study (LS) to the American context as a means of incrementally improving instruction. Much of the existing research around LS is descriptive in nature and offers little insight into if and how participation in LS impacts subsequent instructional practice. This study utilized case study methodology to examine the instructional practice of one group of four middle school science teachers before, during, and after participation in LS. The study attempted to identify specific learning outcomes of a LS process, to identify influences on teacher learning during LS, and to identify subsequent changes in the instructional practice of participants resulting from participation in LS. Key findings from the study include significant teacher learning derived from the LS process, the identification of influences that enhanced or inhibited teacher learning, and clear evidence that participants successfully integrated learning from the LS into subsequent instructional practice. Learning outcomes included deepening of subject matter knowledge, increased understanding of student thinking and abilities, clarity of expectations for student performance, recognition of the ineffectiveness of past instructional practice, specific instructional strategies, shared student learning goals, and an increased commitment to future

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

A Lesson Based on Student-Generated Ideas: A Practical Example Highlighting the Role of a Teacher

Science.gov (United States)

Fuentes, Sarah Quebec

2011-01-01

The role of a teacher is different from that in traditional mathematics instruction when the implementation of a lesson is based on students' ideas. The author's experience teaching the same lesson (of the latter format) to two different classes of pre-service teachers in an elementary mathematics methods course is described. Since whole-class…

Becoming willing to role model. Reciprocity between new graduate nurses and experienced practice nurses in general practice in New Zealand: a constructivist grounded theory.

Science.gov (United States)

Hoarea, Karen J; Millsc, Jane; Francis, Karen

2013-01-01

Graduate nurses in general practice became a feature of New Zealand's health care system in 2008 following an expansion of the New Entrant to Practice Programme. General practice in New Zealand comprises general practitioner business owners who employ nursing and administration staff. Practice nurses are an ageing workforce in New Zealand, it is imperative therefore to attract younger nurses into general practice. This paper reports a section of the findings from a constructivist grounded theory study which examines the use of information by practice nurses in New Zealand. Initially data were collected using the ethnographic technique of observation and field notations in one general practice. Theoretical sensitivity to the value of role models was heightened by this first phase of data collection. A total of eleven practice nurses were interviewed from six general practices. One practice nurse agreed to a second interview; five of the interviewees were new graduate nurses and the other six were experienced practice nurses. The grounded theory constructed from this research was reciprocal role modelling which comprises the following three categories, becoming willing, realising potential and becoming a better practitioner. Graduate nurses and experienced practice nurses enter into a relationship of reciprocal role modelling. Becoming willing, the first core category of this grounded theory features three sub-categories: building respectful relationships, proving yourself and discerning decision making which are reported in this paper. Findings from this study may address the reported phenomenon of 'transition shock' of newly graduated nurses in the work place.

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.

Summary of Planned Implementation for the HTGR Lessons Learned Applicable to the NGNP

International Nuclear Information System (INIS)

Mckirdy, Ian

2011-01-01

This document presents a reconciliation of the lessons learned during a 2010 comprehensive evaluation of pertinent lessons learned from past and present high temperature gas-cooled reactors that apply to the Next Generation Nuclear Plant Project along with current and planned activities. The data used are from the latest Idaho National Laboratory research and development plans, the conceptual design report from General Atomics, and the pebble bed reactor technology readiness study from AREVA. Only those lessons related to the structures, systems, and components of the Next Generation Nuclear Plant (NGNP), as documented in the recently updated lessons learned report are addressed. These reconciliations are ordered according to plant area, followed by the affected system, subsystem, or component; lesson learned; and finally an NGNP implementation statement. This report (1) provides cross references to the original lessons learned document, (2) describes the lesson learned, (3) provides the current NGNP implementation status with design data needs associated with the lesson learned, (4) identifies the research and development being performed related to the lesson learned, and (5) summarizes with a status of how the lesson learned has been addressed by the NGNP Project.

Theory and interpretation in qualitative studies from general practice: Why and how?

Science.gov (United States)

Malterud, Kirsti

2016-03-01

In this article, I want to promote theoretical awareness and commitment among qualitative researchers in general practice and suggest adequate and feasible theoretical approaches. I discuss different theoretical aspects of qualitative research and present the basic foundations of the interpretative paradigm. Associations between paradigms, philosophies, methodologies and methods are examined and different strategies for theoretical commitment presented. Finally, I discuss the impact of theory for interpretation and the development of general practice knowledge. A scientific 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 positions. Basic theoretical features from the philosophy of science explain why and how this is different from positivism. Reflexivity, including theoretical awareness and consistency, demonstrates interpretative assumptions, accounting for situated knowledge. Different types of theoretical commitment 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 a philosopher. Qualitative studies from general practice deserve stronger theoretical awareness and commitment than what is currently established. Persistent attention to and respect for the distinctive domain of knowledge and practice where the research deliveries are targeted is necessary to choose adequate theoretical endeavours. © 2015 the Nordic Societies of Public Health.

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

Interacting institutional logics in general dental practice.

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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.

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

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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.

Quality of routine spirometry tests in Dutch general practices

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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

Social Case-work in General Practice: An Alternative Approach

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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

Patient education about cough: effect on the consulting behaviour of general practice patients.

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Rutten, G; Van Eijk, J; Beek, M; Van der Velden, H

1991-07-01

The aim of this general practice study was to examine how the consulting behaviour of patients with a cough was affected when the tasks and responsibilities of patients, practice nurses and general practitioners were reorganized. In four 'average' single-handed general practices the effects on the consulting behaviour of patients of a rational practice policy on cough and the provision of systematic patient education on cough were compared with patient behaviour in four matched control practices. Changes of behaviour were measured in 548 patients who consulted for cough at least twice, in two successive autumn-winter periods. Significantly more patients in the experimental practice changed their behaviour to follow the practice guidelines than did patients in the control practices (56% versus 30%, P less than 0.001). The proportion of patients who continued to consult in the approved manner was greater among patients receiving intervention (66% versus 29%, P less than 0.001). This was equally true for patients who had suffered less than four episodes of cough or more than four episodes. The more often the patients received the education, the more effective it was. All patients who consulted the general practitioner for cough during the first autumn-winter period filled in a cough diary during the second period. From this it appeared that the intervention did not result in patients delaying consultation when they had a cough lasting longer than three weeks or one with 'serious' symptoms. It would appear that a rational practice policy and the provision of patient education can stimulate patients to modify their consulting behaviour. This could result in a reduction in the costs of health care.

What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan.

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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.

Clinical usefulness of teleradiology in general dental practice

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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.

Ideologies of aid, practices of power: lessons for Medicaid managed care.

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Nelson, Nancy L

2005-03-01

The articles in this special issue teach valuable lessons based on what happened in New Mexico with the shift to Medicaid managed care. By reframing these lessons in broader historical and cultural terms with reference to aid programs, we have the opportunity to learn a great deal more about the relationship between poverty, public policy, and ideology. Medicaid as a state and federal aid program in the United States and economic development programs as foreign aid provide useful analogies specifically because they exhibit a variety of parallel patterns. The increasing concatenation of corporate interests with state and nongovernmental interests in aid programs is ultimately producing a less centralized system of power and responsibility. This process of decentralization, however, is not undermining the sources of power behind aid efforts, although it does make the connections between intent, planning, and outcome less direct. Ultimately, the devolution of power produces many unintended consequences for aid policy. But it also reinforces the perspective that aid and the need for it are nonpolitical issues.

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

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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.

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

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

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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.

Impact challenges in community science-with-practice: lessons from PROSPER on transformative practitioner-scientist partnerships and prevention infrastructure development.

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Spoth, Richard; Greenberg, Mark

2011-09-01

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.

Tired, weak, or in need of rest: fatigue among general practice attenders.

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David, A; Pelosi, A; McDonald, E; Stephens, D; Ledger, D; Rathbone, R; Mann, A

1990-11-24

To determine the prevalence and associations of symptoms of fatigue. Questionnaire survey. London general practice. 611 General practice attenders. Scores on a fatigue questionnaire and reasons given for fatigue. 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 non-physical causes. Physical ill health, including viral infection, was associated with more severe fatigue. Women rather than men blamed family responsibilities for their fatigue. The profile of persistent fatigue did not differ from that of short duration. Only one person met criteria for the chronic fatigue syndrome. Fatigue is a common complaint among general practice attenders and can be severe. Patients may attribute this to physical, psychological, and social stress.

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

Patient and professional attitudes towards research in general practice: the RepR qualitative study.

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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.

Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study.

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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.

"Give Me a Lesson and I'll Deliver It": Teaching Assistants' Experiences of Leading Primary Mathematics Lessons in England

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Houssart, Jenny

2013-01-01

Teaching Assistants (TAs) in primary schools in England have a growing pedagogic role. For some, this sometimes includes responsibility for the whole class instead of the teacher. This article draws on 24 interview transcripts to examine the practice in the context of primary mathematics lessons and from TAs' viewpoints. Emergency cover is often…

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...

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...

TRAINING FUTURE TEACHERS OF COMPUTER SCIENCE FOR WORKING OUT TECHNOLOGICAL CARDS OF LESSONS IN THE CONDITIONS OF REALIZATION OF THE FEDERAL STATE EDUCATIONAL STANDARD FOR GENERAL EDUCATION

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Екатерина Николаевна Кувшинова

2017-12-01

Full Text Available This article is devoted to a problem of readiness of future teachers of informatics for development of flow charts of the lessons displaying the main requirements of Federal state educational standards of the main general education (FGOS of Ltd company to planning and the organization of educational process taking into account system and activity approach in training. Content of system and activity approach in training, the universal educational actions (UEA reveals. Main units of the flow chart of a lesson of informatics are considered. The substantial block of the flow chart of a lesson of informatics determined by a training material which provides achievement of the planned subject results of training, and also forming and development of UUD, all-educational skills, ICT competences, competences of educational and research and project activities is stated.Subject results of training to which the abilities specific to a subject, types of activity on receipt of new knowledge within a subject, to its transformation and application in educational, educational and project and social and project situations, forming of scientific type of thinking, scientific ideas of key theories, types and types of the relations, ownership of scientific terminology, key concepts, methods and acceptances belong [10] are analyzed.Step-by-step training of future teachers of informatics for development of flow charts of lessons is discussed.

General educational disciplines practice-oriented training in intermediate vocational education

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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.

Validation of an observation tool to assess physical activity-promoting physical education lessons in high schools: SOFIT.

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Fairclough, Stuart J; Weaver, R Glenn; Johnson, Siobhan; Rawlinson, Jack

2018-05-01

SOFIT+ is an observation tool to measure teacher practices related to moderate-to-vigorous physical activity (MVPA) promotion during physical education (PE). The objective of the study was to examine the validity of SOFIT+ during high school PE lessons. This cross-sectional, observational study tested the construct validity of SOFIT+ in boys' and girls' high school PE lessons. Twenty-one PE lessons were video-recorded and retrospectively coded using SOFIT+. Students wore hip-mounted accelerometers during lessons as an objective measure of MVPA. Multinomial logistic regression was used to estimate the likelihood of students engaging in MVPA during different teacher practices represented by observed individual codes and a combined SOFIT+ index-score. Fourteen individual SOFIT+ variables demonstrated a statistically significant relationship with girls' and boys' MVPA. Observed lesson segments identified as high MVPA-promoting were related to an increased likelihood of girls engaging in 5-10 (OR=2.86 [95% CI 2.41-3.40]), 15-25 (OR=7.41 [95% CI 6.05-9.06]), and 30-40 (OR=22.70 [95% CI 16.97-30.37])s of MVPA. For boys, observed high-MVPA promoting segments were related to an increased likelihood of engaging in 5-10 (OR=1.71 [95% CI 1.45-2.01]), 15-25 (OR=2.69 [95% CI 2.31-3.13]) and 30-40 (OR=4.26 [95% CI 3.44-5.29])s of MVPA. Teacher practices during high school PE lessons are significantly related to students' participation in MVPA. SOFIT+ is a valid and reliable tool to examine relationships between PE teacher practices and student MVPA during PE. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

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...

Connecting polar research to NGSS STEM classroom lessons

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Brinker, R.; Kast, D.

2016-12-01

Next Generation Science Standards (NGSS) are designed to bring consistent, rigorous science teaching across the United States. Topics are categorized as Performance Expectations (PE), Disciplinary Core Ideas (DCI), Cross-Cutting Concepts (CCC), and Science and Engineering Practices (SEP). NGSS includes a focus on environmental science and climate change across grade levels. Earth and planetary sciences are required at the high school level. Integrating polar science lessons into NGSS classrooms brings relevant, rigorous climate change curriculum across grade levels. Polar science provides opportunities for students to use current data during lessons, conduct their own field work, and collaborate with scientists. Polar science provides a framework of learning that is novel to most students. Inquiry and engagement are high with polar science lessons. Phenomenon related to polar science provide an excellent tool for science teachers to use to engage students in a lesson, stimulate inquiry, and promote critical thinking. When taught effectively, students see the connections between their community, polar regions and climate change, regardless of where on the planet students live. This presentation describes examples of how to effectively implement NGSS lessons by incorporating polar science lessons and field research. Examples of introductory phenomenon and aligned PEs, CCCs, DCIs, and SEPs are given. Suggested student activities, assessments, examples of student work, student research, labs, and PolarTREC fieldwork, use of current science data, and connections to scientists in the field are provided. The goals of the presentation are to give teachers a blueprint to follow when implementing NGSS lessons, and give scientists an understanding of the basics of NGSS so they may be better able to relate their work to U.S. science education and be more effective communicators of their science findings.

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

Factors predicting team climate, and its relationship with quality of care in general practice

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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.

Factors predicting team climate, and its relationship with quality of care in general practice.

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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.

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

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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.

Re-Greening Ethiopia: History, Challenges and Lessons

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Mulugeta Lemenih

2014-07-01

Full Text Available In Ethiopia, deforestation rates remain high and the gap between demand and domestic supply of forest products is expanding, even though government-initiated re-greening efforts began over a century ago. Today, over 3 million hectares (ha of degraded forest land are under area exclosure; smallholder plantations cover 0.8 million ha; and state-owned industrial plantations stagnate at under 0.25 million ha. This review captures experiences related to re-greening practices in Ethiopia, specifically with regards to area exclosure and afforestation and reforestation, and distills lessons regarding processes, achievements and challenges. The findings show that farmers and non-governmental organizations (NGOs are the main players, and that the private sector has so far played only a small role. The role of the government was mixed: supportive in some cases and hindering in others. The challenges of state- and NGO-led re-greening practices are: inadequate involvement of communities; poorly defined rehabilitation objectives; lack of management plans; unclear responsibilities and benefit-sharing arrangements; and poor silvicultural practices. The lessons include: a more active role for non-state actors in re-greening initiatives; more attention to market signals; devolution of management responsibility; clear definition of responsibilities and benefit-sharing arrangements; and better tenure security, which are all major factors to success.

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.

Implementing Mathematics Teaching That Promotes Students' Understanding through Theory-Driven Lesson Study

Science.gov (United States)

Huang, Rongjin; Gong, Zikun; Han, Xue

2016-01-01

Lesson study (LS) has been practiced in China as an effective way to advance teachers' professional development for decades. This study explores how LS improves teaching that promotes students' understanding. A LS group including didacticians (practice-based teaching research specialist and University-based mathematics educators) and mathematics…

General anesthesia in cardiac surgery: a review of drugs and practices.

Science.gov (United States)

Alwardt, Cory M; Redford, Daniel; Larson, Douglas F

2005-06-01

General anesthesia is defined as complete anesthesia affecting the entire body with loss of consciousness, analgesia, amnesia, and muscle relaxation. There is a wide spectrum of agents able to partially or completely induce general anesthesia. Presently, there is not a single universally accepted technique for anesthetic management during cardiac surgery. Instead, the drugs and combinations of drugs used are derived from the pathophysiologic state of the patient and individual preference and experience of the anesthesiologist. According to the definition of general anesthesia, current practices consist of four main components: hypnosis, analgesia, amnesia, and muscle relaxation. Although many of the agents highlighted in this review are capable of producing more than one of these effects, it is logical that drugs producing these effects are given in combination to achieve the most beneficial effect. This review features a discussion of currently used anesthetic drugs and clinical practices of general anesthesia during cardiac surgery. The information in this particular review is derived from textbooks, current literature, and personal experience, and is designed as a general overview of anesthesia during cardiac surgery.

[Changing to a career in general practice - a qualitative study reveals motives of specialists].

Science.gov (United States)

Schwill, Simon; Magez, Julia; Jäger, Cornelia; von Meißner, Wolfgang Cg; Szecsenyi, Joachim; Flum, Elisabeth

2016-12-01

In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice. The postgraduate training program Verbundweiterbildung plus Baden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team. In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of

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

General practice vocational training and public health medicine: a novel collaboration.

Science.gov (United States)

Brenner, H; Money, P; Quinn, R

1994-06-01

The incorporation of a module of public health teaching into a general practice vocational training programme is described. This programme is itself innovative in that in addition to the 2 years of hospital-based training, it provides 2 years of community-based training. While the curriculum of the public health module is evolving with time, the objectives have remained the same, and are being met. The module has been appraised by external observers, and has been evaluated by participating trainees. The public health module is now an established feature of the Sligo general practice training programme.

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

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....

Lessons Learned

Directory of Open Access Journals (Sweden)

Amanda Phelan BNS, MSc, PhD

2015-03-01

Full Text Available The public health nurses’ scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child’s parent(s/guardian(s and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

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

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.

Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice