Nahar, Papreen; Kannuri, Nanda Kishore; Mikkilineni, Sitamma; Murthy, G V S; Phillimore, Peter
This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature - the Registered Medical Practitioner (RMP) - who occupies a niche in the medical market-place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical 'condition', namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of 'informality' in relation to the state in India - one Sarah Pinto's, the other Ananya Roy's. © 2016 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
Author Guidelines. The Nigerian Medical Practitioner, a monthly Journal publishes clinical and research articles in medicine and related fields which are of interest to a large proportion of medical and allied health practitioners. It also publishes miscellaneous articles-hospital administration, business practice, accounting, ...
Luzzi, L; Spencer, A J; Jones, K; Teusner, D
This study was designed to measure job satisfaction among registered clinical dentists so as to identify issues which may influence recruitment and retention of dentists in active clinical practice. A questionnaire measuring dimensions of job satisfaction was mailed to a stratified random sample of 80 private and 80 public sector dentists selected from the 1999 Victorian Dental Register. An adjusted response rate of 60 per cent was achieved (n = 87). Analyses showed significant differences (ANOVA; p satisfaction for various dimensions of job satisfaction by gender, age group and practice type. Differences in job satisfaction between male and female dentists related to the personal time dimension. Differences in satisfaction between dentists of different age groups were attributable to six dimensions: relationships with colleagues, relationships with patients, relationships with staff, personal time, community and administrative responsibilities. Differences between levels of satisfaction among private and public dentists related to the autonomy, relationships with patients, pay and resources dimensions. There are various dimensions of job satisfaction that may be pertinent to issues influencing recruitment and retention of dentists. Differences that exist between levels of job satisfaction among private and public sector dentists, between male and female dentists and dentists of different age groups need to be addressed in order to improve recruitment and retention rates of dentists in active clinical practice in different sectors of the dental care system.
Bliddal, Mette; Broe, Anne; Pottegård, Anton
The Danish Medical Birth Register was established in 1973. It is a key component of the Danish health information system. The register enables monitoring of the health of pregnant women and their offspring, it provides data for quality assessment of the perinatal care in Denmark, and it is used...... on all births in Denmark and comprises primarily of data from the Danish National Patient Registry supplemented with forms on home deliveries and stillbirths. It contains information on maternal age provided by the Civil Registration System. Information on pre-pregnancy body mass index and smoking...
The Council, as a professional body established by Parliament, gives traditional health practitioners registered with it the authority to issue medical certificates in line with the provisions of the Basic Conditions of Employment Act. However, the Council does not seem to be in a position to perform this function yet. Moreover ...
Age and puberty have been found to contribute to malaria resistance. It is expected that knowledge of natural resistance to malaria may aid in developing Vaccines against this deadly disease. Keywords: malaria resistance, puberty, malaria economy, malaria vaccine. Nigerian Medical Practitioner Vol. 49(5) 2006: 133-142 ...
New medical record keeping obligations are implemented by the Medical Practitioners Act (2007), effective July 2009. This audit, comprising review of 347 medical entries in 257 charts on one day, investigated compliance with the Act together with the general standard of medical record keeping. The Medical Council requirement was absent all but 3 (0.9%) of entries; there was no unique identifier or signature in 28 (8%) and 135 (39%) of entries respectively. The case for change is discussed.
Videbæk, Solvej; Jensen, A V; Rasmussen, S
BACKGROUND: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. PURPOSE: The primary purpose of the present study was to estimate...... the prevalence proportion of consultations in general medical practice caused by running-related injuries. The secondary purpose was to estimate the prevalence proportion of injured runners, who consult their GMP, that are referred to additional examinations or treatments. STUDY DESIGN: A survey-based study...
Full Text Available General practitioners are frequently facing medical emergencies. In order to react properly and administer therapy on time, a general practitioner needs to prepare and keep with himself the appropriate set of drugs which could be effectively used for treatment of the emergencies. The following drugs should find their place in the doctor's bag: acetaminophen (for mild and moderate pain, and for fever, morphine (for severe pain, naloxone (for heroin poisoning, ceftriaxone (for meningococcal meningitis, albuterol (for bronchial asthma attack, hydrocortisone (for bronchial asthma attack, glucagon (for severe hypoglycemia, dextrose (for mild to moderate hypoglycemia, diazepam (for febrile convulsions or epileptic status, epinephrine (for anaphylaxis and cardiac arrest, atropine (for symptomatic bradicardia, chloropyramine (for acute allergy, aspirin (for acute myocardial infarction, nitroglycerine (for acute coronary syndrome, metoclopramide (for nausea and vomiting, haloperidol (for delirium, methylergometrine (for control of bleeding after delivery or abortion, furosemide (for acute pulmonary edema and flumazenil (for benzodiazepine poisoning. For each of the listed drugs a physician should well know the recommended doses, indications, contraindications and warnings. All of the listed drugs are either registered in Serbia or available through special import, so general practitioners may fill their bags with all necessary drugs and effectively and safely treat medical emergencies.
Full Text Available The importance of organizational-stakeholder relationships is highlighted in most organizational studies literature. This article investigates the relationship between medical practices and their stakeholders and has been developed to provide guidance on stakeholder engagement and communication. It is intended to provide a useful reference point for all medical practices concerning stakeholder engagement activities. Direction is provided on how to identify and ultimately engage with stakeholders. It should hopefully further develop the effectiveness of engagement efforts that are undertaken between a medical practice and its stakeholders. The ability of a medical practice to cultivate and sustain strong relationships with its prominent stakeholder groups greatly enhances the likelihood that the relationship will endure. Medical practitioners in South Africa are generally in urgent need of pursuing new ways of delivering quality health care through developing new service models that have been developed with the help of relevant stakeholders. Since stakeholder relationship management is critical for corporate sustainability, medical practice management should seek strategic direction by investigating the relative competitive threat and relative supportive value of each stakeholder and then classify them accordingly.
Andersen, Solvej Videbæk; Jensen, A V; Rasmussen, Sten
BACKGROUND: General Medical Practitioners (GMP) in Denmark perform clinical examinations of patients with musculoskeletal pain. However, the prevalence proportion of examinations caused by running-related injuries remains unknown. PURPOSE: The primary purpose of the present study was to estimate...... the prevalence proportion of consultations in general medical practice caused by running-related injuries. The secondary purpose was to estimate the prevalence proportion of injured runners, who consult their GMP, that are referred to additional examinations or treatments. STUDY DESIGN: A survey-based study....... METHODS: An online survey was distributed in October and November 2015 to more than 370 GMPs in Denmark and completed by 27. RESULTS: The median prevalence proportion of consultations caused by running-related injuries in the prior two weeks was 0.80% [25th percentile = 0.00%; 75th percentile = 1...
Full Text Available Mohamed D Keita,1 Valerie J Diaz,1,2 Audrey P Miller,1 Maria Olenick,1 Sharon R Simon1 1Department of Undergraduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, 2Operational Health Support Unit Jacksonville, United States Navy Nurse Corps, Jacksonville, FL, USA Abstract: The nursing shortage in the USA is expected to reach 260,000 registered nurses (RNs by 2025. The most profound shortages are expected in California and Florida, translating into 109,779 and 128,364 RN jobs, respectively. Despite a foreseen growth in nursing career opportunities nationwide, the supply of nurses will be insufficient to meet the corresponding demand. Capitalizing on prior education, experience, and skills of military clinical personnel to fill these jobs could significantly reduce the projected nursing shortage. Florida International University's Nicole Wertheim College of Nursing and Health Sciences is circumventing barriers to recruit, retain, and graduate transitioning veteran medics and corpsmen as Bachelor of Science in Nursing prepared RNs who reintegrate into the civilian workforce. The Veteran Bachelor of Science in Nursing (VBSN program is in the form of a cooperative agreement between Florida International University and the US Health Resources and Services Administration. The VBSN program's main objective is to build upon the unique leadership skills, clinical education, and training of military medics and corpsmen to ensure successful completion of the Bachelor of Science in Nursing curriculum. VBSN students, as veterans themselves, have unique knowledge and exposure to the specific health issues and needs of the veteran population overall. They are poised and best prepared to effectively care for the US population, particularly the current 22 million US veterans and 1.6 million Florida veterans. Additionally, the VBSN program will alleviate the challenges, such as the lack of recognition of
Keita, Mohamed D; Diaz, Valerie J; Miller, Audrey P; Olenick, Maria; Simon, Sharon R
The nursing shortage in the USA is expected to reach 260,000 registered nurses (RNs) by 2025. The most profound shortages are expected in California and Florida, translating into 109,779 and 128,364 RN jobs, respectively. Despite a foreseen growth in nursing career opportunities nationwide, the supply of nurses will be insufficient to meet the corresponding demand. Capitalizing on prior education, experience, and skills of military clinical personnel to fill these jobs could significantly reduce the projected nursing shortage. Florida International University's Nicole Wertheim College of Nursing and Health Sciences is circumventing barriers to recruit, retain, and graduate transitioning veteran medics and corpsmen as Bachelor of Science in Nursing prepared RNs who reintegrate into the civilian workforce. The Veteran Bachelor of Science in Nursing (VBSN) program is in the form of a cooperative agreement between Florida International University and the US Health Resources and Services Administration. The VBSN program's main objective is to build upon the unique leadership skills, clinical education, and training of military medics and corpsmen to ensure successful completion of the Bachelor of Science in Nursing curriculum. VBSN students, as veterans themselves, have unique knowledge and exposure to the specific health issues and needs of the veteran population overall. They are poised and best prepared to effectively care for the US population, particularly the current 22 million US veterans and 1.6 million Florida veterans. Additionally, the VBSN program will alleviate the challenges, such as the lack of recognition of military skills, unemployment, the substandard income, and homelessness that many former service members face after separation from the military.
Freckelton, Ian; Flynn, Joanna
Much about what used to be termed "disciplinary" investigations and hearings is being revisited in the modern era. Therapeutic jurisprudence enables informed and sensitive awareness to potentially therapeutic and counter-therapeutic effects of both investigations and hearings conducted by medical regulatory authorities. This article analyses key aspects of authorities' processes from the perspective of notifiers/complainants and practitioners. Using developments at the Victorian Medical Practitioners Board as a base, it addresses issues of both investigative procedures and decision-making at formal and informal hearings, as well as the ramifications of re-hearings for the integrity of peer review informed regulation. It argues that where reclamation of practitioners is possible (namely where impropriety is not of the most serious order), there is much that is constructive about a focus upon enhancement of performance and competence levels, rather than the traditional preoccupation with whether registered status needs to be affected as a result of practitioner conduct.
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The knowledge and skills gap of medical practitioners delivering district hospital ... and quality health services, and also for guiding appropriate undergraduate, ... The uneven skill and knowledge base in aspects of HIV/AIDS management ...
Visser, Benjamin J; Huiskes, Florian; Korevaar, Daniel A
Increasing numbers of medical practitioners and medical students are using online social and business-related networking websites such as Facebook, Doc2doc and LinkedIn. These rapidly evolving and growing social media have potential to promote public health by providing powerful instruments for communication and education. However, evidence is emerging from studies, legal cases, and media reports that the use of these new technologies is creating several ethical problems for medical practitioners as well as medical students. Improper online activities may harm not only individual reputations and careers, but also the medical profession as a whole, for example by breach of patient confidentiality, defamation of colleagues and employers, undisclosed conflict of interests that bias the medical practitioner's medical advice, posting of advice/information without an evidence base, and infringement of copyright. We developed a self-evaluation checklist for medical practitioners using social media. The checklist addresses three key elements in the use of social media: personal information and accessibility, connections, and postings. It contains questions specifically formulated to evaluate a medical practitioner's social media profile, to prevent unintended, improper online activities and to promote professional online behaviour.
Shanahan, Madeleine [School of Medical Science, RMIT University, Bundoora, Victoria 3083 (Australia)], E-mail: email@example.com; Herrington, Anthony; Herrington, Jan [Faculty of Education, University of Wollongong, New South Wales (Australia)
Purpose: The Internet is an important information source for health practitioners providing immediate access to the most current health and medical information. Factors limiting practitioner access to the Internet have been identified and the literature shows that access to the Internet varies across and within health professions. There is therefore a need for each health profession to investigate practitioner access to the Internet. There has been, however, no identified empirical research investigating medical radiation science (MRS) practitioner access to or use of the Internet. This research sought to establish the professional use of Internet-based tools by Australian MRS practitioners and issues affecting access to the Internet within MRS workplaces. Methods: Qualitative and quantitative approaches were used in this research. These included interviews with 28 MRS practitioners from the four areas of specialisation, namely nuclear medicine, radiation therapy, radiography and sonography and a survey of MRS practitioners. In 2007 a 4-page postal survey was sent to a random sample of 1142 MRS practitioners with a response rate of 32.8%. Results: The Internet is an important information source widely used by MRS practitioners. MRS practitioners search the Internet (87%), access specific web pages (86%), use email (82%) and listservs (39.4%) to update their professional knowledge. It was evident that access to the Internet within the workplace varied within the MRS profession. Whilst the majority (96.4%) of MRS practitioners had some level of access to the Internet in their workplace, factors shown to affect practitioner access were workplace setting (p = 0.000), work environment (p = 0.000), and geographic location (p = 0.025). The majority of clinical workplaces (81%) did not provide practitioners with remote access to electronic resources available in the workplace such as e-journals and databases. Conclusions: This research provides baseline data to the MRS
Shanahan, Madeleine; Herrington, Anthony; Herrington, Jan
Purpose: The Internet is an important information source for health practitioners providing immediate access to the most current health and medical information. Factors limiting practitioner access to the Internet have been identified and the literature shows that access to the Internet varies across and within health professions. There is therefore a need for each health profession to investigate practitioner access to the Internet. There has been, however, no identified empirical research investigating medical radiation science (MRS) practitioner access to or use of the Internet. This research sought to establish the professional use of Internet-based tools by Australian MRS practitioners and issues affecting access to the Internet within MRS workplaces. Methods: Qualitative and quantitative approaches were used in this research. These included interviews with 28 MRS practitioners from the four areas of specialisation, namely nuclear medicine, radiation therapy, radiography and sonography and a survey of MRS practitioners. In 2007 a 4-page postal survey was sent to a random sample of 1142 MRS practitioners with a response rate of 32.8%. Results: The Internet is an important information source widely used by MRS practitioners. MRS practitioners search the Internet (87%), access specific web pages (86%), use email (82%) and listservs (39.4%) to update their professional knowledge. It was evident that access to the Internet within the workplace varied within the MRS profession. Whilst the majority (96.4%) of MRS practitioners had some level of access to the Internet in their workplace, factors shown to affect practitioner access were workplace setting (p = 0.000), work environment (p = 0.000), and geographic location (p = 0.025). The majority of clinical workplaces (81%) did not provide practitioners with remote access to electronic resources available in the workplace such as e-journals and databases. Conclusions: This research provides baseline data to the MRS
Moshabela, Mosa; Bukenya, Dominic; Darong, Gabriel
Objectives: There are concerns that medical pluralism may delay patients’ progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish...
hundred and twenty four private medical practitioners in. Port Harcourt ... pregnant women's access to PMTCT is limited to a few government ... The higher level of patient privacy in private clinics as compared .... wide continuing medical education will go a long way towards ... 7. WHO. Fact Sheet on HIV/AIDS for Nurses and.
Visser, Benjamin J.; Huiskes, Florian; Korevaar, Daniel A.
Increasing numbers of medical practitioners and medical students are using online social and business-related networking websites such as Facebook, Doc2doc and LinkedIn. These rapidly evolving and growing social media have potential to promote public health by providing powerful instruments for
General practitioners are frequently facing medical emergencies. In order to react properly and administer therapy on time, a general practitioner needs to prepare and keep with himself the appropriate set of drugs which could be effectively used for treatment of the emergencies. The following drugs should find their place in the doctor's bag: acetaminophen (for mild and moderate pain, and for fever), morphine (for severe pain), naloxone (for heroin poisoning), ceftriaxone (for meningococcal ...
Pinto, Anna; De Santis, Marta; Moretti, Carlo; Farina, Luca; Ravarotto, Licia
The present study had a dual purpose: to obtain a comprehensive picture of the Italian medical practitioners' opinions, professional experiences, training needs and knowledge of Animal Assisted Interventions (AAI); and to provide a detailed description of the medical practitioners who are characterized by a strongly positive attitude towards AAI. An online survey addressed to Italian medical practitioners was carried out using a 35-items structured questionnaire. Data obtained from the survey were analysed through appropriate summary statistics, analysis of variance (ANOVA) and logistic regression analysis. 670 medical practitioners participated in the online survey. Among them, 508 stated that they knew of AAI. 93.7% of these described themselves fully favourable towards the use of the human-animal relationship for therapeutic purposes, 84.4% defined themselves as confident and interested in studying the theme. A positive attitude towards AAI was greater in females, in people between 45 and 54 years old, in those who are pet owners and in those who believe that conferences are the most suitable tool to share information on AAI. The chance of having a positive attitude towards AAI is higher in respondents with specific characteristics. Data collected could be used as a starting point to promote and implement communication and training activities on AAI addressed to medical practitioners. Copyright © 2017 Elsevier Ltd. All rights reserved.
Shanahan, Madeleine; Herrington, Anthony; Herrington, Jan
Purpose: Updating professional knowledge is a central tenet of Continuing Professional Development (CPD) and professional reading is a common method health practitioners use to update their professional knowledge. This paper reports the level of professional reading by Medical Radiation Science (MRS) practitioners in Australia and examines organisational support for professional reading. Materials and Methods: Survey design was used to collect data from MRS practitioners. A questionnaire was sent to 1142 Australian practitioners, which allowed self-report data to be collected on the length of time practitioners engage in professional reading and the time workplaces allocate to practitioners for professional reading. Results: Of the 362 MRS practitioners who returned the survey, 93.9% engaged in professional reading on a weekly basis. In contrast, only 28.9% of respondents reported that their workplace allocates time for professional reading to practitioners. MRS practitioners employed in universities engaged in higher levels of reading than their colleagues employed in clinical workplaces (p < 0.01) and more university workplaces allocated time for professional reading to their employees than clinical workplaces (p < 0.01). There were no significant differences for clinical practitioners in level of reading across geographic, organisational and professional demographic factors. Significant differences in workplace allocation of time for professional reading in clinical workplaces were evident for health sector (p < 0.01); work environment (p < 0.01); geographic location (p < 0.01) and area of specialisation (p < 0.01). Conclusion: The vast majority of respondent MRS practitioners engage in professional reading to update their professional knowledge. This demonstrates an ongoing commitment at the individual practitioner level for updating professional knowledge. Updating professional knowledge is an organisational as well as an individual practitioner issue. Whilst
Shanahan, Madeleine, E-mail: firstname.lastname@example.org [School of Medical Science, RMIT University, Bundoora, Victoria (Australia); Herrington, Anthony [Head, School of Regional, Remote and eLearning (RRE), Curtin University, Perth (Australia); Herrington, Jan [School of Education, Murdoch University, Perth (Australia)
Purpose: Updating professional knowledge is a central tenet of Continuing Professional Development (CPD) and professional reading is a common method health practitioners use to update their professional knowledge. This paper reports the level of professional reading by Medical Radiation Science (MRS) practitioners in Australia and examines organisational support for professional reading. Materials and Methods: Survey design was used to collect data from MRS practitioners. A questionnaire was sent to 1142 Australian practitioners, which allowed self-report data to be collected on the length of time practitioners engage in professional reading and the time workplaces allocate to practitioners for professional reading. Results: Of the 362 MRS practitioners who returned the survey, 93.9% engaged in professional reading on a weekly basis. In contrast, only 28.9% of respondents reported that their workplace allocates time for professional reading to practitioners. MRS practitioners employed in universities engaged in higher levels of reading than their colleagues employed in clinical workplaces (p < 0.01) and more university workplaces allocated time for professional reading to their employees than clinical workplaces (p < 0.01). There were no significant differences for clinical practitioners in level of reading across geographic, organisational and professional demographic factors. Significant differences in workplace allocation of time for professional reading in clinical workplaces were evident for health sector (p < 0.01); work environment (p < 0.01); geographic location (p < 0.01) and area of specialisation (p < 0.01). Conclusion: The vast majority of respondent MRS practitioners engage in professional reading to update their professional knowledge. This demonstrates an ongoing commitment at the individual practitioner level for updating professional knowledge. Updating professional knowledge is an organisational as well as an individual practitioner issue. Whilst
Syncope is a common presentation in medical practice, and is associated with a higher than normal risk of mortality and morbidity in older individuals; It is essential that an accurate clinical history of the episode described as syncope be obtained, including the events preceding, the observations of eye-witnesses, and the ...
Method The competencies of medical practitioners working in 27 district hospitals were explored by using a self-administered questionnaire containing a competency rating of proxy markers. The data were analysed using the SAS statistical package. Variables were examined for statistically significant differences. Results
Wilson, Coralie J.; Deane, Frank P.; Marshall, Kellie L.; Dalley, Andrew
Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well…
A clinical approach to the management of infertility in Africa is discussed. The role of Assisted Reproductive Techniques (ART), adoption and cloning in management of infertility in Africa is discussed. Key Words: Local Tetanus, Recurrence Piercing Injury, Foreign Objects Nigerian Medical Practitioner Vol. 46 No 1, 2004 ...
to face in selecting the credible practitioners from the bogus ones for registration ... for registration. It is clear that the definition of a traditional health ... medical certificate and its validity can bring about came sharply to the fore in Kievits Kroon ...
Knowledge, Attitude and Practice of Private Medical Practitioners in Calabar towards Post-Abortion Care. ... The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors ...
Cosset, J.M.; Liniecki, J.; Ortiz-Lopez, P.; Ringertz, H.; Sharp, C.; Mettler, F.A. Jr.; Harding, L.K.; Nakamura, H.; Rehani, M.M.; Sasaki, Y.; Ussov, W.Y.; Guiberteau, M.J.; Hiraoka, M.; Vafio, E.; Gusev, L.A.; Pinillos-Ashton, L.V.; Rosenstein, M.; Yin, W.; Mattsson, S.; Cousins, C.
The medical exposures are the first cause of irradiation of populations. The benefit/risk ratio must be taken into consideration. Progress margin exists to reduce the radiation doses delivered to patients. The British people have noticed a reduction of 30% in the doses received by the patients during the last years. A better radiation protection needs a better dialogue between physicians and patients. This is the object of this ICRP guide which is a French translation of the original title 'Supporting guidance 2. Radiation and Your Patient: A Guide for Medical Practitioners', published by Pergamon (2002)
Smith, Tony; Lewis, Sarah
This is the second of two consecutive papers on the topic of radiographer role development. In the first paper, the rationale for role development was put forward and potential pathways for role extension were described and discussed. In this paper, a multi-tiered model of career structure, recently piloted in the United Kingdom, is firstly examined. A similar model, incorporating assistant practitioners, registered practitioners, advanced practitioners and consultant practitioners could be adapted to improve career pathways for Australian radiographers and accommodate future role development opportunities. However, for real benefits to all stakeholders, it would be important that the lower end of the career ladder is not altered without also redeveloping the upper end. The medical imaging professions should strongly resist any redevelopment of the former without the latter. In order for role development to progress successfully a coordinated approach and the involvement of the professional bodies, the educational institutions and government(s), would be essential. The potential contributions of the various stakeholder organisations are discussed and, as a means of promoting communication on the issues, the formation of a Special Interest Group in Radiographer Role Development (SIGRRD) is recommended. SIGRRI) would provide a mechanism for planning, monitoring and evaluating role development initiatives to ensure optimum outcomes Copyright (2003) Australian Institute of Radiography
Nixon, Michael Simon; Vendelø, Morten Thanning
Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience.
Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death. PMID:2319570
Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthanasia. Further, some of the familiar slippery slope arguments against voluntary euthanasia compromise the principle of autonomy to which both supporters and opponents of euthanasia adhere. I discuss a model for doctor/patient relationships which can be applied to cases which would be seen by all disputants as strong prima facie cases for euthanasia. I argue that in certain cases it will be ordinary medical practitioners who are duty-bound to assist death.
Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W
Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
Langade, Deepak; Modi, Pranav D; Sidhwa, Yazad F; Hishikar, Namita A; Gharpure, Amit S; Wankhade, Kalpana; Langade, Jayshree; Joshi, Kedar
Excessive and prolonged work-related stress has always been a cause for burnout among healthcare professionals. This has led to emotional, mental, and physical exhaustion. This survey was conducted to assess the burnout among medical practitioners using the abbreviated Maslach Burnout Inventory (aMBI) and Burnout Clinical Subtype Questionnaire (BCSQ-12) scales. A cross-sectional survey was conducted among 482 registered medical practitioners across India. A questionnaire consisting of 25 socio-demographic and occupational questions related to aMBI and BCSQ-12 scales was used to assess the burnout. The distribution of responses for each variable was examined using frequencies and percentages among the subgroups to find out the burnout levels of various components of the scales. High burnout levels were uniformly recorded for the entire population. For the aMBI, 45.02% (n = 217) and 65.98% (n = 318) of the participants scored high on the emotional exhaustion and depersonalization scales, respectively, whereas 87.14% (n = 420) scored low on the personal accomplishment scale and 62.86% (n = 303) and 11.41% (n = 55) had medium and low scores on the satisfaction with the medical practice scale. The BCSQ-12 scale showed the mean values of 15.89, 11.56, and 10.28 on a scale of 28 for overload, lack of development, and neglect subtypes, respectively, whereas, satisfaction with the financial compensation item showed a mean value of 3.79 on a scale of seven. All these values indicate high levels of burnout. The results suggest high levels of burnout in all domains of aMBI and BCSQ-12 scales in all the occupational and socio-demographic groups of medical practitioners and warrant immediate actions to address this issue.
Adam, Henning; Niebling, Wilhelm-Bernhard; Schott, Gisela
The information about the patient's discharge medication (DM) in the discharge letter guarantees the subsequent pharmacotherapy at the interface between tertiary to primary care. International data however shows that general practitioners (GPs) receive discharge letters with a delay and relevant information about DM is lacking. The aim of this study was to assess the point of view of German GPs concerning the information about DM, since no recent data about this topic is available. In a postal survey 516 GPs in the city of Berlin were contacted and asked about the transit of discharge letters and the information about DM. Results | 117 GPs answered the questionnaire (23 %). Most frequently, the patient himself handed over the information about DM to the GP on the day of his first visit in the practice after discharge. However, more than two third of GPs wished to receive the information before the patient's first consultation (73 %). Therefore, the majority preferred the electronic communication via fax (46 %) or email (9 %). Almost half of the GPs stated that discharge letters were lacking information about changes in medication and reasons for these changes. At the same time, nearly all GPs thought that these informational aspects were important. GPs wish an early and electronic transit of the DM with information concerning changes in medication and reasons. If these wishes were considered, a continuous and thus safer pharmacotherapy at the interface could be guaranteed. © Georg Thieme Verlag KG Stuttgart · New York.
Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed
BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness...... and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... Database therefore offers a valuable source for examining clinical, administrative, and research questions....
Wilson, Coralie J; Deane, Frank P; Marshall, Kellie L; Dalley, Andrew
Appropriate help-seeking is widely recognized as a protective factor, and vital for early treatment and prevention of mental health problems during adolescence. General medical practitioners (GPs), that is, family doctors, provide a vital role in the identification of adolescents with mental health problems and the provision of treatment as well as access to other specialists in mental health care services. The current study examined the association between suicidal ideation and intentions to seek help from a GP for suicidal thoughts, emotional problems and physical health problems, using a sample of 590 Australian high school students that was 56.7% female and aged 13-18 years (M = 15.56 years, SD = .66 years). Higher levels of suicidal ideation and general psychological distress were related to lower intentions to seek help from a GP for suicidal and physical problems. The results suggest that even at subclinical levels, increases in suicidal ideation or psychological distress may lead to help avoidance. School personnel and other gatekeepers need to be aware of this trend in order to be more assertive in encouraging and supporting appropriate help-seeking for mental health problems. School health promotion programs should consider including information to explicitly address the help-negation process.
Boer, Hendrik; Seydel, E.R.
Objectives: To get insight into medical opinions about the use of orthopaedic footwear and the medical and social factors related to the prescription of orthopaedic footwear by orthopaedists and rehabilitation practitioners. Methods: In this study 85 orthopaedists and 96 rehabilitation practitioners
Broers, Sandra; Smets, Ellen; Bindels, Patrick; Bennebroek Evertsz', Floor; Calff, Mart; de Haes, Hanneke
Objective: Adherence to asthma medication regimens is problematic in general practice. We developed and evaluated a communication training for general practitioners (GPs) to help them address medication adherence during routine consultations. This paper describes the development of the training and
Vangile B. Mkhatshwa; Gboyega A. Ogunbanjo; Langalibalele H. Mabuza
Background: Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa.Methods: We conducted a cross-sectional study on 48 medical practitioners at Od...
Full Text Available Although children with medically complex illness represent less than one percent of the total pediatric population, their health care expenditures and health care system utilization far exceed the numbers of other pediatric patients. Nurse practitioners, with their educational background focused on health care promotion and education, are uniquely qualified to reduce this inequity with cost effective care. Currently, nurse practitioners are used in a variety of health care settings and can provide acute and chronic care. Incorporating nurse practitioners at each step in the care of children with medical complexity can improve the quality of life for these children and their families, increase family satisfaction and decrease costs.
Against a background of increasing demands on limited resources, health economics is exerting an influence on decision making at all levels of health care. Health economics seeks to facilitate decision making by offering an explicit decision making framework based on the principle of efficiency. It is not the only consideration but it is an important one and practitioners will need to have an understanding of its basic principles and how it can impact on clinical decision making. This article...
Hakkennes, Sharon; Green, Sally
There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228) formed the sample for this study. Using a standardised data extraction form, one reviewer (SH), extracted the relevant information from the methods and/or results sections of the trials. Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively). Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change in practice, resulted in a change in the ultimate end-point of
Full Text Available Abstract Background There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. Methods The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228 formed the sample for this study. Using a standardised data extraction form, one reviewer (SH, extracted the relevant information from the methods and/or results sections of the trials. Results Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively. Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Conclusion Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change
The widespread availability of non-prescription medications has a significant potential impact on dental practice. Dentists are trained to provide scientifically-based advice on the appropriate use of medications, but it is not uncommon for patients to take matters into their own hands, especially if it is felt that the treatment provided is not solving a specific problem, or is insufficient. Well-meaning but often ill-informed family and friends frequently have an opinion as to what should be done. Not only may the suggested treatment not be effective, it may also be harmful. Over-the-counter medications can easily be obtained, and there is nothing to stop individuals exceeding recommended doses, and if this occurs, there could be adverse medical sequelae. Patient compliance in taking prescription medications is known to be problematic, and when combined with the ready availability of complementary medications, probiotics and illicit drugs, the risk of self-harm can be seen to be a distinct possibility. To compound the position, sometimes there seems to be, in a practical sense, little regulation on the advertising and marketing of non-prescription medications, which can leave consumers not only confused but potentially vulnerable. While complementary medicines may not have a significant role in dental practice in 2012, that may not always be the case as research continues, and reference is made to some aspects of ongoing work. Non-prescription medications are discussed, and some effects on oral health are considered.
Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.; Napolitano, Carlo
Ubiquity of Information and Communication Technology enables innovative telemedicine treatment applications for disease management of ambulant patients. Development of new treatment applications must comply with medical protocols and ‘way of working’ to obtain safety and efficacy evidence before
Loh Andreas; Hermann Katja; Miksch Antje; Kiolbassa Kathrin; Szecsenyi Joachim; Joos Stefanie; Goetz Katja
Abstract Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in ...
Background: Mental health problems can affect anybody including Doctors. It can be related to nature of our work and personal factors. Mental ill health includes a range of conditions like depression, bipolar disorder, anxiety and psychosis. Objective: To determine the prevalence of psychiatric morbidity among Medical ...
A team of four medical students was trained to collect the data and interviewed the subjects in their places of work using open-ended questions. ... this study indicates the absence of expectation and policy in this area of practice in South Africa.
Full Text Available Background: An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. Materials and Methods: A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Results: Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. Conclusion: General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum.
Kaur, Supreet; Khurana, Pankaj; Kaur, Harjit
An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum.
Jaquet, Antoine; Wandeler, Gilles; Tine, Judicaël; Diallo, Mouhamadou Baïla; Manga, Noel M; Dia, Ndeye Mery; Fall, Fatou; Dabis, François; Seydi, Moussa
In highly endemic settings for hepatitis B virus (HBV) infection such as Senegal, access to HBV prevention and care is rapidly evolving. In this context, all medical practitioners should have baseline knowledge on HBV infection and promote access to vaccination, screening, and care. A knowledge and attitudes survey on HBV infection was conducted among a randomly selected sample of medical practitioners in Senegal. Participants were asked to fill-out a questionnaire on the HBV epidemiology, prevention, and treatment. A 60-item knowledge score was computed; the lower quartile of the observed score was used to define poor knowledge. Factors associated with poor knowledge were assessed using a logistic regression model. A total of 127 medical practitioners completed the questionnaire. Only 14 (11.0%) participants knew that HBV vaccine could be safely administered to pregnant women and 65 (51.2%) to newborns. Older practitioners (> 40 years) as well as general practitioners (compared with specialists) were more likely to have a poor knowledge score with odds ratios (ORs) of 3.1 (95% confidence interval [CI] 1.0-9.2) and 2.6 (95% CI 1.0-7.3), respectively. Practitioners who declared not to recommend HBV screening frequently during their consultation were more likely to present a poor knowledge score [OR: 3.0; (95% CI 1.1-8.2)]. As universal HBV screening is being promoted in countries with endemic HBV infection, our finding that poor screening attitudes were associated with a poor knowledge is of concern. There is a need to raise awareness of medical practitioners in Senegal toward universal HBV screening and early vaccination of newborns.
Schadewaldt, Verena; McInnes, Elizabeth; Hiller, Janet E; Gardner, Anne
In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models. A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics. Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of
Agrawal, Ravindra; Foresti, Katia; Rajadurai, Jeremy; Zubaran, Carlos
To investigate the presence of different forms of experiences of discrimination in the medical workplace. A total of 526 questionnaires were sent out, including a demographic survey form and the Everyday Discrimination Scale. Experiences of being "treated with less courtesy than other people are" and feeling as "others acted if they're better than [me]" were reported as having occurred with almost daily frequency by 4.1 % of respondents. Those whose main language was not English and classified as "non-whites" had significantly more experiences ("ever") of discrimination in the medical workplace. The most commonly reported reasons for discrimination were ancestry (31.3%), "race" (28.1%), and gender (21.1%). The results of this survey indicate that a proportion of doctors experience discrimination in the workplace in Australia. This phenomenon was more commonly reported by doctors of minority status.
Debate continues over the acts/omissions doctrine, and over the concepts of duty and charity. Such issues inform the debate over the moral permissibility of euthanasia. Recent papers have emphasised moral sensitivity, medical intuitions, and sub-standard palliative care as some of the factors which should persuade us to regard euthanasia as morally unacceptable. I argue that these lines of argument are conceptually misdirected and have no bearing on the bare permissibility of voluntary euthan...
Full Text Available Abstract Background The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice. Methods A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74 were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data. Results Seventy (95% of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12 reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context. Conclusion Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are
Chang, YunKyung; Mark, Barbara
Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction. The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors. A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States. Error-producing conditions included work environment factors (work dynamics and nurse mix), team factors (communication with physicians and nurses' expertise), personal factors (nurses' education and experience), patient factors (age, health status, and previous hospitalization), and medication-related support services. Poisson models with random effects were used with the nursing unit as the unit of analysis. A significant negative relationship was found between learning climate and medication errors. It also moderated the relationship between nurse mix and medication errors: When learning climate was negative, having more registered nurses was associated with fewer medication errors. However, no relationship was found between nurse mix and medication errors at either positive or average levels of learning climate. Learning climate did not moderate the relationship between work dynamics and medication errors. The way nurse mix affects medication errors depends on the level of learning climate. Nursing units with fewer registered nurses and frequent medication errors should examine their learning climate. Future research should be focused on the role of learning climate as related to the relationships between nurse mix and medication errors.
Parry, Angela M; Barriball, K Louise; While, Alison E
To explore the factors contributing to Registered Nurse medication administration error behaviour. A narrative review. Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error. Copyright © 2014
Ek, Bosse; Svedlund, Marianne
To describe registered nurses' experiences at an Emergency Medical Dispatch Centre. It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patient's arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses. A qualitative design was used for this study. Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used. Two themes emerged during the analysis: 'Having a profession with opportunities and obstacles' and 'Meeting serious and difficult situations', with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned. Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses. Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame
Whayne, Thomas F
Alternative medications as a term call up many different meanings, significance, and perceptions to various medical practitioners. Some are good; others are bad. A wide range of alternative medications with relevance or connection to cardiovascular (CV) disease have been considered. While many are worthless, others have definite benefit, and at least one, chelation therapy, is associated with definite harm, significant risk, no benefit, and enrichment of the practitioners who prescribe it. The issues concerning alternative therapies will likely never be studied with randomized clinical trials due to the lack of a profit motive on the part of pharmaceutical companies--only rarely do other institutions, such as the National Institutes of Health, support medicinal studies. Basic knowledge of alternative therapies is essential for the CV specialist and other practicing physicians and other practitioners, since at least a few of their patients will take these medications regardless of medical advice. The result is that a number of these alternative medications will then interact with conventional CV medications, many times unfavorably.
Phelps, William R.
This training guide is prepared primarily for the Vocational Rehabilitation practitioner, although academicians may also find it of value. Sixteen specific areas are covered, including common abbreviations, prefixes and suffixes, root words, general terms, operative terminology, special senses and body systems, general medical examination, medical…
Clinical biochemistry departments can be a valuable source of clinical advice for further investigations and the need for referral to specialist clinics. This paper outlines the pattern of clinical advice sought by general practitioners in a district hospital setting, and addresses some of the issues regarding seeking such advice and the implications for continuing medical education and training. PMID:9196966
Berendsen, Annette J.; Benneker, Wim H. G. M.; Schuling, Jan; Rijkers-Koorn, Nienke; Slaets, Joris P. J.; Meyboom-de Jong, Betty
Background: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue
Valentin, Jack; )
This didactic text is devoted to patients' protection against unnecessary exposure to ionizing radiation. There are obvious benefits to health from medical uses of radiation, i.e. in X-ray diagnostics, in interventional radiology, nuclear medicine and radiotherapy. However, there are well-established risks from improperly applied high doses of radiation (therapy, interventional radiology) and possible deleterious effects from small radiation doses used in diagnostics). Appropriate use of large doses prevents serious harm from therapy, but low doses carry a risk that cannot be entirely eliminated. Diagnostic use of radiation requires therefore such methodology that would secure high diagnostic gains while limiting the possible harm to the lowest possible level. The text provides ample information on opportunities to minimize the doses, and therefore the risk from diagnostic uses of radiation. This objective may be reached by avoiding unnecessary (unjustified) examinations, and optimizing the applied procedures both from the standpoint of diagnostic quality and of reduction of the excessive doses to patients. Optimization of patient protection in radiotherapy must depend on maintaining sufficiently high doses to irradiated tumours, securing a high cure rate, while protecting the healthy tissues to the largest extent possible. Problems related to special protection of human embryo and foetus in course of diagnostic and therapeutic uses of radiation are presented and respective practical solutions are recommended
The private sector accounts for about 75 percent of outpatient as well as inpatient medical care in Andhra Pradesh. The presence of a large number of unqualified medical practitioners in the rural areas and urban slums indicate that they provide most of the outpatient services in the private sector. Given the huge quantum of services provided by the RMPs, the present study aims at identifying their number, characteristics and the nexus with the qualified doctors through a case study of one di...
The average indemnification has doubled in the last 15 years for all physicians, it has tripled for radiology. Furthermore, 1/3 of all medical malpractice are lost by the radiologist. The most commonly missed diagnoses are breast cancer, lung cancer, and fracture of the spine. Clinical knowledge and practice is no longer a luxury of operating in calm and academic environment. In real life things don’t always go according to plan. Identification of the risk. This may vary depending upon the practice. E.g if the practice involves interpreting studies from a busy trauma center or a mammography center, the practice involves higher risk than a free-standing MRI center. When it is appropriate, a radiologist should not be reluctant to indicate that an additional study or procedure may be of diagnostic or confirmatory value when the initial diagnosis is not clear or in doubt Lack of appropriate and timely communication appears to be one of the greatest problems confronting radiologists today. However, this is the one area in which the radiologist can dramatically improve the odds against being sued, and that is by communicating and documenting the communication. The ACR Guideline for Communication indicates that a precise diagnosis should be given whenever possible and that a differential diagnosis should be given when appropriate Radiologist need be qualified to interpret or perform a procedure and maintain your competence. Do not attempt to interpret studies in an area in which you do not feel comfortable or have not had sufficient training. The ACR Guideline may be a double-edged sword for some. Certainly, the ACR Guideline can be used against you if you deviated from it and did not document why you did so
Sulosaari, Virpi; Suhonen, Riitta; Leino-Kilpi, Helena
The aim of this integrative literature review was to describe registered nurses' medication competence. The objectives of the literature review were to chart the need for future studies and use the results for instrument development. Nurses play a vital role in different phases of a patient's medication process and thus need adequate competence to fulfil their role. Research on nurses' level of medication competence in different competency areas has been published. However, previous studies have lacked a comprehensive or integrated definition or description of medication competence in nursing. Integrative literature review. The integrative literature review followed five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Eligible articles were identified via systematic literature search of research and evidence-based--databases. Twenty-one studies met the selection criteria. Eleven competency areas that constitute nurses' medication competence were identified: (1) anatomy and physiology, (2) pharmacology, (3) communication, (4) interdisciplinary collaboration, (5) information seeking, (6) mathematical and medication calculation, (7) medication administration, (8) medication education, (9) assessment and evaluation, (10) documentation and (11) promoting medication safety as part of patient safety. The analysis revealed three major categories which integrate these competency areas: (1) decision making competence, (2) theoretical competence and (3) practical competence. Medication competence requires a solid knowledge base and the ability to apply that knowledge in real-life situations during often complex and dynamic patient medication processes. Decision making competence was found to be an important and integral part of a nurses' theoretical and practical competence. These main competence categories integrated all of the 11 competency areas identified in this review. It is important to determine
Full Text Available Background and purpose: The purpose of this research was to evaluate the quantity and quality of continuing medical education programs from the viewpoint of general medical practitioners in Ilam province.Methods: The research method was descriptive survey and the statistic sample was a group of 61 general medical practitioners who have been working in Ilam during 2010-2011 and were chosen by simple random sampling method. The data collection tool was a questionnaire with 50 items and reliability coefficient obtained using Cronbach's alpha which was 88%.Results: The findings showed that there is a meaningful/significant relationship between CME (Continuing Medical Education/retraining programs and improving GPs (General Practitioner clinical skills with reliability of 99% and this relationship is direct and positive (r=0.502. It means that increasing the quality and quantity of these programs has positive effect on improving general practitioners’ clinical skills. There was no meaningful/significant relationship between the method of teaching and GPs satisfaction (r=0.160. It means most of these practitioners were not satisfied with using training equipment, teaching methods, teachers' knowledge and manners. Also, there was no meaningful/significant relationship between teaching times and educational materials and GPs satisfaction (r=0.73 .It shows that the rate of GPs satisfaction from teaching times and educational materials is very low and there is little coherence between them. But there was a meaningful/significant relationship between GPs job requirements and educational materials with reliability of 95% (r=0.326. It means presenting suitable teaching materials and content related to GPs jobs requirements led to increase GPs desire to attend educational classes .There was no meaningful/significant relationship between time dedicated to each topic and improving GPs skills (r=0.096. So, findings indicate that there is no coincidence between
Lallukka, Tea; Haukka, Jari; Partonen, Timo; Rahkonen, Ossi; Lahelma, Eero
Objectives We aimed to examine longitudinally whether workplace bullying was associated with subsequent psychotropic medication among women and men. Design A cohort study. Setting Helsinki, Finland. Participants Employees of the City of Helsinki, Finland (n=6606, 80% women), 40–60 years at baseline in 2000–2002, and a register-based follow-up on medication. Primary and secondary outcome measures Workplace bullying comprised questions about current and earlier bullying as well as observing bullying. The Finnish Social Insurance Institution's register data on purchases of prescribed reimbursed psychotropic medication were linked with the survey data. All psychotropic medication 3 years prior to and 5 years after the baseline survey was included. Covariates included age, prior psychotropic medication, childhood bullying, occupational class, and body mass index. Cox proportional hazard models (HR, 95% CI) were fitted and days until the first purchase of prescribed psychotropic medication after baseline were used as the time axis. Results Workplace bullying was associated with subsequent psychotropic medication after adjusting for age and prior medication among both women (HR 1.51, 95% CI 1.18 to 1.93) and men (HR 2.15, 95% CI 1.36 to 3.41). Also observing bullying was associated with subsequent psychotropic medication among women (HR 1.53, 95% CI 1.25 to 1.88) and men (HR 1.92, 95% CI 1.23 to 2.99). The associations only modestly attenuated after full adjustment. Conclusions Our findings highlight the significance of workplace bullying to subsequent psychotropic medication reflecting medically confirmed mental problems. Tackling workplace bullying likely helps prevent mental problems among employees. PMID:23242240
Smith, Tony [University of Newcastle Department of Rural Health, Taree, New South Wales (Australia); Harris, Jillian [Crown Princess Mary Cancer Centre, Westmead, Sydney, New South Wales (Australia); Woznitza, Nick [Homerton University Hospital and School of Allied Health Professions, Canterbury Christ Church University, Canterbury (Australia); Maresse, Sharon [Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia (Australia); Sale, Charlotte [School of Medical Science, RMIT University, Melbourne, Victoria (Australia); University of Newcastle Department of Rural Health, Taree, New South Wales (Australia)
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.
Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities
Bardach, Shoshana H; Real, Kevin; Bardach, David R
Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners' experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one's notes. Limitations in technology-including limited computer availability, documentation complexity, and sluggish sign-in processes-also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care.
Mkhatshwa, Vangile B; Ogunbanjo, Gboyega A; Mabuza, Langalibalele H
Overweight and obesity have become a global problem. Health professionals are poorly prepared in weight management, which has an effect on their attitudes and management skills with regard to overweight and obese patients.Aim and setting: To assess the knowledge, attitudes and management skills of medical practitioners regarding weight management at Odi District Hospital, Gauteng Province, South Africa. We conducted a cross-sectional study on 48 medical practitioners at Odi Hospital between 01 October and 31 October 2013. A self-administered questionnaire was used to assess their knowledge, attitudes and management skills in weight management. The SPSS® statistical software (Version 22) was used for data analysis. A p < 0.05 was considered significant. Fifty medical practitioners were recruited, 48 consented to participate and 28 (58.3%) were male. Their categories were community service doctors (3), medical officers (21), registrars (22) and others (2). Thirty-seven (77.1%) never received training in weight management (p < 0.001). Thirty-two (66.7%) regarded weight management as not confined to a dietician (p < 0.001) and 27 (56.2%) regarded weight management as usually unsuccessful (p = 0.004). Forty-seven (97.9%) provided lifestyle modifications and 43 (89.6%) involved the patient's family in weight management (p < 0.001). More non-registrars [14 (77.8%)] than registrars [8 (38.1%)] measured the body mass index (BMI) routinely (p = 0.013). Few medical practitioners received training in weight management. They regarded weight management as usually unsuccessful and lacked confidence in the same owing to lack of training. They provided lifestyle modifications and involved the patient's family in weight management. Non-registrars measured the BMI routinely. There is a need for training in weight management at undergraduate and post-graduate levels.
Izuka, Nkeonye J; Alexander, Matthew A W; Balasooriya-Smeekens, Chantal; Mant, Jonathan; De Simoni, Anna
Secondary prevention medications reduce risk of stroke recurrence, yet many people do not receive recommended treatment, nor take medications optimally. Exploring how patients report making use of practitioners' advice on secondary prevention medicines on an online forum and what feedback was received from other participants. Thematic analysis of the archive of Talkstroke (2004-2011), UK. Posts including any secondary prevention medication terms, General Practitioner (GP) and their replies were identified. Fifity participants talked about practitioners' advice on secondary prevention medications in 43 discussion threads. Patients consulted practitioners for reassurance and dealing with side effects. Practitioners' advice varied from altering to maintaining current treatment. Three main themes emerged from the use of practitioners' advice: patients following advice (reassured, happy when side effects made tolerable, or still retaining anxiety about treatment); patients not following advice (admitting adherence on-off or stopping medications as side effects still not tolerable); asking other participants for feedback on advice received. Practitioners' advice was disregarded mainly when related to dealing with statin side effects, after one or two consultations. Themes for feedback involved sharing experience, directing back to practitioners, or to external evidence. Side effects of secondary prevention medications and statins in particular, cause anxiety and resentment in some patients, and their concerns are not always addressed by practitioners. Practitioners could consider more proactive strategies to manage such side effects. Forum feedback was appropriate and supportive of the practitioners' advice received. Our findings from peer-to-peer online conversations confirm and widen previous research. © The Author 2017. Published by Oxford University Press.
Al-Madani, Khawla M.; Landman, Jacqueline; Musaiger, Abdulrahman O.
The objective of this study was to evaluate nutrition knowledge, attitudes and practices in Bahrain. A cross-sectional survey was carried out in 1998. Highly statistically significant differences (p less than 0.0001) were observed between practitioners and students in relation to knowledge concerning recommended daily allowance. The results…
Backhouse, Susan H; McKenna, Jim
Central to the work of many medical practitioners is the provision of pharmaceutical support for patients. Patients can include athletes who are subject to anti-doping rules and regulations which prohibit the use of certain substances in and out of competition. This paper examines the evidence on medical practitioners' knowledge, attitudes and beliefs towards doping in sport. A systematic search strategy was followed. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches limited to English language articles published between 1990 and 2010. Articles were assessed for relevance by two independent assessors and the results of selected studies were abstracted and synthesised. Outcomes of interest were knowledge, attitudes and beliefs in relation to doping in sport. Six studies met the inclusion criteria and were examined in detail. Samples reflected a range of medical practitioners drawn from the UK, France (2), Greece, Italy and Ireland. The investigations varied with respect to outcome focus and quality of evidence presented. Whilst the extant empirical research posits a negative attitude towards illegal performance enhancement combined with a positive inclination towards doping prevention, it also exposes a limited knowledge of anti-doping rules and regulations. Insufficient education, leading to a lack of awareness and understanding, could render this professional group at risk of doping offences considering Article 2.8 of the World Anti-Doping Agency Code (WADC). Moreover, in light of the incongruence between professional medical codes and WADC Article 2.8, medical professionals may face doping dilemmas and therefore further discourse is required. At present, the current evidence-base makes it difficult to plan developmentally appropriate education to span the exposure spectrum. Addressing this situation appears warranted. Copyright © 2011 Elsevier B.V. All rights reserved.
Hassali, Mohamed Azmi Ahmad; Al-Haddad, Mahmoud; Shafie, Asrul Akmal; Tangiisuran, Balamurugan; Saleem, Fahad; Atif, Muhammad; Al-Qazaz, Harith
This study aims to explore the perceptions of general practitioners (GPs) from the state of Penang toward the feasibility of implementing the medication reconciliation program in Malaysia. A cross-sectional descriptive study using a validated, self-completed anonymous 18-item questionnaire was undertaken over a period of 2 months in 2010. The study was conducted in the state of Penang, Malaysia. A letter consisting of survey questionnaires and prepaid return envelope were mailed to 429 GPs identified from the Private Medical Practice Control Department Registry. A total of 86 responses were received with response rate of 20.1%. Majority (90.1%) of the respondents agreed that medication reconciliation can be a feasible strategy to improve medication safety, and 97.7% confirmed that having an accurate up-to-date list of the patient's previous medication will be useful in the rational prescribing process. However, about half (56.9%) of them felt that standardization of the medication reconciliation process in all clinics will be difficult to achieve. Three quarters (73.2%) of the respondents believed that the involvement of GPs alone is insufficient, and 74.5% agreed that this program should be expanded to community pharmacy setting. More than 90% of the respondents agreed upon the medication reconciliation card proposed by the researchers. General practitioners in Penang are generally in favor of the implementation of medication reconciliation program in their practice. Because medication reconciliation has been shown to reduce many medicine-related problems, it is thus worth considering the feasibility of nationwide implementation of such program.
Full Text Available Summarises some of the principal findings of a recent study investigation of information usage by general medical practitioners (GPs. The work was based on previous studies of the value and impact of information, these studies being undertaken in the corporate sector in Canada, the USA and the UK. The study used a critical incident technique similar to that employed in the Canadian and USA studies. Twenty seven in-depth interviews were conducted with general practitioners (GPs in the Trent Health Region (only one from each practice. The sample, selected from two health districts, included large, medium and small practices, fund-holding and non-fund-holding practices, and training and non-training practices, with some representation of those located in deprived and non-deprived (socio-economic areas.
Ireland, Michael J; Clough, Bonnie; Gill, Kim; Langan, Fleur; O'Connor, Angela; Spencer, Lyndall
Stress and burnout are highly prevalent among medical doctors, and are associated with negative consequences for doctors, patients, and organizations. The purpose of the current study was to examine the effectiveness of a mindfulness training intervention in reducing stress and burnout among medical practitioners, by means of a Randomised Controlled Trial design. Participants were 44 intern doctors completing an emergency department rotation in a major Australian hospital. Participants were randomly assigned to either an active control (one hour extra break per week) or the 10-week mindfulness training intervention. Measures of stress and burnout were taken pre-, mid- and post intervention. Participants undergoing the 10-week mindfulness training program reported greater improvements in stress and burnout relative to participants in the control condition. Significant reduction in stress and burnout was observed for participants in the mindfulness condition. No such reductions were observed for participants in the control condition. Mindfulness interventions may provide medical practitioners with skills to effectively manage stress and burnout, thereby reducing their experience of these symptoms. It is likely that doctors would benefit from the inclusion of such a training program as a part of their general medical education.
Marteau Theresa M
Full Text Available Abstract Background Many interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptions of the effectiveness of medical interventions. This study aims to explore general practitioners' perceptions of the nature of 'effectiveness'. Methods The design was qualitative in nature using the repertory grid technique to elicit the constructs underlying the perceived effectiveness of a range of medical interventions. Eight medical interventions were used as stimuli (diclophenac to reduce acute pain, cognitive behaviour therapy to treat depression, weight loss surgery to achieve weight loss, diet and exercise to prevent type 2 diabetes, statins to prevent heart disease, stopping smoking to prevent heart disease, nicotine replacement therapy to stop smoking, and stop smoking groups to stop smoking. The setting involved face-to-face interviews followed by questionnaires in London Primary Care Trusts. Participants included a random sample of 13 general practitioners. Results Analysis of the ratings showed that the constructs clustered around two dimensions: low patient effort versus high patient effort (dimension one, and small impact versus large impact (dimension two. Dimension one represented constructs such as 'success requires little motivation', 'not a lifestyle intervention', and 'health-care professional led intervention'. Dimension two represented constructs such as 'weak and/or minimal evidence of effectiveness', 'small treatment effect for users', 'a small proportion of users will benefit' and 'not cost-effective'. Constructs within each dimension were closely related. Conclusions General practitioners judged the effectiveness of medical interventions by considering two broad dimensions: the extent to which interventions involve patient effort, and the size of their impact. The latter is informed by trial evidence, but
Competition laws have only applied to many participants in the health care industry in Australia and New Zealand since the mid 1990s. Since then, the Australian Competition and Consumer Commission has considered a number of applications by medical practitioner associations and private hospitals to authorise potentially anti-competitive conduct, while the New Zealand Commerce Commission has successfully prosecuted a group of ophthalmologists. Amongst medical practitioners, however, there is still confusion and misunderstanding concerning the type of conduct caught by the Australian Trade Practices Act 1974 (Cth) and the New Zealand Commerce Act 1986 (NZ). This is of serious concern given the substantial penalties associated with price-fixing and restrictive trade practices. This article examines the provisions of these Acts most relevant to medical practitioners as well as a number of determinations and judicial decisions. To provide practical assistance to medical practitioners, the key lessons are extracted.
Full Text Available Purpose: In order to train more high-level general practitioners (GPs to work in primary care institutions, China launched the 5+3 model in 2015 as a way to educate GPs nationwide. In this study, we investigated the awareness of the 5+3 model, career choices after graduation, and influences on GP career choice of undergraduate medical students from Zhengzhou University. Methods: The study population consisted of 288 undergraduate medical students from Zhengzhou University. We explored the students׳ awareness of the 5+3 model, career choices after graduation, influences on general practitioner career choice and mental status by using a self-report questionnaire and the Chinese version of the 21-item Depression Anxiety Stress Scale. Results: We found 34.2% of students did not understand the new policy. Only 23.2% of students would choose to work as a GP after graduation, and those tended to be female, to have a monthly family income less than 4000 ¥, or to be from rural areas. Only 10% of undergraduate medical students expressed a preference to work at primary care institutions. The participants showed higher anxiety and stress scores than did a previously published group of Chinese college students, and those who chose to pursue higher education had more anxiety and stress than those who decided to become general practitioners. Discussion: More efforts should be made to popularize the 5+3 model and mental intervention among medical students. More efforts should be tried to increase the income/welfare benefits and strengthen the infrastructure of primary care institutions to attract more medical students. Keywords: 5+3 model, General practitioner, Health care reform, Hierarchical medical system
Nixon, Michael; Kousgaard, Marius Brostrøm
Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP's practice and how do GPs make decisions about discontinuing medication? Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. The results show that different discontinuation cues (related to the type of consultation, medical records and the patient) create situations of dissonance that can lead to the GP considering the option of discontinuation. We also show that there is a lot of ambiguity in situations of discontinuing and that some GPs trialled discontinuing as means of generating more information that could be used to deal with the ambiguity. We conclude that the practice of discontinuation should be conceptualised as a continually evaluative process and one that requires sustained reflection through a culture of systematically scheduled check-ups, routinely eliciting the patient's experience of taking drugs and trialling discontinuation. Some policy recommendations are offered including supporting GPs with lists or handbooks that directly address discontinuation and by developing more person centred clinical guidelines that discuss discontinuation more explicitly.
Makama, Jerry Godfrey; Joshua, Istifanus Anekoson; Makama, Elizabeth Jerry
There has been an increase in the incidence of disasters in many parts of the world. Similarly, Nigeria has witnessed a recent increase of man-made disaster events such as plane crash, fire incidents, flood, and building collapse, including bomb blast orchestrated by terrorists that often create emergency situations. Therefore, the aim of the study was to evaluate family emergency plan and preparedness among medical practitioners in Zaria. This was a cross-sectional descriptive study (May-July, 2013) of medical practitioners in Zaria, Nigeria. The structured questionnaire sought the socio-demographic features of the respondents, the availability of emergency gate(s) in the house, education of safety measures within and outside the house, well-known located shut-off devices for gases, electricity, and water in the house, and written document/policy in the event of disaster. Also, planned orientations/drills/sensitizations, whether there is contact information of family members and supporting agencies. Majority of the respondents were male 56 (80.0 percent) and fall within the age group of 46-50 years (20.0 percent). Only 8.6 percent admitted having an unwritten policy on emergency management in their houses. Similarly, only 8.6 percent do create time to teach their family members on emergency management. Only 27 (38.6 percent) had emergency supplies kits and among this group, water appears to be the most essential component that the respondents had paid attention to, leaving out special items. The communication plans of respondents to likely supportive services/agencies during disaster showed that majority had contact address or have affirmative plans for hospital and ambulance services than for radio and television stations. Family emergency plans and preparedness among medical practitioners in Zaria are extremely low. There is a gap between knowledge of what need to be done to enhance preparedness and internalizing preparedness recommendations in the study area.
de Jonge, Linda; Garne, Ester; Gini, Rosa
INTRODUCTION: Research on associations between medication use during pregnancy and congenital anomalies is significative for assessing the safe use of a medicine in pregnancy. Congenital anomaly (CA) registries do not have optimal information on medicine exposure, in contrast to prescription...... databases. Linkage of prescription databases to the CA registries is a potentially effective method of obtaining accurate information on medicine use in pregnancies and the risk of congenital anomalies. METHODS: We linked data from primary care and prescription databases to five European Surveillance...... of Congenital Anomalies (EUROCAT) CA registries. The linkage was evaluated by looking at linkage rate, characteristics of linked and non-linked cases, first trimester exposure rates for six groups of medicines according to the prescription data and information on medication use registered in the CA databases...
Brom, Heather M; Melnyk, Bernadette M; Szalacha, Laura A; Graham, Margaret
There is a growing demand for nurse practitioners (NPs) within academic medical centers (AMCs) because of physician shortages and increased need for access to care. In order to retain these NPs, it is important to assess their role perception and satisfaction. The purpose of this study was to evaluate these concepts and their relationships to stress and intent to stay. A 90-item descriptive survey, including a new role perception scale and the Misener Nurse Practitioner Job Satisfaction Scale, was administered to all NPs at a Midwestern AMC. The response rate was 62.4% (n = 181). Overall, the NPs had moderate role perception (M = 4.30, SD = 1.23) and were somewhat satisfied (M = 4.23, SD = 0.74). Over a third (39.4%) reported they were unsure about staying or did not intend to stay in their position. Intent to stay and stress were moderately correlated with overall satisfaction and weakly correlated with role perception. There were significant differences in the intrapractice and professional aspects of job satisfaction based on their supervisor. With increased NP needs, it is crucial for AMCs and NP supervisors to assess role perception, satisfaction, and stress among NPs in order to ensure a stable, satisfied, and productive workforce. ©2015 American Association of Nurse Practitioners.
Rajabi, Enayat; Abidi, Syed Sibte Raza
The aim of this paper is to investigate semantic web based methods to enrich and transform a medical discussion forum in order to perform semantics-driven social network analysis. We use the centrality measures as well as semantic similarity metrics to identify the most influential practitioners within a discussion forum. The centrality results of our approach are in line with centrality measures produced by traditional SNA methods, thus validating the applicability of semantic web based methods for SNA, particularly for analyzing social networks for specialized discussion forums.
Watson, Estelle D; Oddie, Brydie; Constantinou, Demitri
There is compelling evidence for the benefits of regular exercise during pregnancy, and medical practitioners (MPs) can play an important role in changing antenatal health behaviours. The purpose of this study was to assess the knowledge, attitudes and beliefs of South African MPs towards exercise during pregnancy. A convenience sample of ninety-six MPs working in the private health care sector, including General Practitioners (n = 58), Obstetricians/Gynaecologists (n = 33) and other Specialists (n = 5), participated in this cross sectional, descriptive survey study. A 33-item questionnaire was distributed manually at medical practices and via email to an on-line survey tool. Descriptive statistics and frequency tables were calculated for all questions. Chi-squared and Fisher's exact statistical tests were used to determine the differences in response by age, speciality and years of practice (p exercise during pregnancy is beneficial, and were knowledgeable on most of the expected benefits. Seventy-eight percent believed that providing exercise advice is an important part of prenatal care, however only 19% provided informational pamphlets and few (24%) referred to exercise specialists. A large majority (83%) were unaware of the recommended exercise guidelines. Although age and years of practice played no role in this awareness, practitioners who focussed on obstetrics and gynaecology were more likely to be aware of the current guidelines, than those in general practice (p exercise during pregnancy, their advice did not always align with the current guidelines. Therefore, better dissemination of available research is warranted, to bridge the gap between clinical knowledge and current recommendations for physical activity promotion.
Ammi, Mehdi; Ambrose, Sarah; Hogg, Bill; Wong, Sabrina
Nurses, whether registered nurses (RNs) or nurse practitioners (NPs), are becoming key providers of primary care services. While evidence for the influence of NPs on patient experience in primary care is mounting, this is less so for RNs. We use the Canadian component of the international Quality and Costs of Primary Care 2013/14 survey to investigate the mechanisms by which nurses can affect patients' experience in primary care, focusing on accessibility and appropriateness of care. The data allow us to distinguish between family practice RNs, specialised RNs and NPs, and covers all types of patients visiting a primary care clinic in a variety of contexts in all Canadian provinces. In addition to the types of nurses and full-time equivalent (FTE) numbers, we explore the role of nurse autonomy and collaboration. Our regression results show that one of the most important predictors of patient experience is the collaboration between health professionals, whereas nurse staffing in terms of FTE numbers has little influence by itself. Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic. Our results can inform decision-makers on how to strengthen primary care provision, and particularly in Canadian context, the adaptation of the recently implemented interprofessional primary care teams. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available The World Health Organization (WHO has acknowledged the large West African Ebola virus disease (EVD outbreak to be a community health disaster of global concern, and the spread of disease demands a synchronized response. Medical practitioners have an increased risk of contracting the disease as compared to others as they are directly exposed to patients’ blood or fluids. This study evaluated the knowledge of medical practitioners in Karachi regarding EVD. It was descriptive and exploratory in nature and took place over a period of 4 months, i.e., August 2016 to November 2016. The respondents were randomly selected by convenience sampling and surveyed with a 20-item questionnaire. Overall, 403 questionnaires were included in the study and a response rate of 80.6% was achieved. The majority (56.3% considered themselves to be somewhat knowledgeable; females had more knowledge as compared to male (p < 0.003. More than 80% knew about the 2014 Ebola outbreak in West Africa. Interestingly, the findings revealed that respondents’ knowledge about diagnosis and identification of EVD is good. Respondents considered EVD a severe disease and emphasized on the need for protective measures when contacting affected patients. Interventions should be tailored to focus on areas where respondents showed a lack of knowledge about the disease.
Full Text Available Justin M Cousins, Luke RE Bereznicki, Nick B Cooling, Gregory M Peterson School of Medicine, Faculty of Health, University of Tasmania, Hobart, TAS, Australia Objective: The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs to nursing home residents with dementia.Subjects and methods: GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from south-eastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.Results: A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141, and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126.Conclusion: According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities. Keywords: dementia, nursing homes, general practitioners, antipsychotic agents, benzodiazepines
Viale, Pamela Hallquist
To describe the marketing strategies of direct-to-consumer (DTC) advertising and the risks, benefits, and potential influence on the prescribing practices of nurse practitioners (NPs). Journal articles, media sources, and clinical experience. The effect of DTC advertising of prescription medications on NPs has not been well studied. Although there are studies that examine the effects of DTC advertising on physician prescribing as well as the effects of this practice on the consumer, opinions on the benefits of DTC advertising are varied. NPs need to recognize the potential influence of DTC advertising and to be prepared to guide patients toward appropriate medication choices by participating in a partnership with patients. Health care providers, including NPs, need to work with the pharmaceutical industry to encourage accountability of DTC advertising, thus improving dissemination of correct information and promoting positive outcomes for health consumers and patients.
Crowley, Des; Collins, Claire; Delargy, Ide; Laird, Eamon; Van Hout, Marie Claire
Governmental debate in Ireland on the de facto decriminalisation of cannabis and legalisation for medical use is ongoing. A cannabis-based medicinal product (Sativex®) has recently been granted market authorisation in Ireland. This unique study aimed to investigate Irish general practitioner (GP) attitudes toward decriminalisation of cannabis and assess levels of support for use of cannabis for therapeutic purposes (CTP). General practitioners in the Irish College of General Practitioner (ICGP) database were invited to complete an online survey. Anonymous data yielded descriptive statistics (frequencies, percentages) to summarise participant demographic information and agreement with attitudinal statements. Chi-square tests and multi-nominal logistic regression were included. The response rate was 15% (n = 565) which is similar to other Irish national GP attitudinal surveys. Over half of Irish GPs did not support the decriminalisation of cannabis (56.8%). In terms of gender, a significantly higher proportion of males compared with females (40.6 vs. 15%; p cannabis should be decriminalised (54.1 vs. 31.5%; p = 0.021). Over 80% of both genders supported the view that cannabis use has a significant effect on patients' mental health and increases the risk of schizophrenia (77.3%). Over half of Irish GPs supported the legalisation of cannabis for medical use (58.6%). A higher percentage of those who were level 1-trained (trained in addiction treatment but not to an advanced level) agreed/strongly agreed cannabis should be legalised for medical use (p = 0.003). Over 60% agreed that cannabis can have a role in palliative care, pain management and treatment of multiple sclerosis (MS). In the regression response predicator analysis, females were 66.2% less likely to agree that cannabis should be decriminalised, 42.5% less likely to agree that cannabis should be legalised for medical use and 59.8 and 37.6% less likely to agree that cannabis has a role in
Liu, Ying; Ren, Wen; Qiu, Yan; Liu, Juanjuan; Yin, Pei; Ren, Jingjing
Mobile phones and mobile phone apps have expanded new forms of health professionals' work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs' current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (χ(2)=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice.
Ewertsson, Mona; Gustafsson, Margareta; Blomberg, Karin; Holmström, Inger K; Allvin, Renée
One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way. The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices. A cross-sectional study with descriptive and comparative design. RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1 year were included in the study (n=113, response rate 57%). Data were collected by means of a postal questionnaire. Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon. This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.
Marteau Theresa M
Full Text Available Abstract Background General practitioners' (GPs negative beliefs about nicotine dependence medications may act as barriers to prescribing them. Methods Study1: Twenty-five GPs from 16 practices across London were interviewed in this qualitative study. Framework analysis was used to identify key themes. Study 2: A convenience sample of 367 GPs completed an internet-based survey. Path-analysis was used to examine the relations between beliefs and intentions to prescribe smoking cessation medications. Results Study 1: Whilst nicotine replacement therapy (NRT and bupropion were generally perceived as effective and cost-effective, the effectiveness of NRT was seen as critically dependent on behavioural support for smoking cessation. This dependence appeared to be influenced by perceptions that without support smokers would neglect psychological aspects of smoking and use NRT incorrectly. GPs perceived bupropion as dangerous and were concerned about its side-effects. Study 2: GPs' beliefs had medium (NRT, f2 = .23 to large (bupropion, f2=.45; NRT without support, f2=.59 effects on their intentions to prescribe medications. Beliefs about effectiveness of NRT and bupropion and the perceived danger of bupropion were the key predictors of intentions to prescribe NRT and bupropion, respectively. Beliefs about neglecting psychological aspects of smoking and incorrect use had indirect effects on intentions to prescribe NRT without support, operating via beliefs about effectiveness. Conclusion GPs vary in their beliefs about the effectiveness and safety of smoking cessation medications. Their intentions to prescribe these medications vary in line with these beliefs. Interventions aimed at increasing the likelihood with which GPs prescribe these medications may be more effective if they addressed these beliefs.
Alber, Kathrin; Kuehlein, Thomas; Schedlbauer, Angela; Schaffer, Susann
Medical overuse is a topic of growing interest in health care systems and especially in primary care. It comprises both over investigation and overtreatment. Quaternary prevention strategies aim at protecting patients from unnecessary or harmful medicine. The objective of this study was to gain a deeper understanding of relevant aspects of medical overuse in primary care from the perspective of German general practitioners (GPs). We focused on the scope, consequences and drivers of medical overuse and strategies to reduce it (=quaternary prevention). We used the qualitative Grounded Theory approach. Theoretical sampling was carried out to recruit GPs in Bavaria, Germany. We accessed the field of research through GPs with academic affiliation, recommendations by interview partners and personal contacts. They differed in terms of primary care experience, gender, region, work experience abroad, academic affiliation, type of specialist training, practice organisation and position. Qualitative in-depth face-to-face interviews with a semi-structured interview guide were conducted (n = 13). The interviews were audiotaped and transcribed verbatim. Data analysis was carried out using open and axial coding. GPs defined medical overuse as unnecessary investigations and treatment that lack patient benefit or bear the potential to cause harm. They observed that medical overuse takes place in all three German reimbursement categories: statutory health insurance, private insurance and individual health services (direct payment). GPs criticised the poor acceptance of gate-keeping in German primary care. They referred to a low-threshold referral policy and direct patient access to outpatient secondary care, leading to specialist treatment without clear medical indication. The GPs described various direct drivers of medical overuse within their direct area of influence. They also emphasised indirect drivers related to system or societal processes. The proposed strategies for
Mieritz, Hanne Beck; Rønnow, Camilla; Jørgensen, Gitte
, and we found that these calls were more likely to contain problematic communication (odds ratio = 5.1). In 18% (n = 236) of the cases, there was not sufficient information to assess if the physician-manned mobile emergency care unit (MECU) should have been dispatched along with the ambulance......INTRODUCTION: When general practitioners (GPs) order an ambulance, their calls are handled by staff at the emergency medical dispatch centre (EMDC) who then select an appropriate response. There are currently no data evaluating this mode of communication between the GPs and the staff at the EMDC....... RESULTS: We found problematic communication in less than 2% (n = 25) of the evaluated calls. In 68% of the 25 problematic cases transactional analysis showed that the staff at the EMDC initiated the problematic communication. In 4% (n = 51) of the calls, the GP delegated the call to a secretary or nurse...
In a recent commentary, Dr. Abhishek Biswas asks the question whether physicians should rely on their "gut feeling" when making clinical decisions. Biswas describes a situation where his intuition resulted in an immediate course of action that prompted urgent medical attention for a patient who had "routine" pain. Inspired by the author's account, I would like to further Biswas' discussion and examine its importance using the educational theories of Donald Schön and his concept of the reflective practitioner. Schön argues that technical knowledge alone is not sufficient to solve the complex problems that professionals face on a daily basis and intuition, developed through a reflective practice, is crucial for any professional's practice, especially in a time of greater uncertainty in the workplace.
Lewandowska, Karolina; Kjær, Niels Kristian; Lillevang, Gunver
of study is to examine why and when Danish junior doctors choose family medicine as their future specialty. Method: We carried out two focus group interviews with medical doctors from two regions. An academic employee from the Danish College of Family Medicine mediated the interviews assisted by a family......Background and Aim: Continued supply of qualified general practitioners is essential for the vitality of the primary health care sector. In Denmark however we have observed a decline in the number of applicants for our family medicine specialist training program, leaving some posts vacant. The aim......-graduate training the structure of the postgraduate educational program, working conditions, respect for general practice, uncertainty about the future for general practice as a profession, when did I decide to choose family medicine. Out of these themes we identified factors, which influenced the choice...
In this thesis, the author first presents 'Isere, pilot department' operation, then the importance of nuclear risks in Isere, considers the role and place of medical practitioners in the management of this risk and in information request of medical personnel. The author also presents the booklet 'Doctors and nuclear risk' and analyzes the results of study on its impact close to medical population. 9 tabs., 25 figs
Kiolbassa, Kathrin; Miksch, Antje; Hermann, Katja; Loh, Andreas; Szecsenyi, Joachim; Joos, Stefanie; Goetz, Katja
In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase
Full Text Available Abstract Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. Results 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance' were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition' for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. Conclusions This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should
Ni Riordain, Richeal
This study investigated the current knowledge and practices of general medical practitioners (GMPs) in Ireland regarding the examination of the oral cavity and the detection of oral malignancy and the training they had received at both undergraduate and postgraduate level and since commencing in practice. A questionnaire survey of GMPs in Ireland was conducted. One hundred and fifty four (65.3%) of the practitioners reported regularly examining the oral mucosa of their patients. Almost half of these (n=68) further qualified this response by stating that they only examined the oral mucosa if the patient reported pain in this area or if the patient specifically requested an oral examination for some reason. Eighty one (34.3%) practitioners surveyed felt confident in their ability to detect oral malignancies with the remaining two thirds unsure of whether they would be able to detect oral cancer. There was a significant association between the undergraduate and postgraduate teaching on examination of the oral cavity and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=4.811, p<0.05]. A statistically significant association was also found between the undergraduate and postgraduate teaching on the diagnosis of oral malignant disease and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=6.194, p<0.05]. In conclusion the level of knowledge of Irish general medical practitioners needs to be addressed with appropriate initiatives both at undergraduate level and via CME.
Md. Nasir Ahmed
Full Text Available Schizophrenia is a subtle disorder of brain development and plasticity; it affects the most basic human processes of perception, emotion, and judgment. In Bangladesh the traditional medical practitioners of rural and remote areas characterized the schizophrenia as an insanity or a mental problem due to possession by ghosts or evil spirits and they have used various plant species’ to treat such symptoms. The aim of the present study was to conduct an ethnomedicinal plant survey and documentation of the formulations of different plant parts used by the traditional medical practitioners of Rangamati district of Bangladesh for the treatment of schizophrenia like psychosis. It was observed that the traditional medical practitioners used a total of 15 plant species to make 14 formulations. The plants were divided into 13 families, used for treatment of schizophrenia and accompanying symptoms like hallucination, depression, oversleeping or insomnia, deterioration of personal hygiene, forgetfulness, and fear due to evil spirits like genies or ghost. A search of the relevant scientific literatures showed that a number of plants used by the medicinal practitioners have been scientifically validated in their uses and traditional medicinal knowledge has been a means towards the discovery of many modern medicines. Moreover, the antipsychotic drug reserpine, isolated from the dried root of Rauvolfia serpentina species, revolutionized the treatment of schizophrenia. So it is very much possible that formulations of the practitioner, when examined scientifically in their entireties, can form discovery of lead compounds which can be used as safe and effective antipsychotic drug to treat schizophrenia.
Ahmed, Md Nasir; Kabidul Azam, Md Nur
Schizophrenia is a subtle disorder of brain development and plasticity; it affects the most basic human processes of perception, emotion, and judgment. In Bangladesh the traditional medical practitioners of rural and remote areas characterized the schizophrenia as an insanity or a mental problem due to possession by ghosts or evil spirits and they have used various plant species' to treat such symptoms. The aim of the present study was to conduct an ethnomedicinal plant survey and documentation of the formulations of different plant parts used by the traditional medical practitioners of Rangamati district of Bangladesh for the treatment of schizophrenia like psychosis. It was observed that the traditional medical practitioners used a total of 15 plant species to make 14 formulations. The plants were divided into 13 families, used for treatment of schizophrenia and accompanying symptoms like hallucination, depression, oversleeping or insomnia, deterioration of personal hygiene, forgetfulness, and fear due to evil spirits like genies or ghost. A search of the relevant scientific literatures showed that a number of plants used by the medicinal practitioners have been scientifically validated in their uses and traditional medicinal knowledge has been a means towards the discovery of many modern medicines. Moreover, the antipsychotic drug reserpine, isolated from the dried root of Rauvolfia serpentina species, revolutionized the treatment of schizophrenia. So it is very much possible that formulations of the practitioner, when examined scientifically in their entireties, can form discovery of lead compounds which can be used as safe and effective antipsychotic drug to treat schizophrenia.
Full Text Available INTRODUCTION: AIDS is the disease that has been stigmatized since its development; stigmatization of people living with HIV is an important barrier to using HIV testing and treatment. It is well known, that stigma is associated with mental disorders including depression and anxiety. Ukraine is a country with one of the highest number of annual HIV infection cases. GOALS: The goal of this study was to evaluate medical practitioners’ (surgeons, psychiatrists, therapists and students and nonmedical specialists’ attitude toward people with HIV/AIDS.METHODS: A total of 180 individuals participated in the study. Acceptance of people who have AIDS or are infected with HIV was assessed with the help of the “Attitudes toward people with HIV or AIDS”. Total scores range from 50 to 10, higher scores indicate high acceptance of persons with HIV/AIDS.RESULTS: Younger participants reported higher acceptance of persons with HIV or AIDS (p.05. Medical practitioners showed greater total score, compare to nonmedical specialists (38.0 ± 6.0 vs. 34.0 ± 5.5, respectively, p<.05. A one-way between-groups analysis of variance was conducted to explore the impact of medical specialty on levels of positive attitudes toward people with HIV or AIDS. The actual difference in mean scores between the 4 groups was moderate (.06. Students and psychiatrists reported more positive attitudes (higher acceptance toward people with HIV and AIDS, but analyses showed, that there was not a statistically significant difference at the level in total score for the groups.CONCLUSION: In this study we evaluated the level of attitudes toward people with HIV or AIDS in Ukraine. Young age and medical education were significantly associated with the positive attitudes toward people with HIV and AIDS. Our findings are important for the programs reducing the stigma and discrimination that should be addressed to the wide layers of the society.
Anastassia E Kossioni
Full Text Available Anastassia E Kossioni1, Anastasios S Dontas21Department of Prosthodontics, Dental School, University of Athens, Greece; 2Hellenic Association of Gerontology and Geriatrics, Athens, GreeceAbstract: Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class. Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.Keywords: stomatognathic system, elderly, oral disease, general health, xerostomia
Sinozić, Tamara; Kovacević, Jadranka
A number of healthcare professionals, specialists in different fields and with different levels of education, as well as non-healthcare professionals, are involved in the care of chronic wound patients, thus forming a multidisciplinary team that is not only responsible for the course and outcome of treatment, but also for the patient quality of life. Family doctor is also member of the team the task of which is to prevent, diagnose, monitor and anticipate complications and relapses, as well as complete recovery of chronic wound patients, with the overall care continuing even after the wound has healed, or is involved in palliative care. A family medicine practitioner with specialized education and their team of associates in the primary health care, along with material conditions and equipment improvement, can provide quality care for patients with peripheral cardiovascular diseases and chronic wounds, organized according to the holistic approach. It is essential that all professional associations of family medicine as well as professional associations of other specialties - fields that are involved in wound prevention and treatment - be included in developing the continuous medical education program. The benefits of modern information technology should be used to good advantage. The education should be adapted to the needs of family practitioners in terms of the form, place, time, volume, financial affordability and choice of topic. The interest shown in team education should be transformed into specialized programs in the creation of which it is essential to include both physicians and nurses and their respective professional associations. Special attention should be paid to education and training of young doctors/nurses, those with less work experience, those that have not yet been part of such education, those that lack experience in working with wound patients, those whose teams deal mostly with elderly patients, and also residents in family medicine and
Ab, Elisabeth; Denig, Petra; van Vliet, Ton; Dekker, Janny H.
Background: Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. Methods: A qualitative study with semi-structured
Slaets Joris PJ
Full Text Available Abstract Background Collaboration between general practitioners (GPs and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates medical specialists to initiate and continue participating with GPs in new collaborative care models. The following question is addressed in this study: What motivates medical specialists to initiate and sustain new models for collaborating with GPs? Methods We conducted semi-structured interviews with eighteen medical specialists in the province of Groningen, in the North of The Netherlands. The sampling criteria were age, gender, type of hospital in which they were practicing, and specialty. The interviews were recorded, fully transcribed, and analysed by three researchers working independently. The resulting motivational factors were grouped into categories. Results 'Teaching GPs' and 'regulating patient flow' (referrals appeared to dominate when the motivational factors were considered. In addition, specialists want to develop relationships with the GPs on a more personal level. Most specialists believe that there is not much they can learn from GPs. 'Lack of time', 'no financial compensation', and 'no support from colleagues' were considered to be the main concerns to establishing collaborative care practices. Additionally, projects were often experienced as too complex and time consuming whereas guidelines were experienced as too restrictive. Conclusion Specialists are particularly interested in collaborating because the GP is the gatekeeper for access to secondary health care resources. Specialists feel that they are able to teach the GPs something, but they do not feel that they have anything to learn from the GPs. With respect to professional expertise, therefore, specialists do not consider GPs as equals. Once personal relationships with the GPs have been established, an
Chellappandian, M; Mutheeswaran, S; Pandikumar, P; Duraipandiyan, V; Ignacimuthu, S
The aim of the present study was to document the knowledge of traditional Siddha medical practitioners from Radhapuram taluk of Tirunelveli district in Tamil Nadu, India, and to quantitatively analyze the data to identify some useful leads for further studies. Successive free listing was the method adopted for the interview. In this study, 84 traditional Siddha medical practitioners were included and their knowledge on medicinal plants was gathered. The data were assessed with the help of two indices viz., Informant Consensus Factor (F(ic)) and Informant Agreement on Remedies (IAR). The present survey is in accordance with some of the aspects of our previous surveys. Regarding the demography of the informants, it exhibited unevenness in male-female ratio and majority of the informants were poorly educated. Practicing this system of medicine as part time job by majority of the informants might indicate the reduced social status of this medicinal system. The present study had recorded the usage of 217 species which were used to prepare 448 formulations, which in turn yielded 812 use reports. Conversion of use reports had yielded a total of 625 claims and 84.16% of the claims were 'singletons'. The illness category 'adjuvants' holds a high F(ic) value. Among the other illness categories, kapha ailments and dermatological ailments have a high percentage of use-reports. Ailments of blood, jaundice and fever were the other illness categories with high F(ic) values. Some of the claims viz., Mukia madarasepatana (kapha ailments), Mollugo nudicaulis (febrifuge), Indigofera asphalathoides (dermatological ailments), Aerva lanata (urinary ailments), Abutilon indicum (hemorrhoids) and Hybanthus enneaspermus (aphrodisiac), which have relatively high consensus can be taken up for further biomedical studies, since no substantial studies have been conducted on them. One of the major aims of National Rural Health Mission is to implement traditional Indian system of medicines into
Koehl, Benjamin; Muenstedt, Karsten; Micke, Oliver; Muecke, Ralph; Buentzel, Jens; Stoll, Christoph; Prott, Franz Josef; Dennert, Gabriele; Senf, Bianca; Huebner, Jutta
In total, 40-70% of cancer patients use complementary or alternative medicine (CAM). Many of them ask for advice from non-medical practitioners (NMPs). Our aim was to investigate the attitude of NMPs regarding their treatments for cancer patients. A survey was performed on members of NMP associations, using an online questionnaire on diagnosis and treatment, goals for using CAM, communication with the oncologist, and sources of information. Of the 1,500 members of the NMP associations, 299 took part. The treatments were found to be heterogeneous. Homeopathy is used by 45% of the NMPs; 10% believe it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets are used by more than 10% of the NMPs. None of the treatments is discussed with the respective physician on a regular basis. Many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies. © 2014 S. Karger GmbH, Freiburg.
Teljeur, Conor; Kelly, Alan; O'Dowd, Tom
The general medical services (GMS) scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amongst Dublin-based general practitioners (GPs). The practice GMS income in Dublin was analysed in relation to practice characteristics including the number of GPs, catchment area population, proportion of over-70-year olds in the catchment area, catchment deprivation, number of GMS GPs within 2 km, and average GMS practice income within 2 km. Practice GMS income was highest in deprived areas but is also a valuable source of income in the least deprived areas. The capitation rate for over-70-year olds provides an incentive for GPs to locate in affluent areas and potentially directs resources away from those in greater need.
Alam, Nazmul; Mridha, Malay K; Kristensen, Sibylle; Vermund, Sten H
Sexually transmitted infection (STI) management is considered rudimentary among rural medical practitioners (RMPs) in Bangladesh. We sought to understand the level of knowledge and skills in STI management and to assess the impact of a two-day training orientation among RMPs in Tangail district. Data were collected through a baseline survey of 225 practicing RMPs in the study area and a three-month follow-up survey of 99 RMPs who participated in a two-day STI/HIV orientation training. The level of formal training among RMPs ranged from none (22.7%), to paramedical training (14.7%) and local medical assistant training (62.6%). The baseline survey revealed a low level of STI/HIV knowledge and misconceptions about the transmission of STI/HIV among RMPs. RMPs mostly prescribed first line antibiotics for treatment of common reproductive tract infections (RTIs) including STIs, but they rarely prescribed the correct dosages according to the national RTI/STI management guidelines. Only 3% of RMPs were able to correctly answer all four HIV transmission (unprotected sexual intercourse, blood transfusion, needle sharing and mother to child transmission) questions at baseline, while 94.9% of RMPs answered all four correctly at three months following the training (p=0.001). Only 10% of RMPs reported suggesting the recommended drug (azithromycin) and only 2% mentioned about the recommended dosage (2gm single dose) for the treatment of urethritis/cervicitis; compared to 49.5% suggested azithromycin at follow-up with 39.4% mentioned the recommended 2gm single dose (p=0.001). Our study found low level of knowledge and poor practices related RTI/STI management among RMPs. Short orientation training and education intervention shown promise to increase knowledge and management skills for RTIs/STIs.
Klazinga Niek S
Full Text Available Abstract Background Collaboration between general practitioners (GPs and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating with medical specialists in new collaborative care models. The following two questions are addressed in this study: What motivates GPs to initiate and sustain new models for collaborating with medical specialists? What kind of new collaboration models do GPs suggest? Methods A qualitative study design was used. Starting in 2003 and finishing in 2005, we conducted semi-structured interviews with a purposive sample of 21 Dutch GPs. The sampling criteria were age, gender, type of practice, and practice site. The interviews were recorded, fully transcribed, and analysed by two researchers working independently. The resulting motivational factors and preferences were grouped into categories. Results 'Developing personal relationships' and 'gaining mutual respect' appeared to dominate when the motivational factors were considered. Besides developing personal relationships with specialists, the GPs were also interested in familiarizing specialists with the competencies attached to the profession of family medicine. Additionally, they were eager to increase their medical knowledge to the benefit of their patients. The GPs stated a variety of preferences with respect to the design of new models of collaboration. Conclusion Developing personal relationships with specialists appeared to be one of the dominant motives for increased collaboration. Once the relationships have been formed, an informal network with occasional professional contact seemed sufficient. Although GPs are interested in increasing their knowledge, once they have reached a certain level of expertise, they shift their focus to another specialty. The preferences for new collaboration
Endacott, Ruth; Bogossian, Fiona E; Cooper, Simon J; Forbes, Helen; Kain, Victoria J; Young, Susan C; Porter, Joanne E
To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. There is a need to encourage less experienced staff to become leaders and for all staff to develop improved
Byrnes, Joshua M; Comans, Tracy A
Abstract To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government ofup to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving.
Schaper, M; Berndt, M; Schrimpf, C; Wilhelmi, M; Elff, M; Haverich, A; Wilhelmi, M
Background: Medial implants help a multitude of patients to gain more health, mobility and thus, quality of life. In collaboration with a still growing expectation of life especially, i.e., within Western industrial countries, this has led to an increasing use of implants over the last years. However, although biomechanical characteristics of modern implant materials have improved considerably, one big challenge still exists - the implant-associated infection. Early diagnostic and therapeutic interventions could clearly mitigate this issue, but are general practitioners sufficiently informed regarding this topic? Material and Methods: In March 2013 and in close cooperation with the Lower Saxony association of general practitioners, we initiated a survey to elucidate the information demands of general practitioners regarding the topic of medical implants. A total of 939 members of the association were contacted via fax and 101 (10.8 %) responded. Based on the obtained data, we then evaluated which topics are most interesting for this group of medical professionals. Results: The survey clearly indicates that general practitioners request more general implant-related data, e.g., type and specification of an implant as well as its location within the individual patient and contact addresses of the implanting hospital, but also want more specific information regarding diagnostic and therapeutic strategies in the case of implant-associated complications. Conclusion: The present article reports in detail on the conducted fax survey and shows some initial strategies as to how the identified challenges might be faced. Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Background The South African healthcare establishment is primarily managed and overseen by medical doctors. This powerbase was established over many years, especially after the early 1930s. World War II gave doctors the final approval to take this supervisory and sole decision-making role regarding healthcare training, practice models and other health workers in South Africa. This phenomenon led initially to doctors having a certain jurisdiction to set the pace and to make the rules. This jurisdiction became more comprehensive and extent with time in South Africa to include a collection of unique medical traditions, customs, privileges, habits, healthcare rights and empowerment as well as exclusive medical training and practice models to become known as the holy grails of the South African medical doctors. The power of these holy grails has become untouchable to anyone outside the medical domain. Since the 1980s, some powers vested in these holy grails have been lost to the allied health professions and to other insiders of the HPCSA brotherhood itself. The recognition of traditional healers by means of the Traditional Health Practitioners Act (Act No 22, 2007 seems to challenge these holy grails of medical doctors. This may also create internal conflict in the South African medical brotherhood that can cost medical doctors more ground. Aims The study aimed to determine if the Traditional Health Practitioners Act No 22 (2007 challenges the holy grails of South African medical doctors, subsequently affecting the long-established management and guardian system of the medical field within South Africa or the practice rights of medical doctors. Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the possible effect of the Traditional Health
Pestka, Deborah L; Sorge, Lindsay A; McClurg, Mary Roth; Sorensen, Todd D
Philosophy of practice is the foundation of any patient care practice because it provides a set of professional values and beliefs that guide actions and decisions in practice. Study objectives were to understand how pharmacists providing comprehensive medication management (CMM) describe their philosophy of practice and compare how participants' philosophies align with predefined tenets of a CMM philosophy of practice. An instrument with closed and open-ended items was developed and administered online to the lead pharmacist at 36 clinics participating in a large CMM study. Participants were asked to describe their philosophy of practice, rate how well their current practice activities align with five predefined CMM philosophy of practice tenets, and provide examples of how they carry out each tenet and how they could improve. Responses were coded, and descriptive analysis was used to calculate participants' practice alignment with the five philosophy of practice tenets. Thirty pharmacists completed the instrument. Twelve codes emerged that participants used to describe their philosophy of practice. These codes were mapped to five predefined tenets of a philosophy of practice. Only 3 (10%) participants included all five tenets in their philosophy of practice, 8 (26.7%) included four, 8 (26.7%) included three, 6 (20%) included two, and 5 (16.7%) included one tenet. Overall, participants rated their alignment with the five tenets highly. "Embracing a patient-centered approach" received the highest mean score of 9.17/10; "Meeting a societal need" had the lowest mean score of 8.37/10. Participants described their philosophy of practice with significant variability. CMM requires a single and consistently applied philosophy of practice to guide practice and the role of the practitioner. We propose five core tenets that resulted from this assessment to be embraced by pharmacists providing CMM and included in their philosophy of practice. © 2017 Pharmacotherapy
Beena Elizabeth Thomas
Full Text Available The Government of India declared TB as a notifiable disease in 2012. There is a paucity of information on the government's mandatory TB notification order from the perspective of private medical practitioners (PPs.To understand the awareness, perception and barriers on TB notification among PPs in Chennai, India.Total of 190 PPs were approached in their clinics by trained field staff who collected data using a semi-structured and pre-coded questionnaire after getting informed consent. The data collected included PPs' specialization, TB management practices, awareness about the TB notification order, barriers in its implementation and their suggestions to improve notification.Of 190 PPs from varied specializations, 138 (73% had diagnosed TB cases in the prior three months, of whom 78% referred these patients to government facilities. Of 138 PPs, 73% were aware of the order on mandatory TB notification, of whom 46 (33% had ever notified a TB case. Of 120 PPs, 63% reported reasons for not notifying TB cases. The main reasons reported for not notifying were lack of time (50%, concerns regarding patients' confidentiality (24% and fear of offending patients (11%. Of 145 PPs, 76% provided feedback about information they felt uncomfortable reporting during notification. PPs felt most uncomfortable reporting patient's government-issued Aadhar number (77%, followed by patient's phone number (37% and residential address (26%. The preferred means of notification was through mobile phone communication (24%, SMS (18% and e-mail (17%.This study highlights that one-fourth of PPs were not aware of the TB notification order and not all those who were aware were notifying. While it is important to sensitize PPs on the importance of TB notification it is also important to understand the barriers faced by PPs and to make the process user-friendly in order to increase TB notification.
Esterhuizen, Tonya; Gathiram, Prem
ABSTRACT Background Family physicians are trained to treat a wide range of diseases, treatment being centred on the patient, family and community irrespective of age, gender, or ethnic or racial background. To deal with inequalities in health care, the South African government introduced the concept of a district health system in 1997. It was only in August 2007, however, that family medicine was legislated as a speciality. This study was undertaken prior to the enactment of this legislation. Method A descriptive quantitative study using a self-administered questionnaire was undertaken. A convenience sampling technique was used (N = 60) to assess the reactions of medical practitioners towards the impending legislation. Results Overall, 60% of the sample was in favour of the legislation. There were no significant differences between those working in the private and public sectors or between generalists and specialists. With regard to those not in favour of the legislation compared to those in favour of the legislation, a significantly increased number answered the following statements in the affirmative: (i) ‘I already carry out the functions of a family physician’ (p = 0.001), (ii) ‘They [specialist family physicians] will not be as qualified as specialists in other categories’ (p = 0.005), (iii) ‘It will have a negative impact on general practice’ (p competitiveness’ (p = 0.021), (v) ‘It will not have any effect on patient care’ (p = 0.010) and (vi) ‘There is no need for such a speciality’ (p = 0.001). Conclusion We concluded that the majority were in favour of the legislation being implemented.
Montelius, Emelie; Astrand, Bengt; Hovstadius, Bo; Petersson, Göran
Many patients receive health care in different settings. Thus, a limitation of clinical care may be inaccurate medication lists, since data exchange between settings is often lacking and patients do not regularly self-report on changes in their medication. Health care professionals and patients are both interested in utilizing electronic health information. However, opinion is divided as to who should take responsibility for maintaining personal health records. In Sweden, the government has passed a law to enforce and fund a national register of dispensed medications. The register comprises all individuals with dispensed medications (6.4 million individuals, September 2006) and can be accessed by the individual online via "My dispensed medications". The individual has the right to restrict the accessibility of the information in health care settings. The aim of the present study was to evaluate the users' attitudes towards their access to "My dispensed medications" as part of a new interactive Internet service on prescribed medications. A password-protected Web survey was conducted among a first group of users of "My dispensed medications". Data was anonymously collected and analyzed with regard to the usefulness and design of the Web site, the respondents' willingness to discuss their "My dispensed medications" with others, their reasons for access, and their source of information about the service. During the study period (January-March, 2007), all 7860 unique site visitors were invited to answer the survey. Invitations were accepted by 2663 individuals, and 1716 responded to the online survey yielding a view rate of 21.8% (1716/7860) and a completion rate of 64.4% (1716/2663). The completeness rate for each question was in the range of 94.9% (1629/1716) to 99.5% (1707/1716). In general, the respondents' expectations of the usefulness of "My dispensed medications" were high (total median grade 5; Inter Quartile Range [IQR] 3, on a scale 1-6). They were also
Erdem, S A; Lacombe, B
Even a brief conceptual review of the current developments in the health care industry indicates that the future of independent medical practitioners is rather challenging. It may be necessary for these parties to pursue proactive and aggressive marketing strategies to be able to compete with the managed care organizations. Accordingly, this paper outlines some of the current trends in health care marketing as they relate to the ongoing changes to which solo medical practitioners need to respond. It is hoped that the review of the issues raised in this paper can provide an initial basis for a better understanding of some of the challenges to come up with more comprehensive and effective strategy decisions.
Langhoff-Roos, Jens; Krebs, Lone; Klungsøyr, Kari
on preceding, underlying and present health problems of the parents and their offspring. Researchers may, with permission from the national authorities, obtain access to individualized or anonymized data from the registers and tissue-banks. These data allow for multivariate analyses but their usefulness...... large cohorts (approximately 100 000 births) in Denmark and Norway have been described by questionnaires, interviews and collection of biological samples (blood, urine and milk teeth), as well as a systematic prospective follow-up of the offspring. National patient registers provide information...
The South African traditional health practitioner as a beneficiary of and provider to medical funds and schemes through the traditional health practitioners Act (Act No 22, 2007: A present-day perspective
Full Text Available Background Payments to traditional health practitioners for services rendered from medical funds and schemes, as envisaged by the Traditional Health Practitioners Act (Act No 22, 2007, is controversial and a point of contention. Such policy was followed before in South Africa in the 1990s when some funds and schemes offered limited alternative healthcare benefits for members consulting traditional healers. Aims The study aimed to offer a contemporary view of the South African traditional health practitioner as a provider to and beneficiary of the medical funds and schemes through the Traditional Health Practitioners Act (No 22, 2007. Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the South African traditional health practitioner as a provider to and beneficiary of the medical schemes and funds through the Traditional Health Practitioners Act (No 22, 2007. The findings are offered in narrative form. Results It seems as if the South African authorities completely misunderstand the future implications of the Traditional Health Practitioners Act (No 22, 2007 on healthcare. This is specifically true when it comes to the right to claim from medical funds and schemes for services rendered by traditional health practitioners and the possible extra costs for these medical schemes and funds. Conclusion The implications of Section 42(2 of the Traditional Health Practitioners Act (No 22, 2007 which aims to set up a claiming process for traditional health practitioners, seems to be very problematic. The fact that Act No 22 (2007 has not been enacted properly nine years after its promulgation has put a halt on the professionalization of traditional healers until 2015. This also affected their status as a beneficiary of and service provider to the
Orkuma J.A; Ayia O.N.
Background: Blood transfusion is predominantly a hospital-based practice in many resourceconstrained economies like Nigeria, wherein the sourcing, storage, processing and clinical use of blood and blood products resides in the often financial and manpower constrained hospitals. Aim: To identify the ethical and legal issues related to hospital-based blood transfusion practice for medical practitioner. Methods: Relevant articles retrieved via PubMed/MEDLINE and Google scholar search...
Ali, Fareedi Mukram; Al-Iryani, Ghassan M; Namis, Sultan Mohammed; Hezam, Asma Ali; Swaid, Salma Abdu; Alomar, Anas Esam
In many health services communities the scope of oral and maxillofacial surgery (OMFS) as a discipline is frequently not probably understood. Good awareness towards OMFS among different branches of health services providers is essential for better referral strategies and will be for the benefit of the patient. The cross-sectional study was done using a specially prepared questionnaire distributed randomly to 125 general medical practitioners working in Jazan province. In this questionnaire, there were also some close-ended questions to evaluate awareness regarding a variety of conditions treated by the oral and maxillofacial surgeons. Out of 125 participants, 105 (84%) were aware of the oral and maxillofacial surgery as a speciality branch of dentistry. Only 52 (41.6%) participants were aware of the different treatment modalities coming under the scope of oral and maxillofacial surgery. Also in the referral of cases to the oral and maxillofacial surgeon, 50 (40%) participants referred their oral and maxillofacial region cases to OMS. Tooth removal was the only procedure where most of the medical practitioners knew it is a speciality procedure of the oral and maxillofacial surgeon. For facial fractures, 76 medical practitioners believe it comes under the scope of the orthopaedic surgeon. Similarly, for facial abscesses, 81 and 36 practitioners responded that it is a job of a general surgeon and OMS respectively. There is low awareness toward the scope of oral and maxillofacial surgery in the medical community. Knowledge and awareness of the scope of oral and maxillofacial surgery can improve the success and promptness of delivery of health services.
Feijen-de Jong, E.I.; Baarveld, F.; Jansen, D.E.M.C.; Ursum, J.; Reijneveld, S.A.; Schellevis, F.G.
Background: Midwives and obstetricians are the key providers of care during pregnancy and postpartum. Information about the consultations with a general practitioner (GP) during this period is generally lacking. The aim of this study is to compare consultation rates, diagnoses and GP management of
Feijen-de Jong, Esther I.; Baarveld, Frank; Jansen, Danielle E. M. C.; Ursum, Jennie; Reijneveld, Sijmen A.; Schellevis, Francois G.
Background: Midwives and obstetricians are the key providers of care during pregnancy and postpartum. Information about the consultations with a general practitioner (GP) during this period is generally lacking. The aim of this study is to compare consultation rates, diagnoses and GP management of
Williamson, Susan; Twelvetree, Timothy; Thompson, Jacqueline; Beaver, Kinta
This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice. Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice. An ethnographic approach was used to explore the advanced nurse practitioner role. Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation. The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role. Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes. © 2012 Blackwell Publishing Ltd.
Viale, Pamela Hallquist; Sanchez Yamamoto, Deanna
To obtain information about the knowledge and attitudes of oncology nurse practitioners (ONPs) concerning the effect of direct-to-consumer (DTC) advertising of prescription medications on prescribing patterns. Exploratory survey. Oncology Nursing Society Nurse Practitioner Special Interest Group members in the United States. 221 of 376 ONPs completed the survey (58%). Researcher-developed 12-question postal survey. Knowledge and attitudes of ONPs on DTC advertising effects on prescribing patterns. The findings were similar to those of previous studies of physicians regarding the number of visits when patients requested DTC-advertised medications. Major differences were the positive attitudes of ONPs toward potentially longer patient visits to explain and educate patients regarding medication requests based on DTC advertising and smaller percentages of ONPs who felt "pressured" to prescribe requested medications. ONPs have mixed opinions regarding the practice of DTC advertising but do not believe that they are influenced heavily by advertising with regard to prescriptive practices. ONPs consider patient encounters for education purposes as appropriate and include information about requested DTC-advertised medications in their approach to patient care. This is an exploratory survey of a specialty group of ONPs. More research is needed to further explore the practice of DTC advertising and potential influences on the prescribing patterns of ONPs. DTC advertising of prescription medications is increasing; ONPs need to increase their knowledge base about the potential for influences of prescriptive practices.
McDowell, Andrew; Pai, Madhukar
Mumbai is a hot spot for drug-resistant TB, and private practitioners trained in AYUSH systems (Ayurveda, yoga, Unani, Siddha and homeopathy) are major healthcare providers. It is important to understand how AYUSH practitioners manage patients with TB or presumptive TB. We conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. We observed 10 providers in clinical interactions, documenting: clinical examinations, symptoms, history taking, prescriptions and diagnostic tests. No practitioners exclusively used his or her system of training. The practice of biomedicine is frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare (only 4% of consultations with homeopaths resulted in homeopathic remedies) and Ayurveda rarer (3% of consultations). For TB, all mentioned chest x-ray while 31 (17.7%) mentioned sputum smear as a TB test. One hundred and sixty-four practitioners (93.7%) reported referring TB patients to a public hospital or chest physician. Eleven practitioners (6.3%) reported treating patients with TB. Nine (5.1%) reported treating patients with drug-susceptible TB with at least one second-line drug. Important sources of health care in Mumbai's slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: email@example.com.
Jaccard Ruedin, Hélène; Seematter-Bagnoud, Laurence; Roth, Maik; Junod, Julien; Santos-Eggimann, Brigitte
Due to population aging, by 2030 Switzerland may face a demand of 24 million family practitioner visits, a growth of 13 percent from the 2005 level. This result is based on the assumption that the per capita demand for doctor visits remains what was observed in 2005 by age groups and sex. During the same period, the total number of practitioners may decrease by 14 percent whereas the female proportion of such practitioners may double. These changes may cause a 33 percent decrease in the supply of physician visits to reach only 14 millions. The comparison of the demand and supply of family doctor visits reveals that by 2030, 10 million visits may be unmet which represents 40 percent of the demand. On the supply side, a full scale implementation of task delegation may partially reduce that gap (minus 2 millions). On the demand side, improved health status may bring in a larger decrease in the needs for visits (minus 4 million).
Full Text Available INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs, such as medication review and prescribing. This study aims to evaluate GPs' perceptions of pharmacists' contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR. GPs were asked their opinions of pharmacists' provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs' major strengths. GPs' perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists' strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting.
Full Text Available In the Netherlands, the postal code is needed to study hospitalizations of individuals in the nationwide hospitalization register. Studying hospitalizations longitudinally becomes troublesome if individuals change address. We aimed to report on the feasibility and validity of a two-step medical record linkage approach to examine longitudinal trends in hospitalizations and mortality in a study cohort. First, we linked a study cohort of 1564 survivors of childhood cancer with the Municipal Personal Records Database (GBA which has postal code history and mortality data available. Within GBA, we sampled a reference population matched on year of birth, gender and calendar year. Second, we extracted hospitalizations from the Hospital Discharge Register (LMR with a date of discharge during unique follow-up (based on date of birth, gender and postal code in GBA. We calculated the agreement of death and being hospitalized in survivors according to the registers and to available cohort data. We retrieved 1477 (94% survivors from GBA. Median percentages of unique/potential follow-up were 87% (survivors and 83% (reference persons. Characteristics of survivors and reference persons contributing to unique follow-up were comparable. Agreement of hospitalization during unique follow-up was 94% and agreement of death was 98%. In absence of unique identifiers in the Dutch hospitalization register, it is feasible and valid to study hospitalizations and mortality of individuals longitudinally using a two-step medical record linkage approach. Cohort studies in the Netherlands have the opportunity to study mortality and hospitalization rates over time. These outcomes provide insight into the burden of clinical events and healthcare use in studies on patients at risk of long-term morbidities.
Berendsen, Annette J.; Benneker, Wim H. G. M.; Jong, Betty Meyboom-de; Klazinga, Niek S.; Schuling, Jan
Background: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating
Berendsen, Annette J.; Benneker, Wim H. G. M.; Jong, Betty Meyboom-de; Klazinga, Niek S.; Schuling, Jan
BACKGROUND: Collaboration between general practitioners (GPs) and specialists has been the focus of many collaborative care projects during the past decade. Unfortunately, quite a number of these projects failed. This raises the question of what motivates GPs to initiate and continue participating
L Surya Chandra Varma
Full Text Available Introduction: Medical emergencies can occur frequently in the dental setting. Effective management of an emergency situation in the dental office is ultimately the dentist responsibility. The assessment of preparedness of dental practitioners would help to bring about required changes in the teaching aspects of dental institutions, which would ultimately help dental graduates to improve knowledge regarding management of medical emergencies. This would also make dental offices available with required emergency drugs. Aim: To evaluate the preparedness for medical emergencies among the dental practitioners in Khammam town. Materials and Methods: A cross-sectional questionnaire-based study with a sample of 301 was conducted among dental clinicians at Khammam to evaluate their knowledge regarding medical emergencies. The questionnaire consisted of nineteen questions. First nine questions are objective questions, requiring a simple yes or no reply. Next ten questions are multiple choice questions regarding Emergency Medical Services and basic life support. Chi-square test was used to analyze the data. A P < 0.05 is considered significant. Results: The results of this study showed that almost all the participants (94.02% enquired about medical and drug history, but only 67.11% of them obtained a complete health history proforma of the patient. About 83.06% record vital signs, 74.09% of members report about attending workshops on emergency training and management, and 50.5% of members were either not sure or not in a position to handle the emergency condition. Conclusion: The results of this study reflect an alarming situation of the capability of dentists to deal with medical emergencies at dental offices and make available all the emergency drugs at their offices.
Durão, Carlos Henrique; Pinto, Rui; Ribeiro, Costa; Vieira, Duarte
Mass catastrophes are realities that come to pass with lamentable frequency. In such situations, one of the fundamental forensic problems is in relation to identifying the victims. All the elements that might be capable of contributing towards this identification process are essential, and among these are orthopedic prostheses, which frequently remain intact. These prostheses consist basically of polymers, ceramics or metals. Metal components, which are usually composed of titanium, chromium, cobalt or steel alloys, are resistant to violent trauma or high temperatures. Human identification is possible if the identity of the implant is established and if this can be correlated with the individual in whom it was implanted. The logo on the prosthesis establishes who the manufacturer was and the serial number can be compared with the clinical process or with a prosthesis register, as has been implemented in several countries. The information in the database should include the patient's name, the implant model and its serial number, for consultation only in cases of forensic identification, while obviously respecting ethical issues of privacy. This article highlights the importance of creating a national prosthesis register. PMID:27047880
Full Text Available Background The South African medical doctor has been well established over the years as the keeper of the holy medical grails. Entrance for newcomers to the medical domain has not been and is still not easy. The hostility towards the allied professions in the 1950s and later in the 1980s provides evidence of this. Certain prerequisites for entrance were set and jealously guarded by the medical fraternity. The Traditional Health Practitioners Act, (Act No 22, 2007 is another such a challenge. This time it is not an outsider fraternity that is fighting alone for its own recognition. They are backed by a government and political force to get the traditional health practitioner (previously known as the traditional healer statutorily recognized. Aims The study aimed to reflect on the future professional relationship between the medical doctor and the traditional health practitioner in South Africa. Methods This is an exploratory and descriptive study that makes use of an historical approach by means of investigation and a literature review. The emphasis is on using current documentation like articles, books and newspapers as primary sources to reflect on the future professional relationship between the medical doctor and the traditional health practitioner in South Africa. The findings are offered in narrative form. Results It is clear that the Traditional Health Practitioners Act No 22 (2007 will put enormous pressure on the medical doctor, not only to relinquish some of his healthcare empowerment, but also to see and to accept the traditional health practitioner as a new, respectable health copractitioner and colleague. Facts hereto reveal that there are in terms of training, health ethics, practice approaches, attitudes and views, basically not a single point of similarity or agreement between the medical doctor and the traditional health practitioner whatsoever. Notwithstanding these enormous differences, the existence of the Traditional Health
Smith, Lauren; Walsh, Margaret
To assess California dental hygiene educators' perceptions of an application of the American Dental Hygienists' Association's (ADHA) advanced dental hygiene practitioner model (ADHP) in medical settings where the advanced dental hygiene practitioner collaborates in medical settings with other health professionals to meet clients' oral health needs. In 2014, 30 directors of California dental hygiene programs were contacted to participate in and distribute an online survey to their faculty. In order to capture non-respondents, 2 follow-up e-mails were sent. Descriptive analysis and cross-tabulations were analyzed using the online survey software program, Qualtrics™. The educator response rate was 18% (70/387). Nearly 90% of respondents supported the proposed application of the ADHA ADHP model and believed it would increase access to care and reduce oral health disparities. They also agreed with most of the proposed services, target populations and workplace settings. Slightly over half believed a master's degree was the appropriate educational level needed. Among California dental hygiene educators responding to this survey, there was strong support for the proposed application of the ADHA model in medical settings. More research is needed among a larger sample of dental hygiene educators and clinicians, as well as among other health professionals such as physicians, nurses and dentists. Copyright © 2015 The American Dental Hygienists’ Association.
Perry, John J.
Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market impact of this large change in nurse practitioner regulation. Using data from the National Sample Survey of Registered Nurses and a dataset of state-level nurse practitioner prescribing authority, a multivariate estimation is performed analysing the impact of greater practice a...
Sisan, Mo'men; Rayan, Ahmad; Elmorsy, Soha; Elyan, Hamza; Salahat, Mosab
Extravasation and infiltration are among the most common intravenous therapy complications. For noncytotoxic agents, the incidence of extravasation remains unknown. There has been little research into extravasation due to ethical considerations limiting controlled research; most evidences are based on small, uncontrolled trials or case reports. The purpose of this study was to assess the knowledge level regarding noncytotoxic medications extravasation and its associated factors among staff nurses.A descriptive correlational design using self-administered questionnaire was employed. A convenience sample of 387 nurses completed a questionnaire about noncytotoxic medication extravasation. Statistical Package for Social Sciences version 21 was used to analyze data by applying the chi-square test, t test, and the Mann-Whitney test to assess the knowledge difference between open and closed units' nurses.The results indicate that only 19.6% of nurses have a good knowledge about noncytotoxic medications extravasation. There was consistently poor staff knowledge regarding noncytotoxic medications extravasation. Although the closed units' nurses reported relatively higher level of knowledge than open units' nurses, their level of knowledge still inadequate. Health care organizations must consider developing specific policies regarding extravasation. Closed and open units' nurses should be enrolled in special education programs to improve their level of knowledge regarding noncytotoxic medication extravasation. Copyright © 2017 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.
Thompson, Stephen; Moorley, Calvin; Barratt, Julian
To investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors. A literature review was conducted, searching for articles published from 1990 - 2012. The review found that nurse practitioners are key to the modernization of the National Health Service. Studies have shown that compared with doctors, nurse practitioners can be efficient and cost-effective in consultations. Qualitative research design. The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment. This study was conducted from May 2012 - January 2013. The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took 3 minutes longer to complete the scenarios. This study suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes. © 2016 John Wiley & Sons Ltd.
Full Text Available Abstract Background Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. Methods A qualitative study with semi-structured interviews using real cases was conducted to explore reasons for not prescribing lipid-lowering medication after a guideline was distributed that recommended the use of statins in most patients with type 2 diabetes. Seven interviews were conducted with general practitioners (GPs in The Netherlands, and analysed using an analytic inductive approach. Results Reasons for not-prescribing could be divided into patient and physician-attributed factors. According to the GPs, some patients do not follow-up on agreed medication and others object to taking lipid-lowering medication, partly for legitimate reasons such as expected or perceived side effects. Furthermore, the GPs themselves perceived reservations for prescribing lipid-lowering medication in patients with short life expectancy, expected compliance problems or near goal lipid levels. GPs sometimes postponed the start of treatment because of other priorities. Finally, barriers were seen in the GPs' practice organisation, and at the primary-secondary care interface. Conclusion Some of the barriers mentioned by GPs seem to be valid reasons, showing that guideline non-adherence can be quite rational. On the other hand, treatment quality could improve by addressing issues, such as lack of knowledge or motivation of both the patient and the GP. More structured management in general practice may also lead to better treatment.
Hills, Danny J
Objectives The aim of the present study was to investigate differences in prevalence, as well as risk and protective factors, for exposure to workplace aggression between male and female clinicians in Australian medical practice settings. Methods In a cross-sectional, self-report study in the third wave of the Medicine in Australia: Balancing Employment and Life survey (2010-11), 16327 medical practitioners were sampled, with 9449 (57.9%) respondents working in clinical practice. Using backward stepwise elimination, parsimonious logistic regression models were developed for exposure to aggression from external (patients, patients' relatives or carers and others) and internal (co-workers) sources in the previous 12 months. Results Overall, greater proportions of female than male clinicians experienced aggression from external (Pworkplace aggression between male and female clinicians, including in relation to state and rural location, need to be considered in the development and implementation of efforts to prevent and minimise workplace aggression in medical practice settings. What is known about the topic? Workplace aggression is prevalent in clinical medical settings, but there are conflicting reports about sex-based differences in the extent of exposure, and little evidence on differences in risk and protective factors for exposure to workplace aggression. What does this paper add? Differences in workplace aggression exposure rates between male and female clinicians are highlighted, including when stratified by doctor type. New evidence is reported on differences and similarities in key personal, professional and work-related factors associated with exposure to external and internal aggression. What are the implications for practitioners? In developing strategies for the prevention and minimisation of workplace aggression, consideration must be given to differences between male and female clinicians, including with regard to personality, age and professional
34 May, 1981, "Nurse, Where Are You?" Judy Armstrong . 5 1nitial Report and Preliminary Recommendations, National Commission on Nursing (September 1981...Interview with Ms. R. Marsh, Staffing Specialist, Force Develop- ment Division, Madigan Army Medical Center, Tacoma, WA (Dec 81) 20Philip Kotler ...Marketing Management. Boston: Allyn and Bacon, Inc., 1980. Kotler , Philip. Marketing for Nonprofit Institutions. Englewood Cliffs, N.D.: Prentice-Hall
Diana du Plessis
Therefore, in order to understand the constraints to breastfeeding, the purpose of this study was to assess the breastfeeding information given to pregnant women by health professionals in private practice. The specific objectives of the study were to determine the breastfeeding recommendations made by private health professionals during pregnancy, to describe the management of breastfeeding in the consulting rooms of private medical practitioners, and to describe women’s experiences of breastfeeding in private hospitals. In Phase 1 of the study the population comprised all mothers who attended a support group for new mothers at a private post-natal clinic In Phase 2 the population comprised all mothers who attended a community baby clinic or support group. The sample consisted of all primigravidae who breastfed or attempted to breastfeed in the first six weeks. Purposive convenient sampling, as described by Babbie and Mouton (2002:166, was used in both phases of the study. All participants chose a gynaecologist as the primary care giver and delivered in various private hospitals in Johannesburg. Data were collected by means of an anonymous questionnaire, compiled from national and international literature, as well as personal interviews. Data from the questionnaires were analysed by hand. Descriptive statistics were applied. The interviews were analysed according to the descriptive analysis suggested by Tesch (in Creswell, 1994:155. Themes that emerged were clustered and coded. A co-coder, experienced in the field of qualitative research, assisted with the analysis of the transcripts of the interviews. A literature control was conducted to validate the findings. Ethical considerations were based on the DENOSA Ethical Standards for Nurse Researchers (1998:2.3.2–2.3.4. Themes and sub-themes were identified. Opsomming Ten spyte van die goed gedokumenteerde gesondheidsvoordele van borsvoeding en die aanbevelings van die Departement van Gesondheid dat vroue vir
Kalakonda, Butchibabu; Koppolu, Pradeep; Baroudi, Kusai; Mishra, Ashank
Periodontal diseases, considered as inflammatory diseases have proved to have a spectrum of systemic implications. Earliest research has associated periodontal disease with common systemic aliments such as hypertension, diabetes, osteoporosis, rheumatoid arthritis to name a few. The evolution of advanced diagnostic aids let researchers make vast inroads in linking periodontal diseases to systemic diseases like Alzheimer's disease (AD) and even Schizophrenia. Our aim was to review and critically evaluate comprehensive literature and provide knowledge to medical practitioners on these associations so as to pave way for closer interactions between medical and dental practitioners in implementing better health care. Electronic databases such as PubMed, Google Scholar and Cochrane databases were used as source of the data for relevant studies published from 2005 up to 2015 with the following keywords, "'Periodontal disease", "systemic conditions", "periodontal disease and Alzheimer's", "Periodontal disease and Schizophrenia", "Periodontal disease and Psoriasis" and "Periodontal disease and erectile dysfunction". The evidence presented ascertains that a reasonable and modest association does exist between Periodontal disease and Alzheimer's, Schizophrenia, Erectile dysfunction, as well as Psoriasis and thus establishes periodontal disease as a potential risk factor.
Renovanz, M; Keric, N; Richter, C; Gutenberg, A; Giese, A
Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.
Cheng, Chen-Hsiu; Chen, Shih-Chien
Nurse practitioner development affirms the social value of nursing staff and promotes the professional image of nursing. As the medical environment and doctor-patient relations change, how should a nurse practitioner carry out clinical care? Apart from having foundations in medical knowledge and high-quality nursing techniques, nurse practitioners must have other clinical skills, in order to break out of their former difficult position, promote nursing competitiveness, provide a multi -dimensional service, win the people's acclamation and develop international links.
Full Text Available The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO’s alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed.
Yen, Wendy; Hodwitz, Kathryn; Thakkar, Niels; Martimianakis, Maria Athina (Tina); Faulkner, Dan
The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO’s alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed. PMID:28344705
Yen, Wendy; Hodwitz, Kathryn; Thakkar, Niels; Martimianakis, Maria Athina Tina; Faulkner, Dan
The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO's alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed.
Härkänen, Marja; Voutilainen, Ari; Turunen, Elina; Vehviläinen-Julkunen, Katri
The aim of this study is to evaluate the nature, quality and effectiveness of educational interventions designed to increase the medication administration skills and safety of registered nurses working in hospitals. A systematic review with meta-analysis. Intervention studies designed to increase the medication administration skills and safety of nurses, indexed in one or more databases (CINAHL, PubMed, Scopus, Cochrane, PsycInfo, or Medic), and published in peer-reviewed journals between January 2000 and April 2015. The nature of the interventions was evaluated by narrative analysis, the quality of studies was assessed using the Effective Public Health Practise Project Quality Assessment Tool and the effectiveness of the interventions was ascertained by calculating effect sizes and conducting a meta-analysis. A total of 755 studies were identified and 14 intervention studies were reviewed. Interventions differed by their nature, including traditional classroom training, simulation, e-learning, slide show presentations, interactive CD-ROM programme, and the use of posters and pamphlets. All interventions appeared to improve medication administration safety and skills based on original p-values. Only five studies reached strong (n=1) or moderate (n=4) quality ratings and one of them had to be omitted from the meta-analysis due unclear measures of dispersion. The meta-analysis favoured the interventions, the pooled effect size (Hedges' g) was large, 1.06. The most effective interventions were a blended learning programme including e-learning and a 60-min PowerPoint presentation. The least effective educational intervention, an interactive internet-based e-learning course, was reported in the study that achieved the only strong quality rating. It is challenging to recommend any specific intervention, because all educational interventions seem to have a positive effect, although the size of the effect greatly varies. In the future, studies sharing similar contents and
Checkland, Kath; Harrison, Stephen; McDonald, Ruth; Grant, Suzanne; Campbell, Stephen; Guthrie, Bruce
In 2004 a new contract was introduced for General Practitioners in the UK, which introduced a significant element of 'pay-for-performance', including both clinical and organisational targets. The introduction of this contract has caused interest across the world, particularly amongst those responsible for commissioning primary care services. It can be argued that the clinical targets in the contract (known as the Quality and Outcomes Framework, QOF) represent a move towards a more biomedical model of health and illness, which is contrary to the ideal of providing holistic (or biopsychosocial) care that has been traditionally espoused by GPs. This paper reports results from two linked studies (in England and Scotland) investigating the early stages of the new contract. We describe the way in which four practices with different organisational approaches and espoused identities have all changed their practice structures, consultations and clinical care in response to QOF in ways which will result in patients receiving a more biomedical type of care. In spite of these observed changes, respondents continued to maintain discursive claims to holism. We discuss how this disconnection between rhetoric and reality can be maintained, and consider its implications for the future development of GPs' claims to a professional identity.
Moskowitz, Gordon B; Stone, Jeff; Childs, Amanda
We investigated whether stereotypes unconsciously influence the thinking and behavior of physicians, as they have been shown to do in other professional settings, such as among law enforcement personnel and teachers. We conducted 2 studies to examine whether stereotypes are implicitly activated in physicians. Study 1 assessed what diseases and treatments doctors associate with African Americans. Study 2 presented these (and control terms) to doctors as part of a computerized task. Subliminal images of African American and White men appeared prior to each word, and reaction times to words were recorded. When primed with an African American face, doctors reacted more quickly for stereotypical diseases, indicating an implicit association of certain diseases with African Americans. These comprised not only diseases African Americans are genetically predisposed to, but also conditions and social behaviors with no biological association (e.g., obesity, drug abuse). We found implicit stereotyping among physicians; faces they never consciously saw altered performance. This suggests that diagnoses and treatment of African American patients may be biased, even in the absence of the practitioner's intent or awareness.
Ghassan M. Al-Irany
Full Text Available Medical emergencies are one of the most stressful situations the staff in a dental practice might encounter. The duty of care toward the attending patients obligates suitable preparedness to provide the necessary care if such emergencies ensue. Unfortunately, we found that 22% of the investigated dental clinics had no emergency kit available. Only 38% of the interviewed dentists felt confident to perform CPR, and 18% had no confidence to manage any medical emergency. An MCQ test of 20 questions examining the dentists’ knowledge in medical emergencies was distributed, and the level of knowledge was found to be suboptimal. The average score of the interviewed dentists was 10.87 out of 20. Experience and specialty training had a negligible effect on the level of knowledge.
Schraagen, Jan Maarten; Verhoeven, Fenne
The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Starting from a Cognitive Systems Engineering perspective, we developed an Impact Flow Diagram showing the relationship of computer technology, cognition, practitioner behavior, and system failure in the area of medical infusion devices. We subsequently conducted a systematic literature review on user-interface issues with infusion pumps, categorized the studies in terms of methods employed, and noted the usability problems found with particular methods. Next, we assigned usability problems and related methods to the levels in the Impact Flow Diagram. Most study methods used to find user interface issues with infusion pumps focused on observable behavior rather than on how artifacts shape cognition and collaboration. A concerted and theory-driven application of these methods when testing infusion pumps is lacking in the literature. Detailed analysis of one case study provided an illustration of how to apply the Impact Flow Diagram, as well as how the scope of analysis may be broadened to include organizational and regulatory factors. Research methods to uncover use problems with technology may be used in many ways, with many different foci. We advocate the adoption of an Impact Flow Diagram perspective rather than merely focusing on usability issues in isolation. Truly advancing patient safety requires the systematic adoption of a systems perspective viewing people and technology as an ensemble, also in the design of medical device technology. Copyright © 2012 Elsevier Inc. All rights reserved.
Chew, B H; Lee, P Y; Ismail, I Z
Personal mission in life can determine the motivation, happiness, career advancement and fulfilment in life of the medical students (MSs) along with improvement in professional/clinical performance of the family physicians. This study explored the personal beliefs, values and goals in the lives of MSs and general practitioners (GPs). Fourth-year MSs at the Universiti Putra Malaysia and GPs who participated in a 2-hour session on 'Ethics in Family Medicine' in 2012 were invited. All the participants submitted the post-session written reflections about their personal missions in life. The written reflections were analysed using thematic analysis. A total of 87 MSs and 31 GPs submitted their written reflections. The authors identified 17 categories from the reflections contained by four themes-good vs. smart doctor, professional improvement vs. self-improvement, self-fulfilment and expressed motivation. The most common categories were "to be a good doctor" (97/330) and "professional improvement" (65/330). Many MSs had expressed motivation and wanted to be a smart doctor as compared to the GPs, whereas a larger number of GPs wished to have a fulfilled life and be a good doctor through professional improvement. The difference between the two student groups might indicate different levels of maturity and life experiences. Medical teachers should engage students more effectively in orientating them towards the essential values needed in medical practice.
Barker, L. Randol
Most of the 23 European providers of continuing medical education (CME) surveyed reported programming on the doctor-patient relationship and psychosocial issues. Visits to programs in France, the Netherlands, and Spain identified the formats used most often in small group instruction, intensive individual learning, and national-level CME. (SK)
Heusser, Peter; Scheffer, Christian; Neumann, Melanie; Tauschel, Diethart; Edelhäuser, Friedrich
To develop the hypothesis that reductionism in medical anthropology, professional education and health care influences empathy development, communication and patient satisfaction. We identified relevant literature and reviewed the material in a structured essay. We reflected our hypothesis by applying it to Anthroposophic Medicine (AM), an example of holistic theory and practice. Reductionism in medical anthropology such as in conventional medicine seems to lead to a less empathetic and less communicative health care culture than holism such as in CAM disciplines. However, reductionism can be transformed into a systemic, multi-perspective holistic view, when the emergent properties of the physical, living, psychic, spiritual and social levels of human existence and the causal relations between them are more carefully accounted for in epistemology, medical anthropology and professional education. This is shown by the example of AM and its possible benefits for communication with and satisfaction of patients. A non-reductionistic understanding of the human being may improve communication with patients and enhance patient benefit and satisfaction. Interdisciplinary qualitative and quantitative studies are warranted to test this hypothesis and to understand the complex relations between epistemology, medical anthropology, education, health care delivery and benefit for patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Kylie N Johnston1, Mary Young2, Karen A Grimmer-Somers1, Ral Antic3, Peter A Frith41International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia; 2Transitional and Community Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 3Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 4Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University Adelaide, South Australia, AustraliaBackground: Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.Methods: Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners' experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.Results: Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1 role clarity of the medical practitioner; (2 persuasive communication with the patient; (3 complexity of behavioral change required; (4 awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to
Bouamrane, Matt-Mouley; Mair, Frances S
Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.
Shin, Dong Won
Heo Yongsuk (1897-1975) was the second female medical doctor to study Western medicine in a foreign country, the second female journalist, and the one of the representative 'new modern woman' in Korea. She is unfamiliar, however, to Korean people. Few historians of medicine and few researchers of the history of literature recall her for her own achievements, instead remembering her as a wife who saved her husband, Yi Gwangsu (1892~1950), the great novelist, from his dreadful tuberculosis. Removing her from the shadow of Yi Gwangsu, this paper tries to uncover her life and her contribution to Korean society during the Japanese colonial period. As a pioneer, she went to Japan to study medicine in 1914 for the purpose of breaking down the long-established custom of female patients, who abhorred showing their bodies to male doctors. After acquiring her license, she opened in Korea for women and children, though this clinic had a brief span of only two years owing to her devotion to caring for her husband as his disease worsened. She became a reporter in place of her husband for about two years. However, with her efforts, she gave women a considerable amount of useful medical information. She wrote many enlightening articles to awaken Korean women's 'nationalistic spirit' against Japanese colonial oppression. She is worthy of a favorable evaluation as the second female reporter and the first who specialized in medicine in the history of newspapers in Korea. As a 'new modern woman,' she presented her own thinking about the best role model for married females, by saying, "Be good mother and good wife in the family household, it is the best way to strengthen Korean race." When she became pregnant, she resigned her job as a reporter. She exerted herself by bringing up her children and nursing her sick husband, gaining fame as the representative of the conservative women's movement. Medical knowledge was always behind her various activities. She can be evaluated successfully
US studies have shown that a clinician's risk-taking propensity significantly predicts clinical behaviour. Other US studies examining relationships between family practice doctors' preferences for CME and their Kolb learning style have described conflicting findings. The aim of the present study was to investigate GPs' learning styles, risk-taking propensities and CME preferences, and to explore links between them. A descriptive confidential cross-sectional postal questionnaire survey of the 304 general practitioner principals within Portsmouth and South East Hampshire Health Authority was conducted. Two hundred and seventy-four GPs returned questionnaires, a response rate of 90.1%. The Kolb learning style types were assimilators 43.8% (predominant learning abilities watching and thinking), divergers 21.1% (feeling and watching), convergers 18.3% (doing and thinking), and accommodators 16.8% (doing and feeling). The Pearson risk-taking propensities were 65.8% risk neutral, 19.4% risk seeking and 14.8% risk averse. Risk-seeking GPs were significantly more likely to be accommodators or convergers than divergers or assimilators (p = 0.006). Majorities of 54.9% stated that the present PGEA system works well, 85% welcomed feedback from their peers, and 76.8% stated that learning should be an activity for all the practice team. Further majorities would welcome help to decide their learning needs (63.8%) and are looking to judge CME effectiveness by changes in GP performance or patient care (54.8%). Further significant correlations and cross-tabulations were found between learning style and risk-taking and CME attitudes, experiences and preferences. It is concluded that risk seekers and accommodators (doing and feeling) prefer feedback, interaction and practical hands-on learning, and assimilators (watching and thinking) and the risk averse tend towards lectures, theoretical learning formats and less interactive activities. Sharing feelings in groups may be difficult for
This publication is aimed at doctors, paramedics and nursing personnel who, especially in small communities and in developing countries, but also in highly industrialized countries can be faced with overexposures and have the task of taking the first decisions about the victims. It provides basic information about radioactivity, radiation and radiation accidents, radiation burns, external and internal contamination by radioactive materials, acute radiation syndrome and the late effects of radiation. In addition, a list of recommended equipment and medications sufficient to allow first aid treatment of acute radiation exposed or contaminated individuals is given
This publication is aimed at doctors, paramedics and nursing personnel who especially in small communities and in developing countries, but also in highly industrialized countries can be faced with overexposures and have the task of taking the first decisions about the victims. It provides basic information about radioactivity, radiation and radiation accidents, radiation burns, external and internal contamination by radioactive materials, acute radiation syndrome and the late effects of radiation. In addition, a list of recommended equipment and medications sufficient to allow first aid treatment of acute radiation exposed or contaminated individuals is given. 7 tabs
Lynöe, N; Mattsson, B
To shed light on attitudes towards loyalty conflicts among general practitioners (GPs) compared with related specialists such as gynaecologists and paediatricians. A postal questionnaire containing three case histories with arguments for and against different ways of acting in loyalty conflicts. The medical problems of the clinical cases varied, but the ethical ones were in principle similar. A random sample of all Swedish GPs, gynaecologists, and paediatricians. GPs (n = 313), paediatricians (n = 197), and gynaecologists (n = 236). On average 71% of the doctors replied. The gynaecologists differed from the other groups by being markedly loyal to the individual patient especially in one case. The paediatricians tended to reply most consistently and they seemed to favour the family perspective, compared with the other doctors. The GPs' response pattern fell in between the other two groups. The study indicates that ethical reasoning depends on the doctors' different medical background with regard to specialty. This study should be followed by others in order to give further explanation of the findings.
A. Weiland (Anne); A.H. Blankenstein (Annette); M.H.A. Willems; J.L.C.M. van Saase (Jan); P.L.A. van Daele (Paul); H.T. van der Molen (Henk); G.B. Langbroek (Ginger B.); A. Bootsma (Aart); E.M. Vriens (Els M.); A. Oberndorff-Klein Woolthuis (Ardi); R. Vernhout (Rene); L.R. Arends (Lidia)
textabstractObjective: To evaluate effects of a communication training for specialists on the quality of their reply letters to general practitioners (GPs) about patients with medically unexplained physical symptoms (MUPS). Methods: Before randomization, specialists included ≤3 MUPS patients in a
This didactic text is devoted to the protection of patients against unnecessary exposure to ionising radiation. It is organised in a questions-and-answers format. There are obvious benefits to health from medical uses of radiation, in x-ray diagnostics, interventional radiology, nuclear medicine, and radiotherapy. However, there are well-established risks from high doses of radiation (radiotherapy, interventional radiology), particularly if improperly applied, and possible deleterious effects from small radiation doses (such as those used in diagnostics). Appropriate use of large doses in radiotherapy prevents serious harm, but even low doses carry a risk that cannot be eliminated entirely. Diagnostic use of radiation requires therefore such methodology that would secure high diagnostic gains while minimising the possible harm. For assessment of the risk, a quantitative measure of exposure is a necessary prerequisite. Therefore, dosimetric quantities are explained and defined (absorbed dose, effective dose). Basic facts are presented on mechanisms of action of ionising radiations on living matter. Undesired deleterious effects in man are categorised into two categories. The first one comprises sequelae resulting from massive cell killing (the so-called deterministic effects), requiring a high dose for their manifestation (exceeding the threshold dose). The second category includes those effects originating from mutational changes in the cellular DNA. These may eventually lead to development of radiation-induced cancer and to hereditary changes, transmitted to descendants of exposed individuals after irradiation of their gonads. Data on the magnitude of threshold doses for cell killing effects are presented. On the basis of experimental, clinical, and epidemiological evidence, assessment is also given of the probability with which cancers and hereditary mutations may be induced by doses of various magnitudes, most likely without a threshold dose (below which no
Mncedisi M. Willie
Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival. Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members. Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic disease prevalence, age stratum and scheme size on GP visits per annum. Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95% CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26. Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.
Lastrucci, Vieri; Lorini, Chiara; Rinaldi, Giada; Bonaccorsi, Guglielmo
Aim To evaluate the possibility of determining predictors of falls in the active community-dwelling elderly from the routine medical records of the general practitioners (GPs). Time constraints and competing demands in the clinical encounters frequently undermine fall-risk evaluation. In the context of proactive primary healthcare, quick, and efficient tools for a preliminary fall-risk assessment are needed in order to overcome these barriers. The study included 1220 subjects of 65 years of age or older. Data were extracted from the GPs' patient records. For each subject, the following variables were considered: age, gender, diseases, and pharmacotherapy. Univariate and multivariable analyses have been conducted to identify the independent predictors of falls. Findings The mean age of the study population was 77.8±8.7 years for women and 74.9±7.3 years for men. Of the sample, 11.6% had experienced one or more falls in the previous year. The risk of falling was found to increase significantly (P<0.05) with age (OR=1.03; 95% CI=1.01-1.05), generalized osteoarthritis (OR=2.01; 95% CI=1.23-3.30), tinnitus (OR=4.14; 95% CI=1.25-13.74), cognitive impairment (OR=4.12; 95% CI=2.18-7.80), and two or more co-existing diseases (OR=5.4; 95% CI=1.68-17.39). Results suggest that it is possible to identify patients at higher risk of falling by going through the current medical records, without adding extra workload on the health personnel. In the context of proactive primary healthcare, the analysis of fall predictors from routine medical records may allow the identification of which of the several known and hypothesized risk factors may be more relevant for developing quick and efficient tools for a preliminary fall-risk assessment.
Goetz, Katja; Mahnkopf, Janis; Kornitzky, Anna; Steinhäuser, Jost
In primary care 15% of patient encounters are perceived as challenging by general practitioners (GP). However it is unknown what impact these encounters have regarding job satisfaction. The aim of this study was to evaluate which encounters are perceived as challenging by German GPs and whether they were associated with job satisfaction. A total of 1538 questionnaires were sent to GPs in the federal state of Schleswig-Holstein, Germany. GPs should rate 14 medical conditions and 8 traits of patients on the perceived challenge using a Likert scale (1: 'not challenging at all' to 10: 'extremely challenging'). Job satisfaction was measured with the Warr-Cook-Wall job satisfaction scale. A linear regression analyses were used to explore potential associations between for the primary outcome variable 'overall job satisfaction'. Total response was 578 (38%). GPs perceived 16% of their patients as challenging. Psychiatric disorders such as somatization disorder (mean = 7.42), schizophrenia (mean = 6.83) and anxiety disorder (mean = 6.57) were ranked as high challenging while diabetes mellitus type 2 (mean = 4.87) and high blood pressure (mean = 3.22) were ranked as a rather low challenging condition. GPs were mostly satisfied with 'colleagues' (mean = 5.80) and mostly dissatisfied with their 'hours of work' (mean = 4.20). The linear regression analysis showed no association with challenging medical conditions and traits of patients but only with different aspects of job satisfaction concerning the outcome variable 'overall job satisfaction'. Especially psychiatric conditions are perceived as challenging the question arises, in what amount psychiatric competences are gained during the postgraduate specialty training in general practice and if GPs with a mandatory rotation in psychiatry perceive these conditions as less challenging. Interestingly this study indicates that challenging encounter in terms of challenging medical conditions and traits
Carter, Stephen R; Moles, Rebekah J; White, Lesley; Chen, Timothy F
Some consumers at risk of experiencing medication-related problems have chosen not to use pharmacist-provided medication management services. Previous research has shown that consumers' willingness to use the Australian Home Medicines Review (HMR) service depends on the extent to which they believe that they will receive medication information to assist them with self-management. The aim of this study was to develop and test a model of willingness to use HMR among consumers who were eligible to receive the service but have not yet experienced it. Specifically, this study aimed to determine the effects of consumers' medication-related worry and the social influence of the consumer's general practitioner (GP) over willingness. A cross-sectional postal survey was conducted among 1600 members of Council on the Ageing (NSW, Australia). Respondents were included in the study if they had not experienced an HMR and were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed or were based on previous research. Confirmatory factor analysis was used to test the reliability and validity of the multi-item scales. Multiple regression analysis and structural equation modeling (SEM) were used to test the model. Surveys received from 390 respondents (24.3%) were analyzed. Respondents held overall low-to-neutral positive outcome expectancy (POE). The SEM analysis revealed that worry had a direct effect on POE (β=0.35, Psocial influence over willingness to use this medication management service. Copyright © 2013 Elsevier Inc. All rights reserved.
Hvidberg, Michael F; Johnsen, Søren P; Glümer, Charlotte
INTRODUCTION: The aim of the current study was to present and discuss a broad range of register-based definitions of chronic conditions for use in register research, as well as the challenges and pitfalls when defining chronic conditions by the use of registers. MATERIALS AND METHODS: The definit......INTRODUCTION: The aim of the current study was to present and discuss a broad range of register-based definitions of chronic conditions for use in register research, as well as the challenges and pitfalls when defining chronic conditions by the use of registers. MATERIALS AND METHODS......: The definitions were defined based on information from nationwide Danish public healthcare registers. Medical and epidemiological specialists identified and grouped relevant diagnosis codes that covered chronic conditions, using the International Classification System version 10 (ICD-10). Where relevant...... definitions were proposed based on record linkage between multiple registers, including registers of prescribed drugs and use of general practitioners' services. CONCLUSIONS THIS STUDY PROVIDED A CATALOG OF REGISTER-BASED DEFINITIONS FOR CHRONIC CONDITIONS FOR USE IN HEALTHCARE PLANNING AND RESEARCH, WHICH IS...
Hadadgar, Arash; Changiz, Tahereh; Masiello, Italo; Dehghani, Zahra; Mirshahzadeh, Nahidossadat; Zary, Nabil
General practitioners (GP) update their knowledge and skills by participating in continuing medical education (CME) programs either in a traditional or an e-Learning format. GPs' beliefs about electronic format of CME have been studied but without an explicit theoretical framework which makes the findings difficult to interpret. In other health disciplines, researchers used theory of planned behavior (TPB) to predict user's behavior. In this study, an instrument was developed to investigate GPs' intention to use e-Learning in CME based on TPB. The goodness of fit of TPB was measured using confirmatory factor analysis and the relationship between latent variables was assessed using structural equation modeling. A total of 148 GPs participated in the study. Most of the items in the questionnaire related well to the TPB theoretical constructs, and the model had good fitness. The perceived behavioral control and attitudinal constructs were included, and the subjective norms construct was excluded from the structural model. The developed questionnaire could explain 66 % of the GPs' intention variance. The TPB could be used as a model to construct instruments that investigate GPs' intention to participate in e-Learning programs in CME. The findings from the study will encourage CME managers and researchers to explore the developed instrument as a mean to explain and improve the GPs' intentions to use eLearning in CME.
Hadadgar, Arash; Changiz, Tahereh; Dehghani, Zahra; Backheden, Magnus; Mirshahzadeh, Nahidalsadat; Zary, Nabil; Masiello, Italo
Electronic modes of continuing medical education (eCME) can provide an appropriate and scalable way of updating the knowledge and skills of general practitioners (GPs). To optimize the adoption of eCME and develop efficient and cost-effective eCME programs, factors explaining GPs' intention to use eCME must first be elucidated. Using the Theory of Planned Behavior as a framework, we developed a questionnaire and administered it to GPs in seven CME seminars in Isfahan, Iran, in 2014. Three domains of GPs' intention to use eCME were measured: attitudes, perceived behavioral control, and subjective norms. We used linear and logistic regression to identify the main predictors of intention and behavior. GPs who had high score in perceived behavioral control and a more positive attitude toward e-learning had a higher intention to adopt it for CME. In contrast, subjective norms (eg, social pressures to use eCME) were not a predictor. Attitude toward usefulness of eCME was the main predictor of being an actual eCME user. Perceived behavioral control and attitude constitute the main predictors of the intention to use eCME. Establishing discussions forums and strengthening organizational support for eCME through an increased awareness among clinical superiors and CME managers would be expected to increase GPs' intention to use eCME.
Patterson, P Daniel; Moore, Charity G; Sanddal, Nels D; Wingrove, Gary; LaCroix, Brian
The primary purpose of this study was to characterize job satisfaction with opportunities for advancement, job satisfaction with pay and benefits, and intent to leave the EMS profession among Nationally Registered EMT-Basics and EMT-Paramedics. A secondary data analysis was performed on the National Registry of EMTs Longitudinal Emergency Medical Technician Attributes and Demographic Study Project (LEADS) 2005 core survey. We used chi-square and multiple logistic regression analyses to test for differences in job satisfaction with opportunities for advancement, job satisfaction with pay and benefits, and intent to leave the EMS profession across years of experience and work location. Among 11 measures of job satisfaction, NREMT-Basics and NREMT-Paramedics were least satisfied with opportunities for advancement and pay and benefits (67.8 and 55.2%, respectively). Nearly 6% of respondents reported intentions of leaving the profession within 12 months. In univariate analyses, job satisfaction with advancement opportunities varied across years of experience and work location. Job satisfaction with pay and benefits varied across years of experience and work location. The proportion reporting intentions of leaving the profession did not vary across the two independent variables of interest. In multivariable logistic regression, statistical differences observed in univariate analyses were attenuated to non-significance across all outcome models. Income, personal health, level of EMS certification, and type of EMS work were significant in several outcome models. EMS workforce research is at its infancy, thus our study adds to a limited but growing body of knowledge. In future and replicated research, one will need to consider different person and organizational variables in predicting different measures of job satisfaction among EMS personnel.
Popper-Giveon, Ariela; Keshet, Yael
Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.
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Adriano Max Moreira Reis
Full Text Available The objective of this study was to analyze the level of evidence regarding the efficacy, effectiveness and safety of over-the-counter (OTC cough medications registered in Brazil. The National Health Surveillance Agency database was used to identify the drugs. Clinical trials, systematic reviews, meta-analyses, and studies on safety were searched on the Medline baseline, the Cochrane Library and SIETES (System of Essential Information in Therapeutics and Health; database in Spanish. Most drugs (62.5% were sold as a fixed-dose combination of two or more drugs. Randomized clinical trials were found for only three drugs: bromhexine, dextromethorphan and guaifenesin. No clinical trials were found for fixed-dose combinations. Systematic reviews on Cochrane did not report any evidence in favor of or against the effectiveness of cough drugs. Efficacy is also unclear, especially regarding fixed-dose combinations. The evidence for the efficacy of OTC cough medications available in Brazil is poor due to the lack of quality studies. Pharmacovigilance of OTC cough medications should be encouraged.O objetivo deste trabalho foi analisar o nível de evidências sobre a eficácia, a efetividade e a segurança dos medicamentos para tosse registrados no Brasil. A base de dados da Agência Nacional de Vigilância Sanitária foi empregada para identificar os medicamentos. Os ensaios clínicos, as revisões sistemáticas, as metanálises e os estudos de segurança foram pesquisados no Medline, the Cochrane Library e SIETES (Sistema de Informações Essenciais em Terapêutica e Saúde, base de dados em espanhol. A maioria dos medicamentos (62,5% eram comercializados como associação em dose fixa com dois ou mais fármacos. Ensaios clínicos randomizados foram encontrados apenas para três fármacos: bromexina, dextrometorfano e guaifenesina; para associações a dose fixa não foram encontrados ensaios clínicos. Revisões sistemáticas publicadas pela Cochrane n
Walther, A L; Pohontsch, N J; Deck, R
General practitioners complain about information deficits, uncertainties and unclear requirements associated with medical rehabilitation. In this study General practitioners' specific information needs are identified and the preferred form for the presentation of information is determined. In a secondary analysis of several focus groups with different stakeholders, rehabilitation specific aspects were identified for which General practitioners could have further information needs. Those were transferred into an online-questionnaire. GPs in Schleswig-Holstein were invited to the online-survey via E-Mail by different medical associations. A total of 194 questionnaires were available for analysis. In general, high information needs covering all rehabilitation topics in the questionnaire are evident. The highest information need is recognised for the following aspects: in which cases it makes sense to file an objection, which measures have to take place before it makes sense to file an objection and what the term "ambulant measures have been exhausted" exactly means. GPs clearly prefer a website as a means of informational source. Under the option of multiple replies 74.2% prefer a website, followed by the option of a brochure (44.8%) and further education (22.2%). General practitioners have high information needs regarding different aspects of rehabilitation which are not satisfied with existing sources of information. The development of a user-friendly website with comprehensible information on the required aspects seems necessary to increase the acceptance and understanding of medical rehabilitation among practitioners and therefore to optimise rehabilitation processes. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Background: To be able to counter the increasing shortage of general practitioners (GPs in many countries, it is crucial to remain up-to-date with the decisive reasons why young physicians choose or reject a career in this field. Materials and Methods: Qualitative content analysis was performed using data from a cross-sectional survey among German medical graduates (n = 659, response rate = 64.2%. Subsequently, descriptive statistics was calculated. Results: The most frequent motives to have opted for a GP career were (n = 74/81: Desire for variety and change (62.2%, interest in a long-term bio-psycho-social treatment of patients (52.7%, desire for independence and self-determination (44.6%, positively perceived work-life balance (27.0%, interest in contents of the field (12.2%, and reluctance to work in a hospital (12.2%. The most frequent motives to have dismissed the seriously considered idea of becoming a GP were (n = 207/578: Reluctance to establish a practice or perceived associated risks and impairments (33.8%, stronger preference for another field (19.3%, perception of workload being too heavy or an unfavorable work-life balance (15.0%, perception of too low or inadequate earning opportunities (14.0%, perception of the GP as a "distributor station" with limited diagnostic and therapeutic facilities (11.6%, perception of too limited specialization or limited options for further sub-specialization (10.6%, rejection of (psycho- social aspects and demands in general practice (9.7%, and perceived monotony (9.7%. Conclusion: While some motives appear to be hard to influence, others reveal starting points to counter the GP shortage, in particular, with regard to working conditions, the further academic establishment, and the external presentation of the specialty.
Full Text Available Abstract Background Despite the importance of continuing medical education (CME for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. Methods This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. Results There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. Conclusions We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs.
Terrill, Matthew; Riordan, John
To review the assessment and management of gout by general practitioners (GPs) and medical officers (MOs) within the Illawarra Network, Australia. A survey was sent to GPs and MOs within the Illawarra Network. Of 110 GPs, 45 responded. Of 129 MOs, 42 responded. The overall response was 32.6%. On analysis, 65.1% felt their knowledge of gout to be adequate and 61.6% thought they had been educated well. In acute assessment, 59.1% of GPs responded that the diagnosis of gout best be confirmed with a joint aspiration and 36.4% clinical suspicion. Differing, 85.7% of MOs chose a joint aspiration. In acute management, if colchicine were used, 59.1% of GPs would give 1 mg followed by 0.5 mg an hour later, then 0.5 mg twice daily, compared to 9.5% of MOs, while 20.5% of GPs would use 1 mg twice daily. Chronic management was answered poorly. After an acute attack, urate lowering therapy (ULT) would be started 14 days after by 47.7% of GPs, compared to 69.0% of MOs. GPs were more likely to start ULT within 7 days (52.3% vs. 31.0%). With dosing of ULT, 45.3% would treat to target, while 46.5% would dose to the creatinine clearance. Prophylactic therapy with ULT would be started by 81.8%, although only 17.4% would continue it for 3-6 months. There is poor adherence to recommended practice for dosing of colchicine in acute gout. Also in the management of chronic gout, in particular, the timing of starting ULT and the use of prophylaxis when initiating ULT. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
van Spaendonck Karel P
Full Text Available Abstract Background Persistent presentation of medically unexplained symptoms (MUS is troublesome for general practitioners (GPs and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. Methods A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. Results GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. Conclusion GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions.
White, Katherine M; Wise, Susi E; Young, Ross McD; Hyde, Melissa K
A qualitative study explored beliefs about active voluntary euthanasia (AVE) in a sample (N = 18) of medical practitioners and nurses from Australia, where AVE is not currently legal. Four behaviors relating to AVE emerged during the interviews: requesting euthanasia for oneself, legalizing AVE, administering AVE to patients if it were legalized, and discussing AVE with patients if they request it. Using thematic analysis, interviews were analyzed for beliefs related to advantages and disadvantages of performing these AVE behaviors. Medical practitioners and nurses identified a number of similar benefits for performing the AVE-related behaviors, both for themselves personally and as health professionals. Benefits also included a consideration of the positive impact for patients, their families, and the health care system. Disadvantages across behaviors focused on the potential conflict between those parties involved in the decision making process, as well as conflict between one's own personal and professional values.
In November 2013, the Irish Regulator for emergency medical technicians (EMTs) introduced the first mandatory requirement for registrants to demonstrate evidence of continuous professional development (CPD)\\/continuous professional competence (CPC). This qualitative study assessed the experience of practitioners with CPC-related materials provided to them by the Regulator in addition to identifying perceived or encountered practical challenges and suggested improvements six months following introduction of the requirement.
... Parts 60 and 61 National Practitioner Data Bank; Proposed Rule #0;#0;Federal Register / Vol. 77, No. 31... CFR Parts 60 and 61 RIN 0906-AA87 National Practitioner Data Bank AGENCY: Health Resources and... section 1921 of the Social Security Act, governing the National Practitioner Data Bank, to incorporate...
..., psychologists, optometrists, podiatrists, audiologists, physician assistants, certified registered nurse anesthetists, nurse practitioners, and certified nurse midwives. IHS policy specifically requires physicians... providers become medical staff members, depending on the local health care facility's capabilities and...
Riley, Lydia; Litsch, Tyler; Cook, Michelle L
The purpose of this study was twofold: to describe the average cost of nurse practitioner (NP) tuition based on degree program, program type, and geography; and to compare the cost of NP tuition to medical school tuition. A listing of all NP degree granting universities was obtained from the American Association of Colleges of Nursing during the fall of 2014, and tuition data were obtained from university websites. Medical school tuition data were obtained online during the fall of 2014 from the American Association of Medical Colleges. Average 1-year tuition rates were calculated for NP programs and medical schools and compared across private and public institutions. Average 1-year resident tuition for public university NP programs ranges between $8671 and $11,077 based on type of program. The cost of 1-year NP program tuition at the master's and the doctoral level is much lower than the cost of 1-year medical school tuition at both private and public universities. NPs can perform many of the same services as physicians in the primary care setting with comparable outcomes, yet the cost of educating NPs is much lower. NPs are a cost-effective solution to the healthcare workforce shortage. ©2015 American Association of Nurse Practitioners.
Pan, Xueni; Slater, Mel; Beacco, Alejandro; Navarro, Xavi; Bellido Rivas, Anna I; Swapp, David; Hale, Joanna; Forbes, Paul Alexander George; Denvir, Catrina; Hamilton, Antonia F de C; Delacroix, Sylvie
Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner's daily routine. This study explores the extent to which portable Immersive Virtual Reality technology can help us gain an accurate understanding of the factors that influence a doctor's response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide). It also considers the potential of such technology to train doctors to face such dilemmas. Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously. Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants' level of presence (together with participants' feedback and body language) suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening.
Full Text Available Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner's daily routine. This study explores the extent to which portable Immersive Virtual Reality technology can help us gain an accurate understanding of the factors that influence a doctor's response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide. It also considers the potential of such technology to train doctors to face such dilemmas.Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously.Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants' level of presence (together with participants' feedback and body language suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening.
Hess-Luttich, Ernest W. B.
The linguistic behavior of a given individual varies; he will on different occasions speak (or write) differently according to what may be roughly described as different social situations: he will use a number of different registers. The application of such registers both in the field of text analysis and in the preparation of teaching materials…
Full Text Available Scientific background: The annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care. Research questions: The presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers. Methods: A systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed. Results: Data concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources.The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers.Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and
AMAHD on the offline platform was conducted by administering paper questionnaires and asking users direct questions about how they respectively rate the performance of AMAHD based on certain evaluation criteria. Furthermore, a separate evaluation of AMAHD was conducted using online survey monkey. Finally, a comparative analysis between the results obtained from the online evaluation and offline evaluation of AMAHD was conducted and presented.The results of the surveymonkey online questionnaire revealed that: 58.49% of the participants agreed that AMAHD can be used to diagnose users ailments based on the hereditary disease symptoms they supplied to the mobile application; 13.21% disagreed, while 28.30% of the participants were indifferent. 71.7% of the participants agreed that AMAHD can act as a complementary resource for supplementary healthcare support; 5.66% disagreed, while 22.64% of the participants were indifferent. 88.46% of the participants agreed that AMAHD can be particularly supportive to developing countries where there is less awareness of the deadly effects on hereditary diseases; 1.92% disagreed, while 9.62% were indifferent. Finally, 86.79% of the participants agreed that AMAHD can be useful as an android health application, 13.21% disagreed. Keywords: Hereditary diseases, Android application, Medical practitioners, Informatics, Bioinformatics, Mobile informatics
Schraagen, J.M.C.; Verhoeven, F.
Purpose : The aims of this study were to investigate how a variety of research methods is commonly employed to study technology and practitioner cognition. User-interface issues with infusion pumps were selected as a case because of its relevance to patient safety. Methods : Starting from a
Mpofu, Charles; Gupta, Tarun Sen; Hays, Richard
Medical migration appears to be an increasing global phenomenon, with complex contributing factors. Although it is acknowledged that such movements are inevitable, given the current globalized economy, the movement of health professionals from their country of training raises questions about equity of access and quality of care. Concerns arise if migration occurs from low- and middle-income countries (LMICs) to high-income countries (HICs). The actions of HICs receiving medical practitioners from LMICs are examined through the global justice theories of John Rawls and Immanuel Kant. These theories were initially proposed by Pogge (1988) and Tan (1997) and, in this work, are extended to the issue of medical migration. Global justice theories propose that instead of looking at health needs and workforce issues within their national boundaries, HICs should be guided by principles of justice relevant to the needs of health systems on a global scale. Issues of individual justice are also considered within the framework of rights and social responsibilities of individual medical practitioners. Local and international policy changes are suggested based on both global justice theories and the ideals of individual justice.
Stubbs, Brendon; Vancampfort, Davy; Mänty, Minna; Svärd, Anna; Rahkonen, Ossi; Lahti, Jouni
This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (≥14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
S. Yu. Martsevich
Full Text Available Aim. To analyze tactics of statins use in patients with high cardiovascular risk on the base of the PROFILE register data.Material and methods. Patients (n=274 who were enrolled into the PROFILE register from May, 1st till December, 31st, 2011 were divided into 3 groups: a control group (82 patients who sought medical care in the medical centre for the first time, the main group A (167 patients who were regularly followed-up in the medical centre and the main group B (25 patients who stopped follow-up in the medical centre over 2 years ago. The incidence rates of statins use and lipid target level achievement, as well as safety of statin therapy were studied in the groups.Results. 25.6, 70.7 and 52% of patients received statins in control group, main group A, and main group B, respectively. Target levels (according to the clinical guidelines of the low density cholesterol (LDC had been reached in 26.3% of patients in the main group A. This characteristic was not valid in the patients of control and main group B because of small size of these groups. Achievement of target LDC level was observed more often in use of statins in moderate and high doses, use of the original drugs, and use of rosu- vastatin. Safety of statin therapy (aspartate and alanine transaminases, creatine kinase activity, and total bilirubin was comparable in the groups of patients who reached or did not reach target LDC levels.Conclusion. High cardiovascular risk patients who were regularly followed-up in the specialized medical centre received statins therapy significantly more often. However statins use is often not correspond to the modern clinical guidelines.
Boyle, Eileen; Saunders, Rosemary; Drury, Vicki
To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.
General practitioners' views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients-A qualitative interview study with GPs (CIM-TRIAD study).
Pohontsch, Nadine Janis; Heser, Kathrin; Löffler, Antje; Haenisch, Britta; Parker, Debora; Luck, Tobias; Riedel-Heller, Steffi G; Maier, Wolfgang; Jessen, Frank; Scherer, Martin
Potentially inappropriate medication (PIM) is defined as medication with uncertain therapeutic effects and/or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest-old patients is high despite the existence of lists of PIM (e.g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners' views on PIM and aspects affecting the (long-term) use of PIM. As part of the CIM-TRIAD study, we conducted semi-structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient-specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development. The majority of the general practitioners were not aware of the PRISCUS list. Agents deemed potentially inappropriate from the general practitioners' point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate medication for elderly patients (e.g. renal function, cognitive state) and emphasized the importance of monitoring. We identified prescription- (e.g. benzodiazepines on alternative private prescription), medication- (e.g. subjective perception that PIM has no alternative), general practitioner- (e.g. general practitioner relies on specialists), patient- (e.g. "demanding high-user", positive subjective benefit-risk-ratio) and system-related aspects (e.g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM. While the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e.g. stronger dissemination of the PRISCUS list, better compensation of
Beck, Anne Marie; Kjær, Stine; Hansen, Birthe Stenbæk
Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.Design:Twelv......Objective:To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients' home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.......Design:Twelve-week single-blind randomized controlled study.Setting and subjects:Geriatric medical patients (65+ years) at nutritional risk.Interventions:Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented......, rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality.Results:One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks...
Erlangsen, Annette; Vach, Werner; Jeune, Bernhard
-level register data. SETTING: Population-based record linkage. PARTICIPANTS: All persons aged 52 and older living in Denmark during 1996 to 1998 (N=1,684,205). MEASUREMENTS: The studied event is completed suicide. The following time-varying variables are included in the analysis: current age, hospitalization...... been hospitalized during the previous 2 years: 113 per 100,000 versus 80 per 100,000 in the general population of men aged 80 and older. Also, the oldest-old women with a history of hospitalization had a higher suicide rate than their peer group. Nevertheless, the oldest old experienced a lower...... with no hospitalization, although they experience a lower increase in risk after hospitalization than the middle-aged. The increased prevalence of medical illnesses explains a part of the greater suicide risk with age, especially for the oldest old women. Considering that hospitalization with medical illness often...
de Jonge, Linda; Garne, Ester; Gini, Rosa; Jordan, Susan E.; Klungsoyr, Kari; Loane, Maria; Neville, Amanda J.; Pierini, Anna; Puccini, Aurora; Thayer, Daniel S.; Tucker, David; Hansen, Anne Vinkel; Bakker, Marian K.
Research on associations between medication use during pregnancy and congenital anomalies is significative for assessing the safe use of a medicine in pregnancy. Congenital anomaly (CA) registries do not have optimal information on medicine exposure, in contrast to prescription databases. Linkage of
Rosenström, Tom; Fawcett, Tim W; Higginson, Andrew D; Metsä-Simola, Niina; Hagen, Edward H; Houston, Alasdair I; Martikainen, Pekka
Divorce is associated with an increased probability of a depressive episode, but the causation of events remains unclear. Adaptive models of depression propose that depression is a social strategy in part, whereas non-adaptive models tend to propose a diathesis-stress mechanism. We compare an adaptive evolutionary model of depression to three alternative non-adaptive models with respect to their ability to explain the temporal pattern of depression around the time of divorce. Register-based data (304,112 individuals drawn from a random sample of 11% of Finnish people) on antidepressant purchases is used as a proxy for depression. This proxy affords an unprecedented temporal resolution (a 3-monthly prevalence estimates over 10 years) without any bias from non-compliance, and it can be linked with underlying episodes via a statistical model. The evolutionary-adaptation model (all time periods with risk of divorce are depressogenic) was the best quantitative description of the data. The non-adaptive stress-relief model (period before divorce is depressogenic and period afterwards is not) provided the second best quantitative description of the data. The peak-stress model (periods before and after divorce can be depressogenic) fit the data less well, and the stress-induction model (period following divorce is depressogenic and the preceding period is not) did not fit the data at all. The evolutionary model was the most detailed mechanistic description of the divorce-depression link among the models, and the best fit in terms of predicted curvature; thus, it offers most rigorous hypotheses for further study. The stress-relief model also fit very well and was the best model in a sensitivity analysis, encouraging development of more mechanistic models for that hypothesis.
Full Text Available Patients of the National Institute of Cardiac Surgery and Interventional Cardiology in Luxembourg who underwent coronary angiography were surveyed for hypertension, hypercholesterolemia, diabetes and overweight/obesity between 2008/9 and 2013/4. For each cardiovascular risk factor (CVRFs, we analysed the associations between the quality of the patients' communication with the medical practitioner and their adherence declared to preventive behaviours.1,289 completed a self-administered questionnaire on communication with the medical practitioner (P'Com-5 items scale; Cronbach 0.87. 61.8% stopped smoking, 57.9% reduced or stopped their consumption of salt, 71.9% of fat, and 62.8% of sugar, and whereas 65% increased their consumption of fruit and vegetables and 19.8% increased their physical activity. Around 37% reported having made changes following their doctor's advice. 90% were followed by a cardiologist and 95.9% by an attending physician.No link was observed between declaration of physical activity, smoking, fats, and quality of communication. Significant associations: for increased consumption of fruit and vegetables was linked with the quality of doctor-patient communication when patients were overweight (OR = 1.081, obese (OR = 1.130, hypercholesterolemic (OR = 1.102, hypertensive (OR = 1.084 or diabetic (OR = 1.103. Reduction in salt intake was linked only to patients with hypertension (OR = 1.102, whereas reduction or cessation of sugar consumption was linked to overweight (OR = 1.093, and more so obese, (OR = 1.106, hypercholesterolemics (OR = 1.103 and diabetics (OR = 1.173.Good doctor-patient communication was related to nutrition, particularly increased consumption of fresh fruits and vegetables. Accurate perception of CVRFs by both patients and medical practitioners is essential for CV protection. The aim of instructing patients is to encourage them to make informed decisions about how to change their lifestyle. In routinely, P
Cortese, Samuele; Holtmann, Martin; Banaschewski, Tobias; Buitelaar, Jan; Coghill, David; Danckaerts, Marina; Dittmann, Ralf W.; Graham, John; Taylor, Eric; Sergeant, Joseph
Background: Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide
Metsä-Simola, Niina; Martikainen, Pekka
The annual prevalence of psychotropic medication use exceeds 10 percent in Europe and the United States, the prevalence being higher among the divorced than the married. We analysed changes in the three-month prevalence of psychotropic medication use (psycholeptics and psychoanaleptics excluding medication for dementia) by proximity to divorce, sex, medication type and socio-demographic characteristics, using register-data on 304,111 Finns between 25 and 64 years of age, of whom 23,956 divorced between 1995 and 2003 and 142,093 were continuously married from 1995 to 2004. Five years before divorce, men and women already displayed about one percentage point higher prevalence of psychotropic medication use than those who continued their marriage. The excess prevalence increased with approaching divorce and peaked six to nine months before divorce, reaching 7.3 percent (95% CI 6.8-8.0) among divorcing men and 8.1 percent (95% CI 7.5-8.8) among divorcing women. The peak was followed by an 18-month decline, after which the excess compared to the continuously married settled at nearly three percentage points. The excess was not due to being socio-economically disadvantaged, and socio-demographic factors also seemed to have few modifying effects. The changes in prevalence were largest for antidepressants and almost non-existent for antipsychotics. Our results suggest that the high prevalence of psychotropic medication use among the divorced results both from selective factors already present five years before divorce and the acute and long-term causal effects of becoming and being divorced. Counselling is needed for individuals in the process of divorce, rather than economic support for divorced individuals. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available A Review of: Quesenberry, A. C., Oelschlegel, S., Earl, M., Leonard, K., & Vaughn, C. J. (2016. The impact of library resources and services on the scholarly activity of medical faculty and residents. Medical Reference Services Quarterly, 35(3, 259-265. http://dx.doi:org/10.1080/02763869.2016.1189778 Objective – This study aimed to determine the use of three library services – literature search service, article delivery service, and library resources – among medical faculty and residents with regard to scholarly activity. Design – Survey. Setting – Medical Library and Health Information Centre at a large university in the United States of America. Subjects – 65 medical faculty and residents. Methods – The authors sent out 433 invitations to participate in a 23-question survey via an email distribution list. A total of 65 individuals participated, for a response rate of 15%. Questions related to the use of library services for scholarly activity, patterns of information-seeking behaviour, and instructional needs. Comments were allowed on several questions, and a final open-ended question was included. Main Results – All respondents used PubMed at least a few times a year, with 71% selecting it as their first choice to search for articles. Only 20% prioritized Google or Google Scholar above PubMed as the first place to begin a search. The most popular reasons for using library resources were “lectures, papers, research, and patient care” (p.262. The first three of these activities are types of scholarly activity. Of the 65 respondents, 46% published article(s or book chapter(s. Within this group of authors, 67% of residents undertaking scholarly activity requested a literature review, 100% accessed online material themselves, and 67% requested articles. Faculty placed similar importance on these services, with 71% having requested a literature review, 87% having accessed materials themselves, and 75% having requested articles
Crowley, Jennifer; Ball, Lauren; Han, Dug Yeo; McGill, Anne-Thea; Arroll, Bruce; Leveritt, Michael; Wall, Clare
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.
Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi
Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.
The foundations of a modern medical ethics does not appear in Britain until the late-eighteenth century, with the publication of John Gregory's Lectures on the Duties and Qualifications of a Physician in 1772. Focusing on the contemporary Moral Sense philosophical ideas formulated primarily by leading members of the Kirk, and the medical writings of the Scottish physicians, George Cheyne, John Gregory, and William Cullen, this chapter explores the fusion of classical and holistic Christian-based medical ethics. It is argued that it was the convergence of new theories of nervous sensibility, Scottish Enlightenment, Christian-based sentimental moral philosophies, and the rhetoric of the "man of feeling" that created a new modern medical ethics.
Wardle, Jon L; Sibbritt, David W; Adams, Jon
Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this study was to survey medical general practitioners (GPs) in rural and regional New South Wales, Australia, to identify their knowledge, attitudes, relationships, and patterns of referral to massage therapy in primary health care. A 27-item questionnaire was sent to all 1486 GPs currently practicing in rural and regional Divisions of General Practice in New South Wales, Australia. The survey had 5 general areas: the GP's personal use and knowledge of massage, the GP's professional relationships with massage practice and massage practitioners, the GP's specific opinions on massage, the GP's information-seeking behavior in relation to massage, and the GP's assumptions on massage use by patients in their local areas. A total of 585 questionnaires were returned completed, with 49 survey questionnaires returned as "no longer at this address" (response rate of 40.7%). More than three-quarters of GPs (76.6%) referred to massage therapy at least a few times per year, with 12.5% of GPs referring at least once per week. The GP being in a nonremote location (odds ratio [OR], 14.28; 95% confidence interval [CI], 3.7-50.0), graduating from an Australian medical school (OR, 2.03; 95% CI, 1.09-3.70), perceiving a lack of other treatment options (OR, 2.64; 95% CI, 1.15-6.01), perceiving good patient access to a wide variety of medical specialists (OR, 11.1; 95% CI, 1.7-50.0), believing in the efficacy of massage therapy (OR, 2.75; 95% CI, 1.58-4.78), experiencing positive results from patients using massage therapy previously (OR, 13.95; 95% CI, 5.96-32.64), or having prescribed any CAM previously (OR, 1.83; 95% CI, 1.03-3.27) were all independently predictive of increased referral to massage therapy among the GPs in this study. There appears to
... Data Bank AGENCY: Health Resources and Services Administration (HRSA), HHS. ACTION: Final rule... ``National Practitioner Data Bank'' which appeared in the April 5, 2013, issue of the Federal Register. The... FURTHER INFORMATION CONTACT: Director, Division of Practitioner Data Banks, Bureau of Health Professions...
In recent decades, family patterns have changed significantly. National laws have taken these changes into account, recognizing new forms of unions, different to heterosexual marriage. Indeed, recently some countries have given the possibility to same-sex couples to enter into various forms of unions. Staff regulations of international organizations are not directly affected by national laws, but in the context of diversity policies, the lack of recognition of these new forms of unions, may appear to discriminate based on sexual orientation and to limit the freedom of choosing marital status. A study by the International Service for Remunerations and Pensions (iSRP) of the OECD in January 2015 (PROS Report (1015) 04) shows that in comparison with other international organizations, CERN offers the least favorable social conditions for its Staff with in a registered partnership. As part of the Five-year review in 2015, it is important that CERN aligns itself with the practice of these other organizations...
Background There will be increasing competition for young physicians worldwide as more and more physicians retire. While enthusiasm towards GP work is important for GP teachers as role models, satisfaction within the profession has declined. This study aims to determine if medical students’ desire to become GPs is related to the job satisfaction of their teaching GPs and explore the factors tied to this job satisfaction. Methods In this cross-sectional, correlational study, teaching GPs of the University of Bern and the fourth year medical students completing internships with them filled in separate questionnaires. Results Whether or not the GP teacher is perceived by a student to be satisfied with her/his job is correlated to that student’s satisfaction with the internship, which in turn, is correlated with student’s wish to be a GP after the internship. Results show which factors are most related to GP job satisfaction and the effect of working hours and their composition. Conclusions Medical students’ perception of their GP teachers’ job satisfaction positively affect their wish to become GPs, and their satisfaction with their internships adds to this. Enhancing the positive aspects of GP work, such as recognition, and improving negative ones, such as administrative duties, are necessary to attract medical students into the GP field. PMID:24655917
Meli, Damian Notker; Ng, Angie; Singer, Sarah; Frey, Peter; Schaufelberger, Mireille
There will be increasing competition for young physicians worldwide as more and more physicians retire. While enthusiasm towards GP work is important for GP teachers as role models, satisfaction within the profession has declined. This study aims to determine if medical students' desire to become GPs is related to the job satisfaction of their teaching GPs and explore the factors tied to this job satisfaction. In this cross-sectional, correlational study, teaching GPs of the University of Bern and the fourth year medical students completing internships with them filled in separate questionnaires. Whether or not the GP teacher is perceived by a student to be satisfied with her/his job is correlated to that student's satisfaction with the internship, which in turn, is correlated with student's wish to be a GP after the internship. Results show which factors are most related to GP job satisfaction and the effect of working hours and their composition. Medical students' perception of their GP teachers' job satisfaction positively affect their wish to become GPs, and their satisfaction with their internships adds to this. Enhancing the positive aspects of GP work, such as recognition, and improving negative ones, such as administrative duties, are necessary to attract medical students into the GP field.
Mutheeswaran, S; Pandikumar, P; Chellappandian, M; Ignacimuthu, S; Duraipandiyan, V; Logamanian, M
Siddha system of traditional medicine has been practiced in Tamil Nadu. This system of medicine has a high number of non-institutionally trained practitioners but studies on their traditional medicinal knowledge are not adequate. The present study is aimed to document and analyze the sastric (traditional) formulations used by the non-institutionally trained siddha medical practitioners in Virudhunagar and Tirunelveli districts of Tamil Nadu, India. After obtaining prior informed consent, interviews were conducted with 115 non-institutionally trained siddha medical practitioners about the sastric formulations used by them for the treatment. Successive free listing method was adopted to collect the data and the data were analyzed by calculating Informant Consensus Factor (Fic) and Informant Agreement Ratio (IAR). The study documented data regarding 194 sastric formulations and they were classified into plant, mineral and animal based formulations. Quantitative analysis showed that 62.5% of the formulations were plant based, while the mineral based formulations had a high mean number of citations and versatile uses. Gastrointestinal (12.0%), kapha (11.3%) and dermatological (10.8%) ailments had a high percentage of citations. Jaundice had a high Fic value (0.750) followed by the dermatological ailments. The illness categories with high Fic values under each type of formulation were as follows: jaundice, aphrodisiac and urinary ailments (plant based); jaundice, cuts & wounds and dermatological ailments (mineral based); and hemorrhoids, kapha ailments and heart ailments (animal based formulations). The scientific studies conducted with important formulations under each illness category are discussed. The present study indicated the importance of some illnesses over the others and inclusion of new illnesses under each formulation. The ingredients used to prepare these formulations have shown varying degrees of scientific evidence; generally limited studies were available
Demling, J H; Neubauer, S; Luderer, H-J; Wörthmüller, M
recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.
Stethoscope diaphragms are frequently colonized by bacteria. This cross-sectional study described the frequency and factors associated with reporting ever cleaning stethoscopes among 408 medical students and doctors at a medical college and 2 teaching hospitals in Rawalpindi, Pakistan. A minority of the respondents (37.7%) reported having ever cleaned their stethoscope. Following normal clinical use, wiping with a dry cloth was the most frequently reported method of cleaning (53.2%). After contamination of the diaphragm with blood or secretions, cleaning with an alcoholic swab was the most common method (64.3%). In univariate and multivariate analyses, history of receiving information on stethoscope cleaning, utilization of personal stethoscope at last use and affiliation with internal medicine department were factors strongly associated with ever cleaning of stethoscope. Future research for improving stethoscope cleaning practices should explore educational interventions aimed at health care professionals.
Loponen, Tiina; Lallukka, Tea; Holstila, Ansku; Lahti, Jouni
Physical activity level and overweight have shown associations with mental health problems but it is not known whether the risk of mental health problems due to overweight varies by physical activity. We examined joint association of physical activity and overweight with subsequent psychotropic medication among 40-60-year-old employees. The questionnaire survey data were derived from Helsinki Health Study baseline postal questionnaires in 2000-02 among employees of the City of Helsinki aged 40-60 years (n = 8960, response rate 67%). Baseline survey data were linked with prospective register data on prescribed psychotropic medication (ATC-codes N05 and N06, except N06D) among those with written consent (74%) for such linkage. The analyses included 6169 responders (78% women, corresponding to the target population). We divided participants into six groups according to their baseline self-reported body mass index and leisure-time physical activity using physically highly active normal-weight participants as a reference group. We used Cox regression analysis adjusted for age, gender, psychotropic medication prior to baseline, and socioeconomic position, marital status, working conditions, limiting long-standing illness, alcohol use, and smoking. At baseline, 49% were overweight and 23% were physically inactive. After adjusting for age and gender, inactive normal-weight (hazard ratio (HR) 1.3, 95% CI 1.1-1.5), moderately active overweight (HR 1.3, 95% CI 1.1-1.5) and inactive overweight (HR 1.4, 95% CI 1.2-1.6) had higher risk for any psychotropic medication compared with group of highly active normal-weight. After adjusting for prior medication, only the inactive overweight group had higher risk (HR 1.4, 95% CI 1.2-1.6). Other covariates made but a minor contribution to the examined associations. For antidepressants the associations were somewhat stronger than for sedatives. Both normal-weight and physical activity help prevent psychotropic medication but physical
Hoertel, N; Crochard, A; Rouillon, F; Limosin, F
Data on the frequency of high-risk alcohol consumption and its medical and social consequences in the French general population remain fragmented. Therefore, our aim was two-fold: (i) to assess the prevalence of different patterns of alcohol consumption using the AUDIT-C scale, according to two different perspectives, i.e., that of family circle members or friends, and that of the general practitioners (GPs), and (ii) to examine the prevalence of medical and social consequences associated with alcohol consumption profiles. Data were drawn from two national surveys conducted in 2013. Investigators were respectively GPs and family circle members or friends. These surveys were respectively representative of GPs (n=1308) and of the general adult population (n=1018). The 12-month prevalence rates of harmful or at risk alcohol consumption rose respectively to 11.1% in the GPs adult patients and to 11.9% in the general adult population. The majority of participants with "at risk" alcohol consumption presented with significant social and medical consequences. Thus, more than seven out of ten participants with chronic at risk consumption endorsed significant negative social event potentially associated with alcohol like withdrawal of driving licence, getting divorced or separated, and losing friends. Over 10% of these participants had liver disease and diabetes mellitus, more than 30% increased blood pressure and nearly 50% anxiety disorder or major depression. Following adjustments for sociodemographic characteristics and alcohol treatment, prevalences of numerous social and medical consequences significantly differed between alcohol-dependent participants, chronic at risk consumers and episodic at risk consumers. Our results suggest that more than one adult out of ten in France showed during the past year harmful or "at risk" alcohol consumption, which appears insufficiently detected and treated. In addition, the majority of at risk alcohol consumers already presents with
Donovan, T.; Manning, D.J.
Reporting by radiographers is currently an extended role. The College of Radiographers however considers that in the future reporting will be a requirement for all radiographers. If performance is looked at, then in certain specific tasks trained radiographers can match the accuracy of radiologists, such as A and E skeletal reporting and mammography. But radiologists themselves are prone to interpretation errors. Communication of radiological findings is important if findings are to be translated into useful diagnostic outcomes for the patient. Radiographers are able to provide a descriptive report but lack the training and flexibility to provide a medical report and make judgments about the relevance of radiological findings. Experts when viewing radiographic images are visually efficient, demonstrate flexible reasoning and have many disease schemata to resolve incongruities in clinical data. We do not yet have a definitive answer to what makes a good reporting radiographer, but without a medical training it is unlikely that radiographers can become experts beyond their current role in certain well-circumscribed tasks
Dwarswaard, J; Hilhorst, M; Trappenburg, M
Society in the 21st century is in many ways different from society in the 1950s, the 1960s or the 1970s. Two of the most important changes relate to the level of education in the population and the balance between work and private life. These days a large percentage of people are highly educated. Partly as a result of economic progress in the 1950s and the 1960s and partly due to the fact that many women entered the labour force, people started searching for ways to combine their career with family obligations and a private life (including hobbies, outings and holidays). Medical professional ethics, more specifically: professional attitudes towards patients and colleagues, is influenced by developments such as these, but how much and in what way? It was assumed that surgery ethics would be more robust, resistant to change and that general practitioner (GP) ethics would change more readily in response to a changing society, because surgeons perform technical work in operating theatres in hospitals whereas GPs have their offices in the midst of society. The journals of Dutch surgeons and GPs from the 1950s onwards were studied so as to detect traces of change in medical professional ethics in The Netherlands. GP ethics turned out to be malleable compared with surgery ethics. In fact, GP medicine proved to be an agent of change rather than merely responding to it, both with regard to the changing role of patients and with regard to the changing work life balance.
Perdrix, A; Decrey, H; Pécoud, A; Burnand, B; Yersin, B
The general practitioner (GP) plays a very important role in early detection of alcoholism. Clinical evaluation is often the only method used, although it has been suggested that any systematic patient history should include the CAGE test. We compare the effectiveness of these two approaches and attempt to determine the applicability of the CAGE test in a general practitioner's usual practice. 12 GPs took part in this study during 6 months. They looked for possible alcohol abuse in each new patient by a standard patient history and clinical examination. Patients were randomized into 2 groups, one of which was given the CAGE test and the other not. For each patient in the CAGE group the applicability of the test was quantified by the GP. 416 patients were included; 214 were randomized into the "CAGE group" and 202 into the control group. On a clinical basis, 15 patients in the control group and 16 in the "CAGE group" (14 men, 2 women) were suspected of alcohol abuse. The CAGE test was positive in 15 patients (7%); among these, 6 were not suspect on a clinical basis. In patients aged 18-34, the detection rate of alcohol-related problems more than doubled when the CAGE test was used. The age of the patients influenced performance of the CAGE test and clinical evaluation. Only 2% of women had a positive CAGE test. Administration of the CAGE test was considered easy in 112 patients and average to difficult in 50, while the test was inapplicable with 52 patients. The latter proportion was higher than that observed in institutions (hospitals, outpatient departments) of the same region. Applicability was influenced neither by the sex nor the age of the patients, but varied greatly according to the physician (from 38% to 100%). The CAGE test increases the number of patients detected with alcohol problems by 37% and seems to be especially useful when administered to young people. The number of women with alcohol problems is probably underestimated by both clinical evaluation
Diabetes Self-Management Education and Medical Nutrition Therapy Improve Patient Outcomes: A Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions through Retrospective Chart Review.
Marincic, Patricia Z; Hardin, Amie; Salazar, Maria V; Scott, Susan; Fan, Shirley X; Gaillard, Philippe R
Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve patient outcomes; poor reimbursement limits access to care. Our aim was to develop methodology for tracking patient outcomes subsequent to registered dietitian nutritionist interventions, document outcomes for patients with type 2 diabetes attending an American Diabetes Association-recognized program, and obtain outcome data to support reimbursement and public policy initiatives to improve patient access to DSME and MNT. Retrospective chart review. A random sample of 100 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSME and individualized MNT, June 2013 to 2014. Data were extracted on body mass index (calculated as kg/m 2 ), weight, hemoglobin A1c, blood glucose, and lipids. Mixed-model analysis of variance was used to determine differences between means for continuous variables; McNemar's tests and γ-statistic trend analysis were used to assess frequency of patients reaching glycemic targets. Significant weight loss was observed from baseline (94.3±21.1 kg) to end of program (91.7±21.2 kg [-1.6±3.9 kg]; P0.05). Significant hemoglobin A1c reduction was observed from baseline (8.74%±2.30%) to end of program (6.82%±1.37% [-1.92%±2.25%]; Phemoglobin A1c targets (≤7.0%) vs 27% at baseline (P=0.008). When stratified by diet alone and diet plus drug therapy, patients exhibited a 1.08%±1.20% (Phemoglobin A1c, respectively. Triglycerides decreased from baseline 181.6±75.5 mg/dL (2.0±0.9 mmol/L) to 115.8±48.1 mg/dL (1.3±0.5mmol/L) (P=0.023). High-density lipoprotein increased from 41.4±12.4 mg/dL (1.1±0.3 mmol/L) to 47.3±12.4 mg/dL (1.2±0.3 mmol/L) (P=0.007). Retrospective chart review provides an operational model for abstracting existing patient outcome data subsequent to registered dietitian nutritionist interventions. In support of universal reimbursement and patient access to DSME with supplemental individualized
Three hundred Irish Medical Organisation members were surveyed on health promotion and health and safety issues. 64.7% responded (65.3 males; 33.7% < thirty-five years). Over half (54.9%) were aware of the safety legislation and very few reported available occupational health services. A majority wanted more such services. Nearly all believed health promotion was important yet only 35.2% always availed of opportunities to give such advice. 36.3% were often stressed, particularly at work. Alcohol was sometimes or frequently used to cope by around half of respondents. Although less than half (47.7%) used whole milk, one third usually or always added salt to their food. 15.5% took no weekly aerobic exercise but 42.0% claimed to do so three times weekly. 11.4 were current smokers. A third of women had never had a cervical smear. We conclude doctors require adequate occupational health services.
Moshabela, Mosa; Bukenya, Dominic; Darong, Gabriel; Wamoyi, Joyce; McLean, Estelle; Skovdal, Morten; Ddaaki, William; Ondeng'e, Kenneth; Bonnington, Oliver; Seeley, Janet; Hosegood, Victoria; Wringe, Alison
There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade. We conducted a multicountry exploratory qualitative study in seven health and demographic surveillance sites in six eastern and southern African countries: Uganda, Kenya, Tanzania, Malawi, Zimbabwe and South Africa. We interviewed 258 PLHIV at different stages of the HIV cascade-of-care, 48 family members of deceased PLHIV and 53 HIV healthcare workers. Interviews were conducted using shared standardised topic guides, and data managed through NVIVO 8/10/11. We conducted a thematic analysis of healthcare pathways and bottlenecks related to medical pluralism. Medical pluralism, manifesting across traditional, faith-based and biomedical health-worlds, contributed to the care cascade bottlenecks for PLHIV through three pathways of impact. First, access to HIV treatment was delayed through the nature of health-related beliefs, knowledge and patient journeys. Second, HIV treatment was interrupted by availability of alternative options, perceived failed treatment and exploitation of PLHIV by opportunistic traders and healers. Lastly, the mixing of biomedical healthcare providers and treatment with traditional and faith-based options fuelled tensions driven by fear of drug-to-drug interactions and mistrust between providers operating in different health-worlds. Medical pluralism contributes to delays and interruptions of care along the HIV cascade, and mistrust between health providers. Region-wide interventions and policies are urgently needed in sub-Saharan Africa to minimise potential harm and consequences of medical pluralism for PLHIV
Tiffin, Paul A; Paton, Lewis W; Mwandigha, Lazaro M; McLachlan, John C; Illing, Jan
International medical graduates working in the UK are more likely to be censured in relation to fitness to practise compared to home graduates. Performance on the General Medical Council's (GMC's) Professional and Linguistic Assessments Board (PLAB) tests and English fluency have previously been shown to predict later educational performance in this group of doctors. It is unknown whether the PLAB system is also a valid predictor of unprofessional behaviour and malpractice. The findings would have implications for regulatory policy. This was an observational study linking data relating to fitness to practise events (referral or censure), PLAB performance, demographic variables and English language competence, as evaluated via the International English Language Test System (IELTS). Data from 27,330 international medical graduates registered with the GMC were analysed, including 210 doctors who had been sanctioned in relation to at least one fitness to practise issue. The main outcome was risk of eventual censure (including a warning). The significant univariable educational predictors of eventual censure (versus no censures or referrals) were lower PLAB part 1 (hazard ratio [HR], 0.99; 95% confidence interval, 0.98 to 1.00) and part 2 scores (HR, 0.94; 0.91 to 0.97) at first sitting, multiple attempts at both parts of the PLAB, lower IELTS reading (HR, 0.79; 0.65 to 0.94) and listening scores (HR, 0.76; 0.62 to 0.93) and higher IELTS speaking scores (HR, 1.28; 1.04 to 1.57). Multiple resits at either part of the PLAB and higher IELTS speaking score (HR, 1.49; 1.20 to 1.84) were also independent predictors of censure. We estimated that the proposed limit of four attempts at both parts of the PLAB would reduce the risk in this entire group by only approximately two censures per 5 years in this group of doctors. Making the PLAB, or any replacement assessment, more stringent and raising the required standards of English reading and listening may result in fewer fitness
Andersson, Kerstin; Furhoff, Anna-Karin; Nordenram, Gunilla; Wårdh, Inger
The purpose of this study was to explore general medical practitioners' (GPs) perceptions of the oral health of their elderly patients. The design was a qualitative study based on individual in-depth interviews with GPs. The criterion for inclusion in the study was that the GP was a specialist in family medicine working in a primary health care centre (PHCC:s) in the county of Stockholm. The participants took part in the study after informed consent. Eleven GPs were interviewed. The interview started with semi-structured questions about the respondents' clinical presentation of their elderly patients', e.g. medication, medical treatment and socioeconomic status. The interview concluded with questions about the respondents' experiences of and perceptions of the oral health of their patients. This process started with the first interview and proceeded with successive interviews until no new relevant information was forthcoming. The initial semi-structured part of the interview guide was analysed for content with special reference to descriptive answers. The final open questions were analysed by a method inspired by grounded theory (GT) and comprised three stages: open coding, axial coding and selective coding. In the GT influenced analysis process, three categories, health perspective, working conditions and cultural differences, each in turn containing subcategories, were identified and labelled. The most significant category, cultural differences, was identified as the core category, explaining the central meaning of the respondents' perceptions of the oral health of their elderly patients. The GPs in this study showed little or no awareness of the oral health of their elderly patients. The interviews disclosed several contributing factors. Barriers to closer integration of oral and general health in the elderly were identified. There existed a cultural gap between the disciplines of dentistry and medicine, which does not enhance and may be detrimental to the
Haddad, Mark; Waqas, Ahmed; Sukhera, Ahmed Bashir; Tarar, Asad Zaman
Depression is common mental health problem and leading contributor to the global burden of disease. The attitudes and beliefs of the public and of health professionals influence social acceptance and affect the esteem and help-seeking of people experiencing mental health problems. The attitudes of clinicians are particularly relevant to their role in accurately recognising and providing appropriate support and management of depression. This study examines the characteristics of the revised depression attitude questionnaire (R-DAQ) with doctors working in healthcare settings in Lahore, Pakistan. A cross-sectional survey was conducted in 2015 using the revised depression attitude questionnaire (R-DAQ). A convenience sample of 700 medical practitioners based in six hospitals in Lahore was approached to participate in the survey. The R-DAQ structure was examined using Parallel Analysis from polychoric correlations. Unweighted least squares analysis (ULSA) was used for factor extraction. Model fit was estimated using goodness-of-fit indices and the root mean square of standardized residuals (RMSR), and internal consistency reliability for the overall scale and subscales was assessed using reliability estimates based on Mislevy and Bock (BILOG 3 Item analysis and test scoring with binary logistic models. Mooresville: Scientific Software, 55) and the McDonald's Omega statistic. Findings using this approach were compared with principal axis factor analysis based on Pearson correlation matrix. 601 (86%) of the doctors approached consented to participate in the study. Exploratory factor analysis of R-DAQ scale responses demonstrated the same 3-factor structure as in the UK development study, though analyses indicated removal of 7 of the 22 items because of weak loading or poor model fit. The 3 factor solution accounted for 49.8% of the common variance. Scale reliability and internal consistency were adequate: total scale standardised alpha was 0.694; subscale reliability for
Full Text Available Abstract Background Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals’ attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan. Methods A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ. A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey. Results Six hundred and one (86 % of the doctors approached consented to participate; almost all respondents (99 % endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes, and 37 % (between 13 and 19 % for particular causes noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression. Conclusions Non
Haddad, Mark; Waqas, Ahmed; Qayyum, Wahhaj; Shams, Maryam; Malik, Saad
Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals' attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan. A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ). A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey. Six hundred and one (86 %) of the doctors approached consented to participate; almost all respondents (99 %) endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes), and 37 % (between 13 and 19 % for particular causes) noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression. Non-psychiatrist medical practitioners in Pakistan hold a range of views
Syah, Nur A; Roberts, Chris; Jones, Alison; Trevena, Lyndal; Kumar, Koshila
There is little research on how GPs experience the demands of maintaining standards of medical practice in developing countries and what strategies might improve their capability to provide high-quality primary health care (PHC). This study aims to explore the underlying factors, which shape GPs' experience within the Indonesian PHC system and impact on their experience of professional practice. A grounded theory approach was applied using semi-structured interviews of 25 purposively selected GPs in West Sumatra, Indonesia. The interviews were analysed inductively through an iterative process of the interplay between empirical data, emerging analysis and theory development. Three major health care systems attribute shaped GPs' experiences of professional practice, including (i) a restricted concept of the PHC system, (ii) lack of regulation of private primary care practice conducted by GPs, midwives, nurses and specialists and (iii) low coverage and inappropriate policy of the health insurance system. The findings indicate that a major revision of current health care system is required with a focus on promoting the concept of PHC services to the population, redefining the role of the GP to deliver recognised best practice within available resources, changing the way GPs are remunerated by the public health system and the health insurance industry, policing of the regulations related to the scope of practice of other health care professionals, particularly midwives and nurses, and regulation of prescribing. GPs can be the champions of the PHC service that Indonesia needs, but it requires sustained systematic change. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Ratnendra R. Shinde
Full Text Available Background The main objective of Integrated Disease Surveillance Project (IDSP was early detection of disease outbreaks. This could be possible only when the public health authorities have a strong and effective surveillance system in collaboration with Private Health Sector. Objectives 1 To assess knowledge, attitude & practice about notification of diseases amongst Private Medical Practitioners (PMPs. 2 To find out barriers experienced by PMPs in reporting of diseases under surveillance. 3 To assess feasibility of various alternative ways of reporting convenient for PMPs. 4 To develop a Public Private Partnership Model of disease notification based on feasible options obtained in the study. Materials and Methods This study was a cross-sectional descriptive study conducted in the F South Municipal ward of Mumbai city during April-May 2011. Two stage simple random sampling was used to select 104 PMPs for the study. Results and Conclusions Nearly 98% PMPs felt importance of notification in health system, but only 46% had practiced it. Most common reason for non-reporting was lack of information about reporting system. The convenient way of reporting for PMPs was to report to the nearest health post personally or to District Surveillance Unit through SMS/phone call and both at weekly interval.
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Pan, Xueni; Slater, Mel; Beacco, Alejandro; Navarro, Xavi; Bellido Rivas, Anna I.; Swapp, David; Hale, Joanna; Forbes, Paul Alexander George; Denvir, Catrina; de C. Hamilton, Antonia F.; Delacroix, Sylvie
Background Dealing with insistent patient demand for antibiotics is an all too common part of a General Practitioner’s daily routine. This study explores the extent to which portable Immersive Virtual Reality technology can help us gain an accurate understanding of the factors that influence a doctor’s response to the ethical challenge underlying such tenacious requests for antibiotics (given the threat posed by growing anti-bacterial resistance worldwide). It also considers the potential of such technology to train doctors to face such dilemmas. Experiment Twelve experienced GPs and nine trainees were confronted with an increasingly angry demand by a woman to prescribe antibiotics to her mother in the face of inconclusive evidence that such antibiotic prescription is necessary. The daughter and mother were virtual characters displayed in immersive virtual reality. The specific purposes of the study were twofold: first, whether experienced GPs would be more resistant to patient demands than the trainees, and second, to investigate whether medical doctors would take the virtual situation seriously. Results Eight out of the 9 trainees prescribed the antibiotics, whereas 7 out of the 12 GPs did so. On the basis of a Bayesian analysis, these results yield reasonable statistical evidence in favor of the notion that experienced GPs are more likely to withstand the pressure to prescribe antibiotics than trainee doctors, thus answering our first question positively. As for the second question, a post experience questionnaire assessing the participants’ level of presence (together with participants’ feedback and body language) suggested that overall participants did tend towards the illusion of being in the consultation room depicted in the virtual reality and that the virtual consultation taking place was really happening. PMID:26889676
Full Text Available Background and purpose: roles and tasks of intended graduates direct medical eductionist for developing the right curriculum. In Iran there has been no systematic study on defining GPs roles. This study is an attempt to systematically clarify the roles of GPs in Iran.Methods: In this questionnaire – based survey executive directors of Universities of medicine of Iran and general practitioners participated. The subjects were selected through stratified sampling procedure. A semi-structured questionnaire was developed which covered the goals and functions of health system as mentioned in World Health Report 2000. For content validity a panel of experts including health care professionals, biostatisticians, and psychometrist evaluated the questionnaire. For the reliability of the questionnaire a pilot study was carried out. Chronbach’s coeficient were calculated as 0.89 .The final revision of the questionnaire included 15 roles in current and ideal states. The respondent should score each role in both states in a range of 0-100.Results: Of 94 subjects who received the questionnaire, 71 (80% completed and returned it. Of all subjects 42.2% were female and 57.8% were male. Of all subjects 25% were faculty members. The subjects believe that in the current state “health care provision” (85.4±18.6 “health center administration” (57.8±24.8, and “leading clinical services and coordinating patients care” (47.6±26.8 are more evident while “fund holding” had the lowest rank(5.0±10.0. They believed that in an ideal national health system physicians should play most of these roles in various extents.Conclusion: The participants believed that GPs should play other roles beyond the clinical care provision to enable health system respond to community needs and expectations. The graduate medical degree should be reformed if the gradates are going to play these new roles.Key words: Role Definition, Curr iculum Development, GP, Primary Health
Erlangsen, Annette; Fedyszyn, Izabela
AIMS: The Nordic countries have a strong tradition of using nationwide social and health registers for research purposes. The aim of the current paper is to provide an overview of the Danish population-based registers in public health and health-related research, and to discuss their strengths...... and limitations. METHODS: Danish registers on somatic and psychiatric hospital contacts as well as care provided by general practitioners were reviewed. The availability of demographic, individual-level variables of relevance for health-related research was summarized. RESULTS: Since 1968, every person living...... of prescribed medications, and a complete follow-up with respect to causes of death support public health studies surveying trends of prevalence and incidence. Historical data on psychiatric and somatic hospitalizations since 1969 and 1977, respectively, allow an in-depth assessment of the burden of disease...
Interprofessional teamwork and collaboration are essential for facilitating perioperative patient centred care. Operating department practitioners (ODPs) and nurses are registered professional 'practitioner' members of the perioperative team. Standards of conduct, communication skills, ethical principles and confidentiality legislation associated with documented patient information underpin and guide perioperative practitioner practice. This article will discuss, from a student's theoretical and practice experience perspective, the registered professional 'practitioner' role in the context of the interprofessional team.
Full Text Available Peter Lange,1,2 Sandra Søgaard Tøttenborg,1 Anne Dichmann Sorknæs,3 Jørgen Steen Andersen,4 Mette Søgaard,5 Henrik Nielsen,5 Reimar Wernich Thomsen,5 Katrine Abildtrup Nielsen6 1Section of Social Medicine, Department of Public Health, University of Copenhagen, 2Lung Diseases Department, Respiratory Medicine Section, Lung Diseases Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, 3Medical Department, Odense Universitetshospital–Svendborg Hospital, Svendborg, 4Danish College of General Practitioners, Copenhagen, 5Department of Clinical Epidemiology, Aarhus University Hospital, 6Registry Support Centre of Clinical Quality and Health Informatics (West, Århus, Denmark Aim of database: The Danish Register of Chronic Obstructive Pulmonary Disease (DrCOPD is a nationwide database aiming to describe the quality of treatment of all patients with chronic obstructive pulmonary disease (COPD in Denmark. Study population: DrCOPD comprises data on all patients with a diagnosis of COPD. In the hospital setting, both in- and outpatients are included. In the setting of the general practice (GP, DrCOPD aims to include all patients with a COPD diagnosis who attend an annual control visit for COPD. Main variables: DrCOPD includes information on forced expiratory volume in 1 second, smoking status, body mass index, dyspnea, treatment modalities such as rehabilitation, smoking cessation, medical treatment, and the use of noninvasive ventilation during hospitalization due to exacerbations. The outcome variables include frequency of readmission and death 30 days after discharge from hospital. Descriptive data: Since 2008, the registration in the Danish hospitals has gradually become more comprehensive. In 2014, ~90% of 16,106 eligible patients had complete data sets that showed an improvement in the processes describing quality of care, including increased offering of smoking cessation, rehabilitation, and correct treatment with inhaled
Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.
Allaert, F A; Dusserre, L
Computerization of medical records is making headway for patients' follow-up, scientific research, and health expenses control, but it must not alter the guarantees provided to the patients by the medical code of ethics and the law of January 6, 1978. This law, modified on July 1, 1994, requires to register all computerized records of personal data and establishes rights to protect privacy against computer misdemeanor. All medical practitioners using computerized medical records must be aware that the infringement of this law may provoke suing in professional, civil or criminal court.
Healthcare is leaking away from the hospital and clinic into everyday life, disrupting work and play. It is no longer confined to a strictly medical sphere. Overwhelmed medical practitioners care for the expanding ranks of chronic dependents. One solution has to been to expand healthcare activities...... and create duties for patients. For the patient at home, it is not just about applying bandages to a wound. They now configure dialysis machines, inject insulin and stock medical supplies. Information technology produces data to be transformed into meaningful knowledge about one’s own body. However, with all...
Drug promotion in a resource-constrained Nigerian environment: A cross-sectional study of the influence of pharmaceutical sales representatives on the prescribing behaviors of medical practitioners in Abia State
Gabriel Uche Pascal Iloh
Full Text Available Background: Pharmaceutical drug promotion is an important component of pharmaceutical care and is one of the factors that may lead to unethical drug prescriptions. As the impetus for rational drug use grows, emphasis should also be focused on prescribing behaviors of physicians, particularly in resource-poor settings. Aim: The study was aimed at describing the influence of drug promotion by pharmaceutical sales representatives (PSRs on the prescribing behaviors of medical practitioners in Abia State, Nigeria. Materials and Methods: A descriptive study was carried out on a cross-section of 185 medical practitioners in Abia State, Nigeria. Data collection was done using a pretested, self-administered questionnaire that elicits information on practice and attitude to drug promotion, types of incentives, frequency of visits, drug promotion methods and information, sources of drug information, and awareness of code of regulation on drug promotion. Results: The age of the participants ranged from 28 to 71 years. There were 166 males and 19 females. The prescribing practices of 47.6% of the medical practitioners were influenced by drug promotion and 66.5% of them had positive attitude to drug promotion. One hundred and sixty-four (88.6% were visited >12 times in the previous year. The most common incentive received was branded stationeries (100.0%; predominant drug promotional method and information were in-person clinic encounter (100.0% and brand names of the drugs (100.0%, respectively. The most common source of drug information was calling a colleague/pharmacist (93.5% while 84.9% of the respondents were aware of code of regulation on drug promotion. The prescribing practice (P = 0.041 and attitude (P = 0.032 to drug promotion were significantly associated with working in public hospitals. Conclusion: Drug promotion by PSRs influenced prescribing practices of medical practitioners with 66.5% of them having positive attitude to drug promotion. The
Chandra, Phool; Hughes, Mark
A study of medical students' choice of anesthesiology as a specialty and the quality of clerkships available established several factors in students' choice, including the negative effect of certified registered nurse anesthetists on the operating room floor. A study of relationships with nurse practitioners, physician's assistants, and…
Time, Cost, Information Seeking Skills and Format of Resources Present Barriers to Information Seeking by Primary Care Practitioners in a Research Environment. A review of: Andrews James E., Kevin A. Pearce, Carol Ireson, and Margaret M. Love. “Information‐Seeking Behaviors of Practitioners in a Primary Care Practice‐Based Research Network (PBRN.” Journal of the Medical Library Association 93.2 (Apr. 2005: 206‐12.
Martha Ingrid Preddie
Full Text Available Objective – To determine the information seeking behaviors of primary care practitioners in order to inform future efforts towards the design of information services that would support quality inprimary care.Design – A cross‐sectional survey.Setting – A primary care practice based research network (PBRN of caregivers who serve a broad population while simultaneously studying and disseminating innovations aimed at improvements in quality, efficiency and/or safety of primaryhealth care in the United States.Subjects – All primary care practitioners in the PBRN including family practitioners, general practitioners, nurse practitioners and physician assistants.Methods – A questionnaire comprising twenty‐six questions was distributed to 116 practitioners. Practitioners attached to academic centres (who were also members of the PBRN were excluded in order “to achieve a sample of practices more representative of the primary care practising population” (208. Descriptive data were collected and analyzed. SPSS v11.5 was used for statistical analyses.Main results – There was a response rate of 51% (59 of 116. Fifty‐eight percent of the respondents stated that they sought information (excluding drug dosing or drug interactions information to support patient care several times a week. Sixty‐eight per cent sought this information while the patient waited. Almost half of therespondents had access to a small medical library (48% or a hospital library (46%, while 21% used a university medical library.Approximately 14% had no immediate access to a medical library. Almost 60% of practitioners stated that they had an e‐mail account. Thirty‐four percent agreed that the use of e‐mail to communicate with patients enhanced medical practice, while 24% disagreed. There was frequent prescribing of Internet‐based consumer health information to patients by only 16% of the practitioners, while Internet support groups were frequently recommended
... Red Dress ® , and Red Dress ® are registered trademarks of U.S. Department of Health and Human Services. National Wear Red Day ® is a registered trademark of the U.S. Department of Health and Human ...
Bjerregaard, Beth; Larsen, Ole B
The National Board of Health, Denmark in 1997 published guidelines for reporting of pathology data and the Danish Pathology Register (DPR) was established.......The National Board of Health, Denmark in 1997 published guidelines for reporting of pathology data and the Danish Pathology Register (DPR) was established....
Ohio State Univ., Columbus. Center on Education and Training for Employment.
This document, which is designed for use in developing a tech prep competency profile for the occupation of registered nurse (with an associate degree), lists technical competencies and competency builders for 19 units pertinent to the health technologies cluster in general and 5 units specific to the occupation of registered nurse. The following…
Petersen, Liselotte; Sørensen, Thorkild I A
The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia.......The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia....
This paper gives a review of Josephson shift register circuits that were designed, fabricated, or tested, with emphasis on work in the 1980s. Operating speed is most important, since it often limits system performance. Older designs used square-wave clocks, but most modern designs use offset sine waves, with either two or three phases. Operating margins and gate bias uniformity are key concerns. The fastest measured Josephson shift register operated at 2.3 GHz, which compares well with a GaAs shift register that consumes 250 times more power. The difficulties of high-speed testing have prevented many Josephson shift registers from being operated at their highest speeds. Computer simulations suggest that 30-GHz operation is possible with current Nb/Al 2 O 3 /Nb technology. Junctions with critical current densities near 10 kA/cm 2 would make 100-GHz shift registers feasible
Anema, J R; Jettinghoff, K; Houtman, I; Schoemaker, C G; Buijs, P C; van den Berg, R
To describe medical management by the general practitioner (GP) and occupational physician (OP) of workers sick listed due to mental health problems, and to determine agreement in diagnosis, main cause of sickness absence and obstacles in return to work. A cohort of 555 employees being sick listed for 12 to 20 weeks due to mental health problems was recruited and followed for 1 year. These employees were interviewed about their mental health and contacts with GP, OP, other specialists and employer. In addition, the GP and/or the OP of 72 employees were interviewed about the medical diagnosis and management. Most employees sick listed for 12-20 weeks visited their GP and OP. According to the employees most interventions applied by the GP were medical interventions, such as referral of employees and prescription of medical drugs. Working conditions were seldom discussed by the GP and work-related interventions were never applied. Most interventions applied by the OP were work-related interventions and/or contact with the employer. The OP more often talked about working conditions and conflicts. According to the employees, the communication between GP and OP only took place in 8% of the cases. Agreement in the diagnosis, main cause of sickness absence, and obstacles in return to work reported by the GPs and OPs of the same employee was poor. In addition, similarity in reported diagnosis by GP and/or OP and the employees' scores on valid questionnaires on (mental) health was limited. The lack of communication and agreement by Dutch GPs and OPs in medical diagnosis and management of employees long-term sick listed due to mental health problems are indicators of sub-optimal medical treatment and return-to-work strategies.
Dexter, Franklin; Ahn, Hyun-Soo; Epstein, Richard H
When a practitioner in a preanesthesia evaluation clinic is not evaluating a patient because no patient is waiting to be seen, the practitioner often has other responsibilities such as reviewing charts of patients. When practitioners differ in how quickly they complete evaluations, multiple scenarios can be created wherein the slowest practitioner would only evaluate patients when the number of patients waiting exceeds a threshold (e.g., at least 2 patients are waiting). Review of operations research studies identified conditions for which such management of the queue can be beneficial (e.g., mean evaluation time of the fastest practitioner is less than half that of the slowest practitioner). These conditions were compared with the actual completion rates of certified registered nurse practitioners at a hospital's clinic. The 99.9% confidence intervals (CI) were calculated for ratios of mean evaluation times. The fastest practitioner was typically 1.23 times faster than the second fastest practitioner (CI 1.22-1.23) and 1.61 times faster than the slowest of three practitioners (1.59-1.61). These are significantly less than the 3 times and 2 times faster, respectively, that would be sufficiently large to warrant managing queue discipline. Practitioners with longer mean evaluation times had larger percentage utilizations of working time (Kendall τb = 0.56, P = 0.0001), inconsistent with preferential assignment of patients to the fastest practitioner(s) available. Practitioners' speeds in evaluating patients do not differ sufficiently for information systems to be used routinely to choose who evaluates the next patient (i.e., state-dependent assignment policy). Clinics aiming to reduce patient waiting should focus on reducing the overall mean evaluation time (e.g., by chart review ahead), appropriately scheduling patients, and having the right numbers of nursing assistants and practitioners.
Maehara, Tadaaki; Nishida, Hiroshi; Watanabe, Takashi; Tominaga, Ryuji; Tabayashi, Koichi
The healthcare system surrounding surgeons is collapsing due to Japan's policy of limiting health expenditure, market fundamentalism, shortage of healthcare providers, unfavorable working environment for surgeons, increasing risk of malpractice suits, and decreasing number of those who desire to pursue the surgery specialty. In the USA, nonphysician and mid-level clinicians such as nurse practitioners (NPs) and physician assistants (PAs) have been working since the 1960s, and the team approach to medicine which benefits patients is functioning well. One strategy to avoid the collapse of the Japanese surgical healthcare system is introducing the NP/PA system. The division of labor in medicine can provide high-quality, safe healthcare and increase the confidence of the public by contributing to: reduced postoperative complications; increased patient satisfaction; decreased length of postoperative hospital stay: and economic benefits. We have requested that the Ministry of Health, Labor and Welfare establish a Japanese NP/PA system to care for patients more efficiently perioperatively. The ministry has decided to launch a trial profession called "tokutei (specifically qualified) nurse" in February 2010. These nurses will be trained and educated at the Master's degree level and allowed to practice several predetermined skill sets under physician supervision. We hope that all healthcare providers will assist in transforming the tokutei nurse system into a Japanese NP/PA system.
National Archives and Records Administration — The Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and...
Petersen, Liselotte; Sørensen, Thorkild I A
The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia. The register encompass information on all 14,425 non-familial adoptions of Danish children legally granted in Denmark 1924-1947. It includes name and date of birth of each adoptee and his or her biological and adoptive parents, date of transfer to adoptive parents and date of formal adoption. The linkage to biological and adoptive parents is close to complete, even biological fathers are registered for 91.4% of the adoptees. Adoption registers are a unique source allowing disentangling of genetic and familial environmental influences on traits, risk of diseases, and mortality.
Full Text Available Background The promulgation of the Traditional Health Practitioners Act No 22 (2007 was seen as the long awaited start-up of the traditional healing profession in South Africa. Act No 22 (2007 was strongly politically driven from the late 1960s onward. Many of these political motivators were based upon outdated cultural ideas, customs and traditions, rooted outside the modern day healthcare needs and demands of the particular population that traditional healing intends to serve. An in-depth needs and skills analysis, to test the viability and sustainability of the South African traditional healers as well as their positions and roles as health practitioners inside the formal healthcare sector, as guided and stipulated by the Traditional Health Practitioners Act No 22 (2007, was lacking in this early development and start-up process. This resulted in the traditional healers’ present and future roles as specific healthcare practitioners being both undefined and insufficiently formulated. In addition their existing education, training, skills and abilities to compete in the formal healthcare sector were ignored. Therefore, since the promulgation of the Act in 2007, there was limited professional-development for traditional healers, to improve their immediate professionalism and thus to promote effective role-playing and management in the formal healthcare sector. The South African traditional healing professional model is still in the foundational stage of its professional development; a stage which the other registered/regulated healthcare practitioners of the country surpassed long ago, making them well-equipped for role-playing and management as health professionals in the formal healthcare sector. The whole venture of the statutory recognition of the traditional health practitioners in 2007 as new healthcare professionals with the promulgation of the Traditional Health Practitioners Act No 22 (2007 seems to increasingly be a failure. There is
Beratan, David N.; Onuchic, Jose N.
Molecular-scale shift registers eventually constructed as parts of high-density integrated memory circuits. In principle, variety of organic molecules makes possible large number of different configurations and modes of operation for such shift-register devices. Several classes of devices and implementations in some specific types of molecules proposed. All based on transfer of electrons or holes along chains of repeating molecular units.
The theoretical part of the thesis analyzes several selected methodologies and best-practices related to information technology risks management, with focus on documents and guidance developed by ISACA. It builds a set of ideas and basic requirements for effective model of an IT risk register. Strong emphasis is placed on mapping CobiT 4.1 based Risk IT to COBIT 5. The practical part describes implementation of an exploratory web-based IT risk register in Python programming language utilizing...
Updated European core curriculum for radiotherapists (radiation oncologists). Recommended curriculum for the specialist training of medical practitioners in radiotherapy (radiation oncology) within Europe.
Baumann, M.; Leer, J.W.H.; Dahl, O.; Neve, W. de; Hunter, R.; Rampling, R.; Verfaillie, C.
AIM: To produce updated state-of-the-art recommendations for harmonised medical specialist training in radiotherapy within Europe. MATERIAL AND METHODS: The Minimum Curriculum for the Theoretical Education in Radiation Oncology in Europe from 1991 was updated under consideration of new developments
Wubetu, Muluken; Abula, Tefera; Dejenu, Getye
One of the services that plants provide for human beings is their wider medicinal application. Although it is not fully assessed, the practice and wider use of traditional medicine is frequent in Ethiopia. Studies conducted previously are confined to the perceptions of modern and traditional health practitioners about traditional medicine. A total of 45 informants were selected purposefully from the study area. For collecting the data, semi-structured interviewees, observation and field walks were employed from August 10 to September 30/2014. To summarize the information, descriptive statistical methods were applied. Sixty species of medicinal plants distributed in 42 families were collected and identified applied locally for the treatment of 55 human disorders. The most commonly treated ones were evil eye, malaria, wound, peptic ulcer disease and rabies. According to this study, leaves were the commonly used plant parts (36.5%) and 39% of the preparations were decoctions. Oral route, 43 (44%) was the commonly used route of application whereas most (54.8%) remedies were administered only once. Fourteen percent of preparations caused vomiting in addition most (40.4%) of the formulations was contraindicated for pregnant patients. Only seventeen percent of the formulations possessed drug food interactions. Most preparations were stored within clothes, 31 (29.8%). There exists a high (ICF = 0.8) evenness of plant use among healers for treating respiratory problems. Alliumsativum (FI = 0.75) for evil eye, Phytolacca dodecandra (FI = 0.8) for rabies and Croton macrostachyus (FI = 0.78) for treating malaria were medicinal plants with highest fidelity levels showing consistency of knowledge on species best treating power. This study also documented that drought, overgrazing and firewood collection are major threats. Dega Damot district is loaded in its medicinal plant diversity and indigenous knowledge though plants are highly affected by drought, overgrazing and
Full Text Available Daniel Bressington,1 Esther Coren,1 Douglas MacInnes21Department of Health, Well-Being and Family, 2Centre for Health and Social Care Research, Canterbury Christ Church University, Canterbury, UKBackground: Nonadherence with medicine prescribed for mental health is a common problem that results in poor clinical outcomes for service users. Studies that provide medication management-related training for the mental health workforce have demonstrated that improvements in the knowledge, attitudes, and skills of staff can help to address nonadherence. This systematic review aims to establish the effectiveness of these training interventions in terms of clinician-related outcomes.Methods: Five electronic databases were systematically searched: PubMed, CINAHL, Medline, PsycInfo, and Google Scholar. Studies were included if they were qualitative or quantitative in nature and were primarily designed to provide mental health clinicians with knowledge and interventions in order to improve service users' experiences of taking psychotropic medications, and therefore potentially address nonadherence issues.Results: A total of five quantitative studies were included in the review. All studies reported improvements in clinicians' knowledge, attitudes, and skills immediately following training. The largest effect sizes related to improvements in clinicians' knowledge and attitudes towards nonadherence. Training interventions of longer duration resulted in the greatest knowledge- and skills-related effect sizes.Conclusion: The findings of this review indicate that training interventions are likely to improve clinician-related outcomes; however, due to the methodological limitations of the current evidence base, future research in this area should aim to conduct robust randomized controlled trials with follow-up and consider collecting qualitative data to explore clinicians' experiences of using the approaches in clinical practice.Keywords: staff training
, construct their identities in the light of inclusive education, and how they negotiate the tensions and contradictions emerging from the processof becoming inclusive practitioners. Central to this discussion is the understanding that teachers' ...
Full Text Available Background and purpose: roles and tasks of intended graduates direct medical eductionist for developing the right curriculum. In Iran there has been no systematic study on defining GPs roles. This study is an attempt to systematically clarify the roles of GPs in Iran.Methods: In this questionnaire – based survey health care professionals participated. The subjects were selected through convinient sampling and snowballing. A semi-structured questionnaire was developed which covered the goals and functions of health system as mentioned in World Health Report 2000. For content validity a panel of experts including health care professionals, biostatisticians, and psychometrist evaluated the questionnaire. For the reliability of the questionnaire a pilot study was carried out. Chronbach’s coeficient were calculated as 0.89 .The final revision of the questionnaire included 15 roles in current and ideal states. The respondent should score each role in both states in a range of 0-100.Results: Of 50 subjects who received the questionnaire, 40 (80% completed and returned it. Of all subjects 30% were female and 70% were male. Of all subjects 90% were faculty members. The subjects believe that in the current state “health care provision” (74.7.3±29.7 “health center administration” (37±21.8, and “leading clinical services and coordinating patients care” (29.5±24.4 are more evident while “fund holding” is rather non-existence (1.2±3.7. They believed that in an ideal national health system physicians should play most of these roles in various extents.Conclusion: The participants believed that GPs should play other roles beyond the clinical care provision to enable health system respond to community needs and expectations. The graduate medical degree should be reformed if the gradates are going to play these new roles.Key words: Role Definition, Curriculum Development, GP, Primary Health Care
Kaipa, Sudhakar; Pydi, Siva Kumar; Krishna Kumar, Rathikota Veeravenkata Sathyasai; Srinivasulu, Gomasani; Darsi, Venkata Rajesh Kumar; Sode, Munikumar
Background: This cross-sectional study was designed to measure the level and distribution of job satisfaction of registered dental practitioners and to explore the factors associated with it. Materials and Methods: The study was conducted among 66 registered dentists in Srikakulam, India. Job satisfaction was measured by using a modified version of the Dentists Satisfaction Survey questionnaire. The statistical tests employed were ?t? test and analysis of variance (ANOVA). Post hoc test (Sche...
Institute for Political/Legal Education, Sewell, NJ.
Organizational procedures and appropriate forms for high school students to conduct a community survey of non-registered voters are provided. Duties for student coordinator, field staff, and clerical staff are described and a flow chart depicts the relationship of personnel to one another and to the community. Students are instructed to notify…
Mańko, R.; Thiel, M.; Bauer, E.
Widespread lobbying in the EU institutions has led to criticism regarding the transparency and accountability of the EU's decision-making process. In response to these concerns, the Parliament set up its transparency register in 1995, followed by the Commission in 2008. The two institutions merged
Abildstrøm, Steen Z; Madsen, Mette
Introduction: The Danish Heart Register (DHR) is a clinical database of invasive procedures within cardiology. Content: All providers of these procedures have been obliged to report to DHR since 2000. DHR is used to monitor the activity and quality of the procedures and serves as a data source...
Christiansen, Erik; Jensen, Børge Frank
The Register for Suicide Attempts (RSA) is a product of the WHO research project "WHO/Euro Multicentre Study on Parasuicide", which, among other things, had the purpose of collecting data on suicide attempts from 13 European countries. Data is collected in order to calculate trends and identify...
Background. Mental health literacy on the part of medical practitioners is an important component of mental healthcare. General practitioners (GPs) are typically the first doctors consulted by a person who is ill. Exploration of their perceptions regarding mental illness, aetiological issues and treatment is important. Objective.
Suman, Arnela; Schaafsma, Frederieke G; van de Ven, Peter M; Slottje, Pauline; Buchbinder, Rachelle; van Tulder, Maurits W; Anema, Johannes R
To improve patient care, and to reduce unnecessary referrals for diagnostic imaging and medical specialist care for low back pain, an evidence-based guideline for low back pain was developed in the Netherlands in 2010. The current study evaluated the effect of a multifaceted implementation strategy on guideline adherence among Dutch general practitioners. The implementation strategy included a multidisciplinary training, provision of educational material and an interactive website for healthcare professionals, supported by a multimedia eHealth intervention for patients with low back pain. Adherence was measured using performance indicators based on 3 months data extracted from the contacts with patients with low back pain recorded in the electronic medical records of participating general practitioners. Performance indicators were compared between two groups: a usual care group and an implementation group. Performance indicators were referrals to consultations with medical specialists, to diagnostic imaging, and to psychosocial and/or occupational physician consultations, and inquiries about psychosocial and occupational risk factors. The electronic medical records of 5130 patient contacts for LBP were analysed; 2453 patient contacts in the usual care group and 2677 patient contacts in the implementation group. Overall, rates of referral and of recorded inquiries regarding psychosocial and occupational risk factors remained low in both groups over time. The only statistically significant difference found was a reduction in the number of referrals to neurologists in the implementation group (from 100 (7%) to 50 (4%)) compared to the usual care group (from 48 (4%) to 50 (4%), (p strategy did not result in improved guideline adherence among general practitioners, and it is not recommended for widespread use. However, baseline referral rates in participating practices were already low, possibly leaving only little room for improvement. Inquiries for psychosocial and
Need of Department of General Practice / Family Medicine at AIIMS (All India Institute of Medical Sciences): Why the apex medical institute in India should also contribute towards training and education of general practitioners and family physicians.
Pal, Ranabir; Kumar, Raman
Family medicine or general practice is the practicing discipline of the majority doctors in India, however formal academic departments of general practice (or family medicine) do not exist in India, as it is not a mandatory requirement as prescribed by the Medical Council of India; the principal regulator of medical education. Currently India has capacity to produce more than 60,000 medical graduates per year, majority of whom are expected to become general practitoners or primary care doctors without under going any vocational training in general practice or family medicine. The 92 nd parliamentary standing committee report (on health and family welfare) of the Indian Parliament recommended that Government of India in coordination with State Governments should establish robust postgraduate programs in Family Medicine and facilitate introducing Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous health care for the individuals and families. The authors concur with the parliament of India and strongly feel that "Family Medicine" (community-based comprehensive clinical practice) deserves dedicated and distinct department at all medical colleges in India in order to availability of qualified medical doctors in the community-based health system. AIIMS, New Delhi, along with other newly established AIIMS, should rise to their foundation mandate of supporting excellence in all disciplines of medical science and to this historic responsibility; and not just remain an ivory tower of tertiary care based fragmented (into sub specialties) hospital culture.
I have been delivering the flexible family work approaches outlined in this supplement at Aquarius for the past 8 years. Aquarius is an English Midlands-based addictions charity working with people who have problems with alcohol, drugs, or gambling and supporting their family members/concerned others. I have been a practitioner participating in…
The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malpractice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the standard of care the law required of him in the particular circumstances and that he acted with guilt and therefore can be blamed for the deed. This paper describes medical practitioner negligence and reviews relevant cases.
Alexia, Vinel; Chloé, Vachon; Pierre, Barthet; Sara, Laurencin-Dalicieux
With 39,359 entries on PubMed, periodontal medicine has a prominent position in periodontal research. Good patient care requires well-advised physicians, and whereas the dental community is informed about the relationships between periodontal diseases (PDs) and an increasing number of systemic pathologies, we wondered whether general practitioners were too. Thus, we aimed to evaluate their knowledge of the links between periodontal and systemic diseases. To this end, we sent an electronic questionnaire to the 2350 general practitioners registered to the URPS (Union régionale des Professionnels de Santé) of Midi-Pyrénées, France. They were asked about their practice, their attitude during a medical examination, and their knowledge about PDs. The analysis of 222 properly answered questionnaires showed that while most general practitioners are aware of the relationships between PDs and diabetes or cardiovascular diseases, the majority of them are unaware that obesity and respiratory and joint diseases are also concerned. Indeed, 94% of the questioned subjects consider their insight of PDs to be insufficient. Nevertheless, more than half of the interrogated physicians cared about their patients' oral health and dental care. Education regarding relationships between periodontal and systemic diseases must be improved among general practitioners who are in the front line to refer high-risk patients to a periodontist. Copyright © 2017 Elsevier Inc. All rights reserved.
Ksenofontov, Andri, 1962-
Näitused: Eesti Kujundusgraafikute Liidu aastanäitus "Register 2007" Kunstihoone galeriis, Signe Kivi "Võimuvaibad ja vaimukleidid" Arhitektuuri- ja Disainigaleriis, "Kehaturg / Sex market" (Dagmar Kase, Eveli Variku tööd) Tallinna Kunstihoones, Andrei Maksimjuki "Surematu klassika" Ühispanga galeriis, Katrin Veegeni "Varsti" A-galeriis, Eda Lõhmuse "Ülespoole" ja Rein Kelpmani "Grosso modo" ArtDepoo Galeriis, Jaan Elkeni "Valge valgus" Galeriis 008, Paul Rodgersi "Transplants" Hobusepea galeriis, Masayo Ave "Haptic Interface Design" Arhitektuuri- ja Disainigaleriis ja workshop Eesti Kunstiakadeemias
Bouwmeester, S.; Verkoeijen, P. P.J.L.; Aczel, B.
and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed...... the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned...
Jensen, Vibeke Myrup; Rasmussen, Astrid Würtz
to adults continuing education and training stem from administrative education reports. Therefore, for cohorts born 1945-1990, 97 percent of the Danish population has a valid education identifier. For the immigrant population born in the same cohorts the coverage is 85-90 percent. Despite a higher level......Collection of systematic information on education is a long established practice in Denmark. Since 1910, the Danish Ministry of Education's annual reports collects information about individual-level test scores in e.g. compulsory schooling. Today, several registers from compulsory schooling...
Jensen, Vibeke Myrup; Würtz Rasmussen, Astrid
to adults continuing education and training stem from administrative education reports. Therefore, for cohorts born 1945-1990, 97 percent of the Danish population has a valid education identifier. For the immigrant population born in the same cohorts the coverage is 85-90 percent. Despite a higher level......Collection of systematic information on education is a long established practice in Denmark. Since 1910, the Danish Ministry of Education’s annual reports collects information about individual-level test scores in e.g. compulsory schooling. Today, several registers from compulsory schooling...
Jensen, Vibeke Myrup; Rasmussen, Astrid Würtz
Collection of systematic information on education is a long established practice in Denmark. Since 1910, the Danish Ministry of Education’s annual reports collects information about individual-level test scores in e.g. compulsory schooling. Today, several registers from compulsory schooling...... to adults continuing education and training stem from administrative education reports. Therefore, for cohorts born 1945-1990, 97 percent of the Danish population has a valid education identifier. For the immigrant population born in the same cohorts the coverage is 85-90 percent. Despite a higher level...
Full Text Available A move has taken place internationally in the delivery and “consumption” of health care where if clients and patients (health care consumers hold the opinion that the health care professionals/providers' behaviour has had a negative effect, impact or outcome on them, they may lodge a complaint with the relevant health professional regulatory body. Ethical transgressions of health care providers can generally be clustered into the following three categories: a Competence and conduct with clients (e.g. abandonment, sexual intimacies, dishonesty, disclosure of information; b Business practices (e.g. billing, reports, documentation; and c Professional practice (e.g. referral upon termination, obtaining appropriate potential employment opportunities, nonprofessional relationships.The primary objective of this study was to analyse the ethical transgressions of registered members of the twelve professional boards in the Health Professions Council of South Africa (HPCSA in the period 2007 to 2013. A mixed methods approach was followed in this study which specifically focused on a historical research approach. The results indicate that the boards with the highest number of transgressions per the registered practitioners were firstly the Medical and Dental practitioners, closely followed by the Optometry and Dispensing Opticians Board. The predominantly complaint made against members of both these boards was for fraudulent conduct (collectively totalling to 85% of all fraudulent cases during the period and included actions such as charging for non-rendered services, issuing false statements and submitting fraudulent medical aid claims. Cognisance needs to be taken that the South African public will increasingly demand better services and that since they are being better informed via the media of their rights and have access to a broader database of knowledge (rightly or wrongly so the internet practitioners' opinions will not necessarily be accepted
Cyro Ciari Jr.
Full Text Available Propõe-se um método para auditoria de fichas clínicas de serviços de pré-natal, baseado no preenchimento de duas fichas modelos I e II. A primeira refere-se ao grau de preenchimento dos itens da ficha e a segunda à coerência entre os itens assinalados e o diagnóstico e conduta. Tendo como base o modelo de ficha usado pelo serviço em auditoria, são elaboradas duas listas de itens que depois são aplicadas para obtenção de dados que irão constar nas fichas I e II. O método foi usado em algumas unidades Sanitárias (CS I e III da Secretaria de Saúde de S. Paulo (Brasil revelando ser de simples aplicação e fácil análise dos resultados, porém necessitando de pessoal qualificado, como enfermeira e médico com experiência na área da Saúde Materna.A method for qualitative analysis of medical registers in Prenatal Care Services is proposed, based on the filling percentage of the items and on the coherence of the data of history, physical examination, diagnosis and management. The method, used in some Prenatal care units of the Health Secretary of São Paulo, has proved to be easily conducted, when applied by qualified manpower, such as skilled nurses and physicians.
Toxoplasmosis is caused by an obligate intracellular protozoan parasite, Toxoplasma gondii which is estimated to infect about a third of the human population. Infections have also been documented in more than 350 species of birds and mammals. Cats are the only definitive hosts. Infection is mostly a symptomatic in ...
an alternative understanding of collaborative design practice as participatory inquiry. The paper suggests that participatory inquiry, as it more fully takes into account the learning driven and relational nature of design practice, could help inform alternative design educational strategies.......There is an inherent dilemma that some research indicates ways and means of doing design practice, in particular how practitioners bring what this paper identifies as informal resources into play, that are seldom reflected in how and what design students are taught or learn. The question is posed...... as to whether today’s design students are in fact equipped to be tomorrow’s practitioners. This paper introduces a range of literature and empirical observations that describe a number of different appreciations of process and practice, from both design and non-design perspectives. This in order to draw up...
Lu, Chueh-Fen; Tung, Ching-Chuan; Ely, Linda
Sponsored by the pilot overseas internships project of the Ministry of Education, Taiwan, the authors and ten undergraduate students from Taiwan visited several mental health facilities in Virginia for one month. These facilities included the Catawba State Hospital, Salem Veteran Affairs Medical Center, Carilion Saint Albans Behavioral Health (New River Valley Medical Center), Warm Hearth Village, Adult & Child Family Counseling private outpatient clinic, the Free Clinic of the New River Valley, New Life Clubhouse, and Self-Government Program for Assertive Community Treatment. In-depth dialogue and participation in nursing care under the supervision of registered nurses facilitated the authors' reflection on mental health care and the roles and functions of Taiwanese nurse practitioners. The present article adopts a macro view in order to compare the related issues between Taiwan and Virginia, including: geographic features, history, culture of health-seeking behavior, healthcare insurance, and the relationships among various professionals. How these issues relate to social-cultural background and how the overall healthcare environment impacts upon the roles of nurse practitioners in Taiwan are rarely discussed in literature. We expect that this cross-cultural contrast and reflection will elicit a better understanding of how these factors have shaped and affected the roles of Taiwanese nurse practitioners. Further, suggestions about how to improve the nursing profession in Taiwan are presented.
The Irish Medical Practitioners Act 2007 places a statutory obligation on all registered Medical Practitioners to maintain their professional competence by participating in a recognised Professional Competence Scheme. A questionnaire survey was conducted among 48 GPs attending educational meetings to see if doctors had concerns about the Professional Competence Scheme and to ask if they felt they had the necessary time, skills and knowledge to carry out an audit. Twenty-eight GPs (58%) had concerns regarding their participation in the Professional Competence Scheme; 75% were concerned about the time required, and 67% felt they needed further education about the scheme. Although 73% of doctors reported that they understand how to undertake a clinical audit and 50% reported they have carried out an audit in practice, 60% have never had any teaching on audit and 85% would like teaching in this area. Only 48% of the group surveyed felt that audit was practical in their current practice. Doctors have some concerns about the new Professional Competence Scheme, including the audit component. In particular, they report a requirement for more teaching in this area, and are concerned about the time involved.
Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290
Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M
Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.
Odintsova, Veronika V; Willemsen, Gonneke; Dolan, Conor V; Hottenga, Jouke-Jan; Martin, Nicholas G; Slagboom, P Eline; Ordoñana, Juan R; Boomsma, Dorret I
Twin registers are wonderful research resources for research applications in medical and behavioral genetics, epidemiology, psychology, molecular genetics, and other areas of research. New registers continue to be launched all over the world as researchers from different disciplines recognize the
Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders
BACKGROUND: Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale...... and organizational characteristics. DESIGN AND SETTING: A cross-sectional study using a sampled survey questionnaire and the official register from the Danish General Practitioners' Organization comprising all registered Danish GPs. METHOD: The Danish version of the MES Questionnaire was distributed and the survey...... and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs....
Background: Nurse practitioners are increasingly conducting consultations with\\ud patients on the same basis as medical doctors. However little is known about\\ud communication within nurse practitioner consultations. Research on communication\\ud in nurse practitioner consultations has identified nurse practitioners communicate\\ud with patients in a hybrid style, combining biomedical information with the discussion\\ud of subjective information from everyday life. Research has not fully explain...
Patrícia Lacerda Bellodi
Full Text Available OBJECTIVE: To investigate and characterize the professional stereotypes associated with general medicine and surgery among Brazilian medical residents. METHODS: A randomized sample of residents of the General Medicine and Surgery Residence Programs were interviewed and their perceptions and views of general and surgical doctors were compared. RESULTS: The general practitioner was characterized by the residents in general to be principally a sensitive and concerned doctor with a close relationship with the patient; (45%; calm, tranquil, and balanced (27%; with intellectual skills (25%; meticulous and attentive to details (23%; slow to resolve problems and make decisions (22%; and working more with probabilities and hypotheses (20%. The surgeon was considered to be practical and objective (40%; quickly resolving problems (35%; technical with manual skills (23%; omnipotent, arrogant, and domineering (23%; anxious, stressed, nervous, and temperamental (23%; and more decided, secure, and courageous (20%. Only the residents of general medicine attributed the surgeon with less knowledge of medicine and only the surgeons attributed gender characteristics to their own specialty. CONCLUSION: There was considerable similarity in the description of a typical general practitioner and surgeon among the residents in general, regardless of the specialty they had chosen. It was interesting to observe that these stereotypes persist despite the transformations in the history of medicine, i.e. the first physicians (especially regarding the valorization of knowledge and the first surgeons, so-called "barber surgeons" in Brazil (associated with less knowledge and the performance of high-risk procedures.OBJETIVOS: Investigar e caracterizar entre residentes brasileiros os estereótipos profissionais associados ao médico clínico e ao cirurgião. METODOLOGIA: uma amostra randomizada de residentes dos programas de Clínica Médica e Cirurgia foi entrevistada e suas
Phung, T.K.T.; Andersen, B.B.; Phung, T.K.T.
.24-0.48). Conclusion: The validity of dementia syndrome in the Danish hospital registers was high and allows for epidemiological studies about dementia. Alzheimer's disease, although underregistered, also had a good validity once the diagnosis was registered. In general, other ICD-10 dementia subtypes in the registers......Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time...... with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety...
Weiland, Sandra A
This Gadamerian hermeneutic study was undertaken to understand the meaning of autonomy as interpreted by nurse practitioners (NPs) through their lived experiences of everyday practice in primary health care. A purposive sample of nine NPs practicing in primary health care was used. Network sampling achieved a broad swath of primary care NPs and practice settings. Data were collected by face-to-face interviews. Because NP autonomy is concerned with gender and marginalization, Gilligan's feminist perspective was utilized during interpretive analysis. Having Genuine NP Practice was the major theme, reflecting the participants' overall meaning of their autonomy. Practicing alone with the patient provided the context within which participants shaped the meaning of Having Genuine NP Practice. Having Genuine NP Practice had four subthemes: relationships, self-reliance, self-empowerment, and defending the NP role. The understanding of Having Genuine NP Practice will enable NPs to articulate their autonomy clearly and better influence healthcare reform. Implications for advanced practice nursing education include integrating findings into classroom discussion to prompt self-reflection of what autonomy means and socialization to the NP role. ©2014 American Association of Nurse Practitioners.
Hsu, Hsiu-Ying; Chang, Shu-Chen; Chang, Ai-Ling; Chen, Shiah-Lian
Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors. The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners. The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD. On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430. Copyright 2017, SLACK Incorporated.
Halbig, J.K.; Bourret, S.C.; Hansen, W.J.; Hicks, D.V.; Klosterbuer, S.F.; Krick, M.S.
An electronics package for a small, battery-operated, self-contained, neutron coincidence counter based on a portable shift-register (PSR) has been developed. The counter was developed for applications not adequately addressed by commercial packages, including in-plant measurements to demonstrate compliance with regulations (domestic and international), in-plant process control, and in-field measurements (environmental monitoring or safeguards). Our package's features, which address these applications, include the following: Small size for portability and ease of installation;battery or mains operation; a built-in battery to power the unit and a typical detector such as a small sample counter, for over 6 h if power lines are bad or noisy, if there is a temporary absence of power, or if portability is desired; complete support, including bias, for standard neutron detectors; a powerful communications package to easily facilitate robust external control over a serial port; and a C-library to simplify creating external control programs in computers or other controllers. Whereas the PSR specifically addresses the applications mentioned above, it also performs all the measurements made by previous electronics packages for neutron coincidence counters developed at Los Alamos and commercialized. The PSR electronics package, exclusive of carrying handle, is 8 by 10 by 20 cm; it contains the circuit boards, battery, and bias supply and weighs less than 2 kg. This instrument package is the second in an emerging family of portable measurement instruments being developed; the first was the Miniature and Modular Multichannel Analyzer (M 3 CA). The PSR makes extensive use of hardware and software developed for the M 3 CA; like the M 3 CA, it is intended primarily for use with an external controller interfaced over a serial channel
Shams, Marie-Lise Antoun
This study was designed to identify core journals for the nurse practitioner specialty and to determine the extent of their indexing in bibliographic databases. As part of a larger project for mapping the literature of nursing, this study followed a common methodology based on citation analysis. Four journals designated by nurse practitioners as sources for their practice information were selected. All cited references were analyzed to determine format types and publication years. Bradford's Law of Scattering was applied to identify core journals. Nine bibliographic databases were searched to estimate the index coverage of the core titles. The findings indicate that nurse practitioners rely primarily on journals (72.0%) followed by books (20.4%) for their professional knowledge. The majority of the identified core journals belong to non-nursing disciplines. This is reflected in the indexing coverage results: PubMed/MEDLINE more comprehensively indexes the core titles than CINAHL does. Nurse practitioners, as primary care providers, consult medical as well as nursing sources for their information. The implications of the citation analysis findings are significant for collection development librarians and indexing services.
Berg, Selina Kikkenborg; Svanholm, Jette; Lauberg, Astrid
Introduction: Patient reported health status, which includes symptom burden, functional status and quality of life, is an important measure of health. Differences in health status between diagnostic groups within cardiology have only been sparsely investigated. These outcomes may predict morbidity...... in national registers. The following instruments are used: SF-12, Hospital Anxiety and Depression Scale, EQ-5D, Brief Illness Perception Questionnaire (B-IPQ), HeartQoL and Edmonton Symptom Assessment Scale. The following variables are collected from national registers: action diagnosis, procedures......, comorbidity, length of hospital stay, type of hospitalisation, visits to general practitioners and other agents in primary healthcare, dispensed prescription medication, vital status and cause of death. Labour market affiliation, sick leave, early retirement pension, educational degree and income...
Full Text Available BACKGROUND: We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. METHODS: A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. RESULTS: On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. CONCLUSIONS: This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.
This article presents a comprehensive assessment model for pediatric nurse practitioner (PNP) practice that integrates familiar elements of the classical medical history, Gordon's Functional Health Patterns, and developmental fields into one system. This model drives the diagnostic reasoning process toward consideration of a broad range of disease, daily living (nursing diagnosis), and developmental diagnoses, which represents PNP practice better than the medical model does.
Elsas, Siegward M
This paper addresses the challenge on how to obtain information from practitioners with experience in using medicinal plants. Collecting information on medicinal uses of plants is very challenging; since botanical remedies are used within the context of multiple differing medical systems, practitioners differ in training from Western physicians and scientists, and active ingredients of botanicals vary with preparation method, growth, and harvest conditions. A model on how useful data on safety and efficacy can be obtained from botanical practitioners is presented, based on methods developed by the association of anthroposophic physicians in Europe, a system of integrative medicine which includes the use of botanicals and is practiced mostly by medical doctors. Decades of experience by hundreds of practitioners are summarized and made accessible in a manual, which alphabetically lists the most commonly used botanicals and describes the most successful therapeutic experiences which could be confirmed by several of the contributing practitioners. This approach of continuous, multilingual systematic collection of successful therapeutic experiences within a community of practitioners with similar goals and a common therapeutic framework can be used not only for the training of successful future botanical practitioners, but also for helping to identify promising botanicals for scientific research and to further their development, and could support their official registration with governing bodies in countries of their use. This article is part of a Special Issue entitled "Botanicals for Epilepsy". Copyright © 2015 Elsevier Inc. All rights reserved.
East African Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 78, No 1 (2001) >. Log in or Register to get access to full text downloads.
Background PubMed is the largest bibliographic index in the life sciences. It is freely available online and is used by professionals and the public to learn more about medical research. While primarily intended to serve researchers, PubMed provides an array of tools and services that can help a wider readership in the location, comprehension, evaluation, and utilization of medical research. Objective This study sought to establish the potential contributions made by a range of PubMed tools and services to the use of the database by complementary and alternative medicine practitioners. Methods In this study, 10 chiropractors, 7 registered massage therapists, and a homeopath (N = 18), 11 with prior research training and 7 without, were taken through a 2-hour introductory session with PubMed. The 10 PubMed tools and services considered in this study can be divided into three functions: (1) information retrieval (Boolean Search, Limits, Related Articles, Author Links, MeSH), (2) information access (Publisher Link, LinkOut, Bookshelf ), and (3) information management (History, Send To, Email Alert). Participants were introduced to between six and 10 of these tools and services. The participants were asked to provide feedback on the value of each tool or service in terms of their information needs, which was ranked as positive, positive with emphasis, negative, or indifferent. Results The participants in this study expressed an interest in the three types of PubMed tools and services (information retrieval, access, and management), with less well-regarded tools including MeSH Database and Bookshelf. In terms of their comprehension of the research, the tools and services led the participants to reflect on their understanding as well as their critical reading and use of the research. There was universal support among the participants for greater access to complete articles, beyond the approximately 15% that are currently open access. The abstracts provided by PubMed were
Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic
AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995...
The transition from registered nurse (RN) to nurse practitioner (NP) is often a stressful career change. Data are lacking on the factors affecting NP role transition. This study examined the relationships between NP role transition, prior RN experience, and a formal orientation. From a sample of 352 NPs, only a formal orientation contributed significantly to the regression model indicating a positive relationship with NP role transition (b = 6.24, p < .001). Knowledge of the factors that expl...
Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. This article provides an outline of the current research around medical tourism, especially its impact on Australians. Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad.
A series of court and tribunal decisions in the course of 2012 in Australia has highlighted the vulnerability of seriously ill patients to overtures and advertising by charismatic health practitioners offering panaceas of unproven efficacy. Drawing upon the findings of the Victorian Court of Appeal in relation to Noel Campbell, the Deputy State Coroner of Western Australia in relation to Helfried Sartori, and the Victorian Civil and Administrative Tribunal in relation to Reza Ghaffurian, it is argued that there is a strong public interest in the capacity for effective early intervention by government in relation to unscrupulous and unethical conduct by health practitioners, whether they are registered or unregistered. For Australia a constructive reform would be nationally consistent legislation to regulate unregistered health practitioners.
As a practitioner, I have to rely on outside clinical laboratories and affiliated hospitals to perform laboratory tests. In this abstract, I describe specific problems I have encountered with third-party laboratories, and propose solutions for these problems to optimize use of laboratory tests. BLOOD TESTS: The most frequent problem in ordering blood tests is the lack of detailed information regarding sampling conditions. I often have to call laboratories to check whether the sample should be serum or plasma, what volume is needed, whether the sample should be cooled, etc. I propose that clinical laboratories should provide practitioners' manuals that describe specific sampling information. Most laboratories do not keep the data from ultrasonographic tests. The lack of these is most problematic when test results are interpreted differently by laboratories and by practitioners. Retaining the data would also help private laboratories improve the quality of the test by enabling them to compare their interpretations with others'. ANNUAL MEDICAL SCREENING: Even if an abnormal finding is detected at medical screening clinics, the final diagnosis is usually not sent back to the screening facilities. This is highly recommended to establish an official system that mediates the feedback to screening centers. MRI: Due to miscommunication between practitioners and radiologists, the test is sometimes performed inappropriately. A thorough consultation should occur before the test to clarify specific goals for each patient. PATHOLOGICAL TESTS: Interpretation of results is often inconsistent among laboratories. Independent clinical laboratories tend to report results without indicating sample problems, while pathology departments at affiliated hospitals tend to emphasize sample problems instead of diagnosis or suggesting ways to improve sample quality. Mutual communication among laboratories would help standardize the quality of pathological tests.
Kianmehr, Nahid; Haghighi, Anousheh; Bidari, Ali; Sharafian Ardekani, Yaser; Karimi, Mohammad Ali
Fibromyalgia syndrome (FMS) is a common rheumatologic disorder characterized by easy fatigability, widespread musculoskeletal pain and sleep disorder. In spite of its high prevalence, general practitioners, as primary care providers, seem to have inadequate knowledge about FMS. This study aimed to assess Iranian general practitioners' knowledge about FMS and its treatment. A detailed questionnaire (including items on signs and symptoms, diagnostic criteria and treatment) was completed by 190 general practitioners (54.7% male; mean age: 41 years). Data analysis was performed with SPSS for Windows 15.0 and awareness about all aspects of FMS was reported as percentages. About one-third (30%) of the participants had seen at least one case of FMS during their practice. Most subjects (62.7%) claimed to know 1-6 tender points. Only 3.2% knew 16-18 points. The common proposed symptoms of FMS were widespread pain (72.6%), excessive fatigue (72.6%), weakness (60.5%), sleep disorder (36.3%), anxiety (34.7%) and depression (34.2%). Wrong symptoms including elevated erythrocyte sedimentation rate and C-reactive protein, arthritis, joint swelling, weight loss and abnormal radiologic findings were selected by 27.9%, 18.9%, 14.7%, 12.6% and 2.1% of the physicians, respectively. Moreover, selective serotonin reuptake inhibitors, tricyclic antidepressant and pregabalin were identified as treatment options for FMS by, respectively, 45.8%, 22.1% and 15.3% of the participants. Finally, 52.1% and 23.7% of the subjects incorrectly considered nonsteroidal anti-inflammatory drugs and corticosteroids as treatment modalities for FMS. Iranian general practitioners are not well informed about FMS. Therefore, FMS should be specifically integrated in continuing medical education programs and undergraduate medical training curriculum. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Mancini, Joseph A.
This applied dissertation presented a mixed method design to gain a broader perspective of the perceptions of classroom management practitioners within a particular school district. Many teachers, or practitioners, experience issues with classroom management because of their understanding of strategies they use. Because of the researcher's…
Finnegan, Alan; Jackson, Robin; Simpson, Robin
In the UK, primary healthcare practices choose from a series of Read codes to detail certain characteristics onto a patient's medical documentation. One of these codes is for military veterans indicating a history relating to military service. However, veterans are poor at seeking help, with research indicating that this code is only applied in 7.9% of cases. Clinical staff have a clear role in motivating veterans to declare their ex-Forces status or register with a primary healthcare center. The aim of this study was to motivate veterans to notify primary healthcare staff of their armed forces status or register with a general practitioner, and to improve primary healthcare staff's understanding of veterans' health and social care issues. Data were provided by four primary healthcare centers' containing 40,470 patients in Lancashire, England during 2017. Pre- and post-patient medical record Read Code searches were conducted either side of a 6-wk intervention period centered on an advertising campaign. The data identified those veterans with the military specific Read code attached to their medical record and their age, gender, marital status and mental health disorders. Further information was gathered from interviews with eight members of staff, some of whom had completed an e-learning veteran healthcare academic module. The study was approved by the University of Chester's Research Ethics Committee. The pre-intervention search indicated that 8.7% (N = 180) of veterans were registered and had the correct military specific code applied to their medical record. Post-intervention, this figure increased by nearly 200% to N = 537. Mental health disorders were present in 28% (N = 152) of cases, including 15% (N = 78) with depression. Interviews revealed the primary healthcare staff's interpretation of the factors that motivated patients to declare their ex-Forces status and the key areas for development. The primary healthcare staff took ownership and responsibility
Phung, T.K.T.; Andersen, B.B.; Phung, T.K.T.
Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time...... with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety......-seven journals were available for review and 51 patients were interviewed. A registered diagnosis of dementia was found to be correct in 169 (85.8%) cases. Regarding dementia subtypes, the degree of agreement between the registers and the results of the validating process was low with a kappa of 0.36 (95% CI 0...
Freed, Gary L; Dunham, Kelly M; Martyn, Kristy; Martin, Jean; Moran, Lauren M; Spera, Laura
The demand for hiring pediatric nurse practitioners (PNPs) is strong. However, the number of newly educated PNPs has remained relatively flat during the past several years. Understanding the rationale and timing for the decision to pursue this profession is essential to having a positive impact on increasing the future workforce. A mail survey of all new PNPs certified between January 2009 and July 2011 (N = 1040) was conducted. The response rate was 79.9%. Nearly half of all respondents (45%, N = 314) reported that they work in outpatient general pediatrics, 26% (N = 184) in outpatient subspecialty pediatrics, and 22% (N = 152) in inpatient settings. More than one third (36%, N = 253) spend most of their time in a private practice. Forty percent (N = 307) reported that they decided to pursue education as an advanced practice nurse while in practice as a registered nurse (RN), and 38% (N = 289) made the decision before pursuing RN education. Efforts to increase the PNP pipeline will need to be directed both to students during their RN education and to creating opportunities for current RNs to pursue advanced practice nurse education that is focused on children. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
Altman, M.; Conlon, M.; Cristan, A.L.; Dawson, L.; Dunham, J.; Hickey, T.; Hook, D.; Horstmann, W.; MacEwan, A.; Schreur, P.; Smart, L.; Smith-Yoshimura, K.; Wacker, M.; Woutersen, S.
Registering researchers in some type of authority file or identifier system has become more compelling as both institutions and researchers recognize the need to compile their scholarly output. The report presents functional requirements and recommendations for six stakeholders: researchers,
Nurse-physician relationships remain, for the most part, hierarchical in nature. A hierarchical structure allows the person at the top, most notably the physician, the highest level of authority and power for decision making. Other health care providers are delegated various tasks related to the medical plan of care. One role of nonmedical health care providers, including nurses, is to support the medical plan of care and increase the productivity of physicians. Medical centers have house staff, usually interns and residents, who work collaboratively with the attending physicians in care delivery. At one medical center, a shortage of medical house staff for internal medicine prompted the development and evaluation of an alternative service. The alternative service utilized master prepared, certified nurse practitioners on a nonteaching service to provide care for selected types of medical patients. Physicians consulted with nurse practitioners, but retained decision-making authority concerning patient admission to the service. This paper describes the development and evaluation of an alternative service based on a collaborative practice model and the role of nurse practitioners working under such a model. Discussion includes suggestions for process guideline development for organizations that want to improve collaborative practice relationships between unit nursing staff, nurse practitioners, and physicians.
Full Text Available Abstract Background The Swedish National Inpatient Register (IPR, also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973 but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.
Full Text Available Timed automata and register automata are well-known models of computation over timed and data words respectively. The former has clocks that allow to test the lapse of time between two events, whilst the latter includes registers that can store data values for later comparison. Although these two models behave in appearance differently, several decision problems have the same (undecidability and complexity results for both models. As a prominent example, emptiness is decidable for alternating automata with one clock or register, both with non-primitive recursive complexity. This is not by chance. This work confirms that there is indeed a tight relationship between the two models. We show that a run of a timed automaton can be simulated by a register automaton, and conversely that a run of a register automaton can be simulated by a timed automaton. Our results allow to transfer complexity and decidability results back and forth between these two kinds of models. We justify the usefulness of these reductions by obtaining new results on register automata.
Sepehrmanesh Z.1 PhD,
Full Text Available Aims General practitioners have an essential role in patient care and are exposed to high levels of job stress. General practitioners’ mental health has effects on their functional abilities and medical managements.This study was carried out to evaluate the mental health of general practitioners in emergency wards in KashanUniversity of Medical Sciences, Iran. Materials & Methods In this cross-sectional study, all of General practitioners in emergency wards (n=87 were studied. The survey instruments includedtwo questionnaires: 1-demographic variables and 2- General Health Questionnaire (GHQ-28. Data were analyzed using SPSS 16 software and Chi square, Fisher exactand Mann-Whitney statistical tests. Findings The mean age of general practitioners was 36.11±5.67 years; 89.7% of them were married; 60.3% were male. 41% of the total general practitioners had mental health problems. The mean score of GHQ was 22.56±9.24. There were significant relationships between mental health and each age, employment situation, and number of children (p0.05. Conclusion The majority of employed general practitioners in emergency rooms do not have proper mental health statuses.
Never have there been such a vast number of career opportunities for all levels of staff within the perioperative environment including healthcare support workers, operating department practitioners and nurses.
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As access to published materials becomes more readily available, the ability to plagiarise material, deliberately or unwittingly has become easier than ever. This article explores important recent decisions in Australia and the United Kingdom regarding registered health practitioners who have engaged in plagiarism, both related and unrelated to their clinical practice, and explores the ways in which regulatory authorities in these countries have viewed scholarly misconduct committed by registered health professionals. This article also examines the implications of plagiarism for the registered health professions, and makes suggestions for strategies to reduce its influence and incidence in modern clinical practice.
Ghaida M.J. Al-Shoraian
Full Text Available Background: Job burnout is an important syndrome that can deplete the emotional health aspects of physicians. Its impacts are reflected both on the physicians and their patients through undermining the performance of physicians and degrading the quality of the administered medical care leading to dissatisfaction of the patients about the medical service. Objectives: This study is formulated to compare the prevalence of high burnout among family physicians and general practitioners and reveal the predictors of high grades of burnout among physicians. Subjects and methods: A cross sectional study was carried out. Out of 378 physicians working in two health regions in Kuwait, 200 physicians returned a filled questionnaire, of these 105 were family physicians and the rest were primary health care physicians. Maslach Burnout Inventory–Human Service Survey tool was used to estimate high degree of burnout on three domains, namely emotional exhaustion, depersonalization and personal accomplishment. Results: General practitioners were more likely to suffer from high grades of emotional exhaustion (63.2% than family physicians (19.0%. They also suffered from high grade of depersonalization (65.3% compared with family physicians (27.6%. Those suffering from high grades of personal accomplishment burnout (inverse score constituted 61.1% of primary health care physicians and 33.3% of family physicians. Those suffering from grades for the three burnout domain constituted more than one third of primary health care physicians (36.8% compared with only 5.7% of family physicians. Type of physician job and marital status proved to be significant predictors of high grades of burnout. Conclusion: Burnout is more common among primary care than family physicians. Searching for and eliminating all sources of stress in the primary health care centers in addition to training of these physicians on coping strategies to deal with stress at work seems to be an important
Blenstrup, Lene Tølbøll; Knudsen, Lisbeth B.
Introduction: The establishing of three Danish population based registers, namely the Fertility Database, the Register of Legally Induced Abortions and the In Vitro Fertilisation register aimed at providing data for surveying of reproductive outcome. Content: The registers include information...... on births, abortions and assisted reproduction as well as selected characteristics of the women (and men) involved. Validity and Coverage: Both the validity and coverage of each register is considered of high quality. Conclusions: These registers provide, both individually and in combination, unique...
19. SA JOURNAL OF RADIOLOGY • August 2004. Abstract. The progress made in diagnostic and therapeutic medicine has resulted in an increase in the number of malprac- tice suits brought against medical practitioners. To constitute negligence it must be shown that the conduct of the accused did not measure up to the.
O. S. Kobyakova
Full Text Available Within the limits of the regional program «Prevention and treatment of an arterial hypertension for the period of 2004—2008» the electronic register of the patients with hypertensia inTomskRegion has been created.The electronic register is a two-level system where interaction of two kinds of databases is carried out: the first level is the databases of separate medical organization; the second level is the central integrated database.The basic information for the electronic register are documents confirmed by the Health service Ministry of the Russian Federation, that is the coupon of the out-patient patient and a card of dynamic supervision over the patient with hypertensia.All the data about the patients, included in the register are subdivided into unchangeable and changeable ones.The electronic register is an effective control system providing local leading of health service bodies with qualitative and high-grade information in processes of preparation of decision-making and measure taken for prevention and treatment of hypertensia.The electronic register is an effective monitoring system, providing medical authority of important information for taking decisions establishment measures for prevention and treatment of hypertensia.
Kaipa, Sudhakar; Pydi, Siva Kumar; Krishna Kumar, Rathikota Veeravenkata Sathyasai; Srinivasulu, Gomasani; Darsi, Venkata Rajesh Kumar; Sode, Munikumar
This cross-sectional study was designed to measure the level and distribution of job satisfaction of registered dental practitioners and to explore the factors associated with it. The study was conducted among 66 registered dentists in Srikakulam, India. Job satisfaction was measured by using a modified version of the Dentists Satisfaction Survey questionnaire. The statistical tests employed were "t" test and analysis of variance (ANOVA). Post hoc test (Scheffe test) was employed for multiple comparisons. The response rate was 82.5%. The mean score of overall job satisfaction among dentists was 3.08 out of 5. The most satisfying aspect was income (3.7) and the least satisfying aspect was staff (2.5). Overall satisfaction increased with age. Male practitioners showed less satisfaction with staff, income, and overall satisfaction and more satisfaction in professional relations and time, when compared to females. Job satisfaction was found to be more in practitioners with postgraduate qualification. This study suggests that patient relations, perception of income, personal time, and staff are the important factors for job satisfaction among dentists. The findings of this study will be helpful to policymakers to design plans in order to increase the level of job satisfaction.
Rahman, Em; Wills, Jane
This article explores the lessons learned for workforce development from an evaluation of a regional programme to support the assessment and registration of public health practitioners to the UK Public Health Register (UKPHR) in England. A summative and process evaluation of the public health practitioner programme in Wessex was adopted. Data collection was by an online survey of 32 public health practitioners in the Wessex area and semi-structured interviews with 53 practitioners, programme support, employers and system leaders. All survey respondents perceived regulation of the public health workforce as very important or important. Managers and system leaders saw a register of those fit to practise and able to define themselves as a public health practitioner as a necessary assurance of quality for the public. Yet, because registration is voluntary for practitioners, less value was currently placed on this than on completing a master's qualification. The local programme supports practitioners in the compilation of a retrospective portfolio of evidence that demonstrates fitness to practise; practitioners and managers stated that this does not support current and future learning needs or the needs of those working at a senior level. One of the main purposes of statutory regulation of professionals is to protect the public by an assurance of fitness to practise where there is a potential for harm. The widening role for public health practitioners without any regulation means that there is the risk of inappropriate interventions or erroneous advice. Regulators, policy makers and system leaders need to consider how they can support the development of the public health workforce to gain professional recognition at all levels of public health, including practitioners alongside specialists, and support a professional career framework for the public health system. © Royal Society for Public Health 2014.
Burman, Mary E.
Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…
Haargaard, Birgitte; Nyström, Alf; Rosensvärd, Annika
examination with a pencil light at age 5 weeks, whereas newborn red reflex examination using a handheld ophthalmoscope is routine protocol in Swedish maternity wards. Data regarding age of referral were derived from the Pediatric Cataract Register (PECARE). All children operated on before 1 year of age...
Baldwin, R.; English, C.; Lemmen, C.H.J.; Rose, I.; Smith, A.; Solovov, A.; Sullivan, T.
This paper explores the possibility of using local registers to manage and update land rights. Secure land rights are largely taken for granted in the developed world. Yet for many people in developing nations, clear and enforceable land rights are not a reality. In the developed world, land rights
Christensen, Jakob; Vestergaard, Mogens; Olsen, Jørn
PURPOSE: To validate the diagnosis of epilepsy in the Danish National Hospital Register. METHODS: We randomly selected 200 patients registered with epilepsy in the Danish National Hospital Register between 1977 and 2002 and validated the diagnosis according to the guidelines developed...... by the International League Against Epilepsy. RESULTS: We reviewed the medical records of 188 (94%) persons from 57 departments at 41 hospitals. The epilepsy diagnoses were confirmed in 153 patients, providing a positive predictive value for epilepsy of 81% (95% confidence interval (95% CI): 75-87%). Among the 35...... for syndrome classification was 60% (95% CI: 44-74%) for epilepsy with complex focal seizures and 35% (95% CI: 22-51%) for primary generalized epilepsy. CONCLUSION: The validity of the epilepsy diagnoses in the Danish National Hospital Register has a moderate to high positive predictive value for epilepsy...
Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study
Hempler, Nana Folmann; Diderichsen, Finn; Larsen, Finn Breinholt
We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin...
Chadwick, Barbara L; Groves, Gemma; Dransfield, Kathryn
To identify the advice given by piercing parlours prior to orofacial piercing and to determine how many dental practitioners see complications from orofacial piercings. Administered questionnaire to 19 piercing parlours and postal questionnaire to 400 dental practitioners in south-east Wales. Ninety-nine per cent of 227 dental practitioners in south-east Wales had treated patients with orofacial piercings, over three-quarters had seen a patient for a complication caused by the piercing, and over half (N=120) had treated a patient for a complication of piercing. Tongue (N=225) and lip (N=209) piercings were most frequently seen and the most commonly occurring complication was fractured or cracked teeth (N=176). Almost all practitioners wanted more information on orofacial piercing and its sequelae. All 19 piercing parlours in south-east Wales warned clients about pain following piercing and 18 mentioned swelling; only four discussed possible damage to teeth and none discussed the risk of airway obstruction. Despite the concerns of dental and medical professionals orofacial piercing remains popular and the complications it causes are frequently seen by dental practitioners. There is a need for literature to assist both dental practitioners and piercers in advising and safeguarding patients.
Achanta, Shanta; Jaju, Jyoti; Kumar, Ajay M V; Nagaraja, Sharath Burugina; Shamrao, Srinivas Rao Motta; Bandi, Sasidhar Kumar; Kumar, Ashok; Satyanarayana, Srinath; Harries, Anthony David; Nair, Sreenivas Achutan; Dewan, Puneet K
Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC. Cross- sectional survey using semi-structured interviews. Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.
Full Text Available SETTING: Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. OBJECTIVES: To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC, and factors associated with compliance with ISTC. DESIGN: Cross- sectional survey using semi-structured interviews. RESULTS: Of 296 randomly selected private practitioners, 201 (68% were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6% followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14% private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment. Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. CONCLUSION: Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.
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Baker, Jennifer L; Sørensen, Thorkild I A
The Copenhagen School Health Records Register is an electronic register of health examination information on 372,636 children who attended school in Copenhagen, Denmark from 1936 to 2005.......The Copenhagen School Health Records Register is an electronic register of health examination information on 372,636 children who attended school in Copenhagen, Denmark from 1936 to 2005....
Sosnouskaya, Alena; Kotava, Aksana; Ivanov, Victor; Maksutov, Marat
Creation of operation of uniform medical and dosimetric data banks for carrying out of collateral wide-scale radiation epidemiological researches and prediction of medical consequences of Chernobyl accident (ChA) in territory of Russia and Belarus. On the basis of medical and dosimetric data banks of the national registers of Russia and Belarus the uniform technology of collection personal of a state information of health of the population, injured from ChA . Three levels of observation are created. The first level - Bryansk area of Russia and Gomel area of Belarus, interests of research - radiation hazards of oncologic diseases of various localizations for the population living in these territories. The second level - Bryansk, Kaluga, Tula and Oryol area of Russia and Brest, Vitebsk, Gomel, Grodno, Minsk and Mogilyov area of Belarus, preferred direction of researches - thyroid cancer. The third level all territory of Russia and Belarus, area of research - medical consequences for health of the liquidators, their children and persons migrating from polluted territories. Personal uniform sub-registers are created and function on a stationary value to a basis. Is sub-registers containing information about diseases by a thyroid cancer, leukemia and breast cancer, uniform register of the liquidators and their children, uniform cancer-register of the liquidators and uniform cancer-register of the population living in territories with density of contamination on Cs 137 more than 185 kBq/m 2 . The personal information on 20440 cases of thyroid cancer, 5234 cases of a leukemia, 16679 cases of breast cancer, 252884 liquidators, 6882 cases of a cancer of various localizations among the liquidators, 35423 children of the liquidators, 11407 cases of oncologic diseases among the population living in territories with density of contamination on Cs 137 more than 185 kBq/m 2 is accumulated. (author)
Morgenroth, Eberhard Friedrich; van Loosdrecht, M. C. M.; Wanner, O.
Even though mathematical biofilm models are extensively used in biofilm research, there has been very little application of these models in the engineering practice so far. However, practitioners would be interested in models that can be used as tools to control plant operation under dynamic...... conditions or to help them handle complex interactions between particle removal, carbon oxidation, nitrification, denitrification and biological phosphorus removal. But even though there is a whole range of biofilm models available, it is difficult for the practitioner to select the appropriate modeling...
Ian Campbell's paper, originally delivered at a conference on the development of 'The reflective practitioner' while he was Unit General Manager of Sunderland Royal Infirmary, describes the liaison between general and nurse managers in the hospital. Management must give a hospital organisation direction and must set the parameters of corporate and individual performance, but it must also be responsive to the feedback received from practising clinicians. The key concept is quality of service, and in this managers and practitioners can work together towards a common goal.
OBJECTIVE: To describe Danish general practitioners' perception of their own role and to register their actual behaviour in the prevention of HIV/AIDS. DESIGN: Data collection was carried out by a) questionnaire and b) prospective registration of consultations dealing with HIV/AIDS in a two...... (94%) were of the opinion that GPs should play a central part in the prevention of HIV; 96% found that their knowledge was sufficient to advise on the prevention of HIV, and 90% thought that the GP should take the initiative to talk about HIV. The median number of consultations dealing with HIV......-week period in September 1992. SETTING: General practice, Denmark. SUBJECTS: One thousand general practitioners (GPs), selected at random, were asked to participate. The study population comprised 352 GPs who returned the questionnaire and participated in the prospective registration. RESULTS: Most of the GPs...
Carlos Henrique Durão
establishes who the manufacturer was and the serial number can be compared with the clinical process or with a prosthesis register, as has been implemented in several countries. The information in the database should include the patient's name, the implant model and its serial number, for consultation only in cases of forensic identification, while obviously respecting ethical issues of privacy. This article highlights the importance of creating a national prosthesis register.
This Register is intended to serve as a source of information on research which is being conducted in all fields (both natural and human sciences) in the Republic of South Africa. New research projects commenced during 1983 or 1984, and significantly changed research projects, as well as project that were completed or terminated during this period, on which information was received by the compilers before December 1984, are included, with the exception of confidential projects.
A system and method for visualization of subsurface anatomy includes obtaining a first image from a first camera and a second image from a second camera or a second channel of the first camera, where the first and second images contain shared anatomical structures. The second camera and the secon....... A visual interface displays the registered visualization of the first and second images. The system and method are particularly useful for imaging during minimally invasive surgery, such as robotic surgery....
Carducci, A; Cargnelutti, M; Tassinari, F; Bizzarro, A; Cordio, G; Carletti, S; Maccarini, L; Pelissero, G
Non-critical medical devices, as stethoscopes, have long been considered as vectors in microorganisms' transmission. Cleaning standards for non-critical medical equipment are often unclear. This study was designed to assess the attitude of General Practitioners (GPs) towards cleaning their stethoscope and the degree of microbiological contamination of doctor's instrument in outpatient setting. Observational, crossover study. A structured questionnaire was administered to GPs to test their knowledge about medical instrument's cleanliness recommendations and the surface of the diaphragm of their stethoscopes was analyzed for bacteriological isolates using mass spectrometry technique. Most of GPs declared they don't know cleaning recommendations for non-critical medical devices and a relevant bacterial growth was identified on the majority of the stethoscopes' membranes. Almost all microbiological isolates resulted typically found in cutaneous flora. We can't state that the GP's stethoscopes feature a risk of transmission for microbiological pathogens; anyway, because of the level of contamination we observed, cleaning recommendations to disinfect instruments on a regular basis should be better indicated.
Berland, Astrid; Bentsen, Signe Berit
To explore registered nurses' experiences of medication errors and patient safety in home care. The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. An exploratory qualitative design with focus group interviews was used. Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications. © 2017 John Wiley & Sons Ltd.
Bakker, A.B.; Schaufeli, W.B.; Sixma, H.J.; Bosveld, W.
This study used a representative sample of 507 general practitioners (GPs) to test the hypothesis that burnout is contagious. Following a two-dimensional conceptualization of burnout, it is assumed that burnout is comprised of emotional exhaustion and negative attitudes (i.e., depersonalization and
Erin Parks; Andrew Holdnak
Job satisfaction among recreation professionals can be affected by many working conditions. This study has investigated the impact fourteen variables had on the job satisfaction of recreation practitioners. The sample consisted of 106 responses from members of the Resort and Commercial Recreation Association (RCRA). The results of the regression analysis for job...
Wismeijer, A.A.J.; van Assen, M.A.L.M.
Introduction It has been generally thought that the practice of bondage-discipline, dominance-submission, sadism-masochism (BDSM) is in some form associated with psychopathology. However, several more recent studies suggest a relative good psychological health of BDSM practitioners. Aim The aim of
Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders; Kristensen, Troels; Lykkegaard, Jesper; Nexøe, Jørgen; Barwell, Fred; Spurgeon, Peter; Søndergaard, Jens
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: email@example.com.
Ballotari, Paola; Chiatamone Ranieri, Sofia; Vicentini, Massimo; Caroli, Stefania; Gardini, Andrea; Rodolfi, Rossella; Crucco, Roberto; Greci, Marina; Manicardi, Valeria; Giorgi Rossi, Paolo
To describe the methodology used to set up the Reggio Emilia (northern Italy) Diabetes Register. The prevalence estimates on December 31st, 2009 are also provided. The Diabetes Register covers all residents in the Reggio Emilia province. The register was created by deterministic linkage of six routinely collected data sources through a definite algorithm able to ascertain cases and to distinguish type of diabetes and model of care: Hospital Discharge, Drug Dispensation, Biochemistry Laboratory, Disease-specific Exemption, Diabetes Outpatient Clinics, and Mortality databases. Using these data, we estimated crude prevalence on December 31st, 2009 by sex, age groups, and type of diabetes. There were 25,425 ascertained prevalent cases on December 31st, 2009. Drug Dispensation and Exemption databases made the greatest contribution to prevalence. Analyzing overlapping sources, more than 80% of cases were reported by at least two sources. Crude prevalence was 4.8% and 5.9% for the whole population and for people aged 18 years and over, respectively. Males accounted for 53.6%. Type 1 diabetes accounted for 3.8% of cases, while people with Type 2 diabetes were the overriding majority (91.2%), and Diabetes Outpatient Clinics treated 75.4% of people with Type 2 diabetes. The Register is able to quantify the burden of disease, the first step in planning, implementing, and monitoring appropriate interventions. All data sources contributed to completeness and/or accuracy of the Register. Although all cases are identified by deterministic record linkage, manual revision and General Practitioner involvement are still necessary when information is insufficient or conflicting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Frost, Rachael; O'Meara, Susan; MacPherson, Hugh
The survey aimed to assess how often and in what ways herbal practitioners use comfrey (Symphytum officinale L.) externally in everyday practice. A 2-sided A4 survey was sent to all UK members of the National Institute of Medical Herbalists, the College of Practitioners of Phytotherapy and the Association of Master Herbalists with viable practice addresses (n = 598). 239 herbalists responded, of whom 179 (75%) reported regularly using comfrey, in 15% of their consultations. It was most commonly prescribed as a cream for tendon, ligament and muscle problems, for fractures, and for wounds, the indications for which it was also perceived to be most effective. Comfrey was rated least effective for haemorrhoids, varicose veins and boils and was considered to carry the greatest risk when prescribed for ulcers, wounds and boils. Practitioner experience suggests that comfrey can be used safely and effectively externally for certain indications. Copyright © 2014 Elsevier Ltd. All rights reserved.
Oshel, R E; Croft, T; Rodak, J
The National Practitioner Data Bank became operational September 1, 1990, as a flagging system to identify health care practitioners who may have been involved in incidents of medical incompetence. Query volumes have grown substantially over the Data Bank's first 4 years of operation. The greatest increase has come in the number of voluntary queries. By the end of 1994, the Data Bank had processed more than 4.5 million requests for information on practitioners, more than 1.5 million of which were received in 1994 alone. The proportion of queries for which the Data Bank contains information on the practitioner in question has grown as the Data Bank has come to contain more reports. During 1994, 7.9 percent of queries were matched. The Data Bank contained more than 97,500 reports at the end of 1994. More than 82 percent of the reports concerned malpractice payments. Licensure reports made up the bulk of the rest. Physicians predominate in reports, accounting for slightly more than 76 percent of the total. The remainder are related to dentists (16 percent) and all other types of practitioners (8 percent). Since reporting of adverse actions is mandatory only for physicians and dentists, the proportion of reports attributable to these types of practitioners is higher than it would be if adverse action reporting requirements were uniform for all practitioners. State malpractice payment rates and adverse action rates vary widely, but a State's rate in any given year is highly correlated with its rate in any other year. State malpractice rates are not strongly correlated with adverse action rates, neither are the rates for physicians strongly correlated with those for dentists. There is a weak tendency for States with smaller physician populations to have higher levels of licensure and privileging actions.
Boucher, Nathan A; Mcmillen, Marvin A; Gould, James S
Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization's quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts.
Klutz, Diane L
To inform nurse practitioners (NPs) about the issues related to tort reform and its relationship to malpractice insurance costs. Current journals, newspapers, professional newsletters, and Internet sites. NPs are paying more for their malpractice premiums, and many are losing their places of employment as clinics close due to the increased cost of premiums. One method proposed for curbing the flow of monies spent on premiums and litigation is tort law reform. California serves as an example; its Medical Injury Compensation Reform Act (MICRA) tort reform law was passed 25 years ago, and it has maintained stable malpractice premiums. Other states have proposed similar laws, but some have not had similar success. To curb litigation costs, not only should tort laws be reformed, but NPs and physicians should keep abreast of current practice standards in order to provide quality medical care. Like physicians, NPs are affected directly by tort laws. These laws hold NPs accountable at the same level as physicians. In addition, many states limit NPs' practice to delegation of authority by a physician. Liability is therefore transferred from the NP to the physician and vice versa in cases of injury or wrongful act. In addition, many NPs are finding it increasingly difficult to locate insurers who will write policies for medical liability.
Wong, Ides; Wright, Eryn; Santomauro, Damian; How, Raquel; Leary, Christopher; Harris, Meredith
To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models (n = 21 staff), consultation records describing clinical processes and time use (n = 289 consultations), and a patient satisfaction survey (n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. Results suggest that nurse practitioner models can be successfully integrated into a
Holmes, William H
This textbook on statistics is written for students in medicine, epidemiology, and public health. It builds on the important role evidence-based medicine now plays in the clinical practice of physicians, physician assistants and allied health practitioners. By bringing research design and statistics to the fore, this book can integrate these skills into the curricula of professional programs. Students, particularly practitioners-in-training, will learn statistical skills that are required of today’s clinicians. Practice problems at the end of each chapter and downloadable data sets provided by the authors ensure readers get practical experience that they can then apply to their own work. Topics covered include: Functions of Statistics in Clinical Research Common Study Designs Describing Distributions of Categorical and Quantitative Variables Confidence Intervals and Hypothesis Testing Documenting Relationships in Categorical and Quantitative Data Assessing Screening and Diagnostic Tests Comparing Mean...
Recent publications in Dutch national newspapers on palliative sedation have raised concerns about its use in general practice. There is now evidence that there is no significant increase in the incidence of palliative sedation. Euthanasia requests were pending in 20.8% of the cases in which palliative sedation was performed, but the general practitioners could clearly justify why they made this choice. This is important because it indicates that they are aware of a sharp distinction between euthanasia and palliative sedation. Although the decision to perform palliative sedation was discussed with almost all cancer patients, patient involvement was less present in non-cancer conditions. This may be related to different disease trajectories, but it also indicates that attention should be devoted to earlier identification of patients in need of palliative care. The findings confirm that the practice of palliative sedation by general practitioners largely reflects the recommendations of the Dutch National Guideline on Palliative Sedation.
Galina Nielsen, Helena; Sofie Davidsen, Annette; Dalsted, Rikke
AIM: Group supervision is a sparsely researched method for professional development in general practice. The aim of this study was to explore general practitioners' (GPs') experiences of the benefits of group supervision for improving the treatment of mental disorders. METHODS: One long-establish......AIM: Group supervision is a sparsely researched method for professional development in general practice. The aim of this study was to explore general practitioners' (GPs') experiences of the benefits of group supervision for improving the treatment of mental disorders. METHODS: One long...... considered important prerequisites for disclosing and discussing professional problems. CONCLUSION: The results of this study indicate that participation in a supervision group can be beneficial for maintaining and developing GPs' skills in dealing with patients with mental health problems. Group supervision...... influenced other areas of GPs' professional lives as well. However, more studies are needed to assess the impact of supervision groups....
Paixão, Jairo Antônio da; Tucher, Guilherme
As an adventure sport, paragliding exposes participants to different levels of life risk. However, the boundary between calculated risk and real risk is a subtle one, depending on the practitioner’s perception. Thus, this study aimed to analyze risk perception of 73 paragliding practitioners. The descriptive-exploratory study method was used. Data was col-lected via a questionnaire validated according to the Delphi technique. Variables were evaluated from a bipolar Likert type scale, ranging ...
Pressman, Roger S
This indispensable guide to software engineering exploration enables practitioners to navigate the ins and outs of this rapidly changing field. Pressman's fully revised and updated Fourth Edition provides in-depth coverage of every important management and technical topic in software engineering. Moreover, readers will find the inclusion of the hottest developments in the field such as: formal methods and cleanroom software engineering, business process reengineering, and software reengineering.
Baduni, Neha; Prakash, Prem; Srivastava, Dhirendra; Sanwal, Manoj Kumar; Singh, Bijender Pal
It is important that every member of our community should be trained in effective BLS technique to save lives. At least doctors including dental practitioners, and medical and paramedical staff should be trained in high quality CPR, as it is a basic medical skill which can save many lives if implemented timely. Our aim was to study the awareness of Basic Life Support (BLS) among dental students and practitioners in New Delhi. This cross sectional study was conducted by assessing responses to 20 selected questions pertaining to BLS among dental students, resident doctors/tutors, faculty members and private practitioners in New Delhi. All participants were given a printed questionnaire where they had to mention their qualifications and clinical experience, apart from answering 20 questions. Data was collected and evaluated using commercially available statistical package for social sciences (SPSS version 12). One hundred and four responders were included. Sadly, none of our responders had complete knowledge about BLS. The maximum mean score (9.19 ± 1.23) was obtained by dentists with clinical experience between 1-5 years. To ensure better and safer healthcare, it is essential for all dental practitioners to be well versed with BLS.
Kelvin, Joanne Frankel; Moore-Higgs, Giselle Josephine
Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high-quality patient care in radiation oncology. One mechanism is the implementation of nonphysician practitioner roles. The purpose of this paper is to describe the roles and responsibilities of clinical nurse specialists (CNSs), nurse practitioners (NPs), and physician assistants (PAs) currently working in the field of radiation oncology in the United States. Methods and Materials: A nationwide mailing was sent to elicit responses to an 8-page self-report questionnaire. Results: The final sample of 86 included 45 (52%) CNSs, 31 (36%) NPs, and 10 (12%) PAs. Two-thirds worked in private practice settings. Most of the nonphysician practitioners frequently obtained histories (57-90%) and ordered laboratory studies (52-68%). However, NPs and PAs were more likely than CNSs to frequently perform 'medical' services such as perform physical exams (42-80% vs. 19-36%), order radiologic studies (50% vs. 17%), and prescribe medication (60-84% vs. 26%). CNSs were more likely to provide 'supportive' services such as develop educational materials, participate in quality improvement initiatives, and develop policies and procedures. Conclusions: Nonphysician practitioners are not substituting for physicians, but rather are working in collaboration with them, performing designated tasks
Meehan, Elaine M; Reid, Susan M; Williams, Katrina J; Freed, Gary L; Sewell, Jillian R; Reddihough, Dinah S
The aim of the study was to investigate the patterns of medical service use in children with cerebral palsy (CP), taking into account child and family characteristics. Nine hundred and one parents and carers of children registered with the Victorian CP Register were invited to complete a survey. Participants were asked about their child's appointments with general practitioners and public and private paediatric medical specialists over the preceding 12 months. Information on family characteristics and finances was also collected. Data on CP severity and complexity were extracted from the CP Register. Three hundred and fifty parents and carers (39%) participated. Of these, 83% reported that their child had ≥1 appointment with a general practitioner over the preceding 12 months, while 84% had ≥1 appointment with a public or private paediatric medical specialist. Overall, 58% of children saw 2-5 different paediatric medical specialists, while 9% had appointments with ≥6 clinicians. Children with severe and complex CP were more likely to have had ≥1 appointment with a publically funded paediatric medical specialist and had seen a greater number of different clinicians over the study period. Family characteristics were not associated with service use. Children with CP are managed by a number of paediatric medical specialists, and they continue to see a range of specialists throughout adolescence. In Victoria, differences in service use are not based on family characteristics; instead the highest service users are those with severe and complex CP. For this group, care co-ordination and information sharing between treating clinicians are important, if gaps in care are to be avoided. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
Murray, Melanie; Sundin, Deborah; Cope, Vicki
To critically appraise available literature and summarise evidence pertaining to the patient safety knowledge and practices of new graduate registered nurses. Responsibility for patient safety should not be limited to the practice of the bedside nurses, rather the responsibility of all in the healthcare system. Previous research identified lapses in safety across the health care, more specifically with new practitioners. Understanding these gaps and what may be employed to counteract them is vital to ensuring patient safety. A focused review of research literature. The review used key terms and Boolean operators across a 5-year time frame in CINAHL, Medline, psycINFO and Google Scholar for research articles pertaining to the area of enquiry. Eighty-four articles met the inclusion criteria, 39 discarded due to irrelevant material and 45 articles were included in the literature review. This review acknowledges that nursing has different stages of knowledge and practice capabilities. A theory-practice gap for new graduate registered nurses exists, and transition to practice is a key learning period setting new nurses on the path to becoming expert practitioners. Within the literature, there was little to no acknowledgement of patient safety knowledge of the newly registered nurse. Issues raised in the 1970s remain a concern for today's new graduate registered nurses. Research has recognised several factors affecting transition from nursing student to new graduate registered nurse. These factors are leaving new practitioners open to potential errors and risking patient safety. Understanding the knowledge of a new graduate registered nurse upon entering clinical practice may assist in organisations providing appropriate clinical and theoretical support to these nurses during their transition. © 2017 John Wiley & Sons Ltd.
Lovink, Marleen H; van Vught, Anneke J A H; Persoon, Anke; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H
More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The
Ardonne, E.; Schoutens, K.
We present explicit wavefunctions for quasi-hole excitations over a variety of non-abelian quantum Hall states: the Read-Rezayi states with k ≥ 3 clustering properties and a paired spin-singlet quantum Hall state. Quasi-holes over these states constitute a topological quantum register, which can be addressed by braiding quasi-holes. We obtain the braid properties by direct inspection of the quasi-hole wavefunctions. We establish that the braid properties for the paired spin-singlet state are those of 'Fibonacci anyons', and thus suitable for universal quantum computation. Our derivations in this paper rely on explicit computations in the parafermionic conformal field theories that underly these particular quantum Hall states
Lin, Li-Chun; Lee, Sheuan; Ueng, Steve Wen-Neng; Tang, Woung-Ru
The objective of this study was to test the reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale. The role of nurse practitioners has attracted international attention. The advanced nursing role played by nurse practitioners varies with national conditions and medical environments. To date, no suitable measurement tool has been available for assessing the roles and competencies of nurse practitioners in Asian countries. Secondary analysis of data from three studies related to nurse practitioners' role competencies. We analysed data from 563 valid questionnaires completed in three studies to identify the factor structure of the Nurse Practitioners' Roles and Competencies Scale. To this end, we performed exploratory factor analysis using principal component analysis extraction with varimax orthogonal rotation. The internal consistency reliabilities of the overall scale and its subscales were examined using Cronbach's alpha coefficient. The scale had six factors: professionalism, direct care, clinical research, practical guidance, medical assistance, as well as leadership and reform. These factors explained 67·5% of the total variance in nurse practitioners' role competencies. Cronbach's alpha coefficient for the overall scale was 0·98, and those of its subscales ranged from 0·83-0·97. The internal consistency reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale were good. The high internal consistency reliabilities suggest item redundancy, which should be minimised by using item response theory to enhance the applicability of this questionnaire for future academic and clinical studies. The Nurse Practitioners' Roles and Competencies Scale can be used as a tool for assessing the roles and competencies of nurse practitioners in Taiwan. Our findings can also serve as a reference for other Asian countries to develop the nurse practitioner role. © 2015 John Wiley & Sons Ltd.
Ghazeeri, Ghina; Zebian, Dina; Nassar, Anwar H; Harajly, Sally; Abdallah, Alain; Hakimian, Stephanie; Skaiff, Bassem; Abbas, Hussein A; Awwad, Johnny
Fertility preservation (FP) aims to help individuals overcome the infertility associated with cancer treatments such as chemotherapy and radiation. The objective of this study was to assess the awareness, attitudes and knowledge of oncologists' and clinical practitioners' (CPs) about fertility preservation and its options in Lebanon. This was a cross-sectional study with surveys carried out between March 2012 and February 2013 on CPs at the American University of Beirut Medical Centre and Saint Jude's Children Cancer Centre as well as all registered oncologists in Lebanon. Ninety percent of CPs (n = 88) and 94% of oncologists (n = 53) agreed that fertility preservation should be discussed with patient before their cancer treatment. Our data showed a gender bias in relation to patients being informed of their FP options, as well as conflicting knowledge of FP options available in Lebanon among oncologists. The CPs were more likely to have accurate knowledge of FP options and treatment than oncologists. A proactive approach is required to: (1) increase the awareness and knowledge of FP; (2) improve attitudes towards FP; and (3) encourage its communication between CPs, oncologists and patients in Lebanon. Increased education programs, awareness campaigns and development of dedicated FP centres are needed.
Adams, Jon; Steel, Amie; Moore, Craig; Amorin-Woods, Lyndon; Sibbritt, David
The purpose of this paper is to report on the recruitment and promotion strategies employed by the Australian Chiropractic Research Network (ACORN) project aimed at helping recruit a substantial national sample of participants and to describe the features of our practice-based research network (PBRN) design that may provide key insights to others looking to establish a similar network or draw on the ACORN project to conduct sub-studies. The ACORN project followed a multifaceted recruitment and promotion strategy drawing on distinct branding, a practitioner-focused promotion campaign, and a strategically designed questionnaire and distribution/recruitment approach to attract sufficient participation from the ranks of registered chiropractors across Australia. From the 4684 chiropractors registered at the time of recruitment, the project achieved a database response rate of 36% (n = 1680), resulting in a large, nationally representative sample across age, gender, and location. This sample constitutes the largest proportional coverage of participants from any voluntary national PBRN across any single health care profession. It does appear that a number of key promotional and recruitment features of the ACORN project may have helped establish the high response rate for the PBRN, which constitutes an important sustainable resource for future national and international efforts to grow the chiropractic evidence base and research capacity. Further rigorous enquiry is needed to help evaluate the direct contribution of specific promotional and recruitment strategies in attaining high response rates from practitioner populations who may be invited to participate in future PBRNs. Copyright © 2016. Published by Elsevier Inc.
Abeed Sarker; Diego Molla; Cecile Paris
Background Evidence Based Medicine (EBM) practice requires practitioners to extract evidence from published medical research when answering clinical queries. Due to the time-consuming nature of this practice, there is a strong motivation for systems that can automatically summarise medical documents and help practitioners find relevant information. Aim The aim of this work is to propose an automatic query-focused, extractive summarisation approach that selects informative sentences from medic...
Examining the Learning Requirements of General Practitioner Courses in the Areas of Cognitive, Psychological-Motor and Emotion from the Perspective of Professors of Kurdistan University of Medical Sciences
Full Text Available Introduction: It is necessary to analyze the limitations and essentials of the medical students’ learning compatible with their future working environment in order to control the quality of the education. This study was designed to investigate the basics of learning and to prepare educational logbooks for all clinical departments at Kurdistan University of Medical Sciences in line with promotion of educational and students’ assessment. Methods: This study was carried out in three phases. In the first phase, content was confirmed according to the expert views. In the second phase, materials were analyzed in terms of being core and non-core. In the third phase, prioritized subjects were summarized and locations selected for teaching each skill, rotation style, regulations and responsibilities of the students, assessment method and group’s expectations from students were determined. The data were analyzed by analytic hierarchy process (AHP, comparison of the content of materials and qualitative methods.Results: All the faculty members considered capabilities such as taking the patient’s history, physical examination, diagnostic decision, patient’s referral skills, and appropriate relationship with patient and colleagues as the priorities of education. In addition, 93% of the faculty members added the interpretation of laboratory tests to the given list. Conclusion: In this model, the main focus was on the content and process of education. It seems necessary, however, to pay attention to other issues like student’s motivational and research factors during designing the parallel patterns.
Morris, Stephen; Goudie, Rosalind; Sutton, Matt; Gravelle, Hugh; Elliott, Robert; Hole, Arne Risa; Ma, Ada; Sibbald, Bonnie; Skåtun, Diane
We analyse the determinants of annual net income and wages (net income/hours) of general practitioners (GPs) using data for 2271 GPs in England recorded during Autumn 2008. The average GP had an annual net income of £97,500 and worked 43 h per week. The mean wage was £51 per h. Net income and wages depended on gender, experience, list size, partnership size, whether or not the GP worked in a dispensing practice, whether they were salaried of self-employed, whether they worked in a practice with a nationally or locally negotiated contract, and the characteristics of the local population (proportion from ethnic minorities, rurality, and income deprivation). The findings have implications for pay discrimination by GP gender and ethnicity, GP preferences for partnership size, incentives for competition for patients, and compensating differentials for local population characteristics. They also shed light on the attractiveness to GPs in England of locally negotiated (personal medical services) versus nationally negotiated (general medical services) contracts.
Armour, A.; Bharucha, H.
We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 w...
Gamble, Clair; Ion, Robin
Concerns have been raised in recent years about standards of care in the UK. Notable failures have been identified in the care of vulnerable older adults. This article identifies and discusses some logical steps which might be taken to minimise the risk of individual and systemic care failure in settings for older adults. These steps include frank discussion about ageism to promote empowerment and respect for older people; ensuring robust policies are in place that support and encourage the reporting of poor care; and ensuring that registered practitioners are aware of their accountability for their actions and also their omissions should they witness poor care. In addition to reducing the risk of poor care, these steps could contribute to having a more confident, competent and empowered workforce.
Canhão, H; Faustino, A; Martins, F; Fonseca, J E
Since June 2008, Portuguese rheumatologists have been collecting on a routine basis, data into the nationwide Reuma.pt, the Rheumatic Diseases Portuguese Register from the Portuguese Society of Rheumatology (SPR), which includes rheumatic patients (rheumatoid arthritis - RA, ankylosing spondylitis - AS, psoriatic arthritis - PsA and juvenile idiopathic arthritis - JIA) receiving biological therapies or patients receiving synthetic disease modifying anti-rheumatic drugs (DMARDs). The aim of this publication is to describe the structure of Reuma.pt and the population registered since June 2008. Demographic and anthropometric data, life style habits, work status, co-morbidities, disease activity and functional assessment scores, previous and current therapies, adverse events codified by the Medical Dictionary for Regulatory Activities (MedDRA), reasons for discontinuation and laboratory measurements are registered at each visit. The platform is based on a structured electronic medical record linked to a SQL Server database. All Rheumatology Departments assigned to the Portuguese National Health Service (n=21), 2 Military Hospitals (Lisboa and Porto), 1 public-private Institution and 6 private centers adhered to the Register. Until now, 18 centers have entered data into Reuma.pt. By January 2011, 3438 patients and 16130 visits had been registered. 2162 (63%) were RA patients, 700 of them treated with biological agents and 1462 with synthetic DMARDs. From the 515 (15%) AS patients, 297 were medicated with biological and 218 with non-biological therapies. 293 (8%) were PsA patients, 151 treated with biological drugs and 142 with other treatment strategies. 368 (11%) had the diagnosis of JIA, 68 were under biological treatment and 300 were managed with other treatment options. The register also includes 100 (3%) patients with other rheumatic diseases, submitted to treatments that required hospital day care infusions including 18 exposed to biological therapies. Registers
Since 1974 a number of organisations have been working closely together in this pollutant register (PRTR) project to collect and formally establish the yearly releases of pollutants to air, water and soil in the Netherlands. Results of this project serve to underpin the national environmental policy. Data is in this way also provided for the many environmental reports to international organisations such as the European Union and the United Nations, e.g. the National Inventory Report for the Kyoto Protocol. This website shows the yearly releases (emissions) of the most important pollutants in the Netherlands. You can explore the emission data through various channels, such as maps, graphs and tables. But you can also download all the details into your own database. The data shown in this website is updated 2 to 3 times a year. The current release shows emissions for 1990, 1995, 2000, 2004, 2005 and 2006 The 2006 emissions are preliminary data and not yet shown in the maps. We expect to add an extra year in August 2008 [nl
Grant, Aileen; Ure, Jenny; Nicolson, Donald J; Hanley, Janet; Sheikh, Aziz; McKinstry, Brian; Sullivan, Frank
Difficulties with recruitment pose a major, increasingly recognised challenge to the viability of research. We sought to explore whether a register of volunteers interested in research participation, with data linkage to electronic health records to identify suitable research participants, would prove acceptable to healthcare staff, patients and researchers. We undertook a qualitative study in which a maximum variation sampling approach was adopted. Focus groups and interviews were conducted with patients, general practitioners (GP), practice managers and health service researchers in two Scottish health boards. Analysis was primarily thematic to identify a range of issues and concerns for all stakeholder groups. The concept of a national research register was, in general, acceptable to all stakeholder groups and was widely regarded as beneficial for research and for society. Patients, however, highlighted a number of conditions which should be met in the design of a register to expedite confidence and facilitate recruitment. They also gave their perceptions on how a register should operate and be promoted, favouring a range of media. GPs and practice managers were primarily concerned with the security and confidentiality of patient data and the impact a register may have on their workload. Researchers were supportive of the initiative seeing advantages in more rapid access to a wider pool of patients. They did raise concerns that GPs may be able to block access to personal patient data held in general practice clinical systems and that the register may not be representative of the whole population. This work suggests that patients, healthcare staff and researchers have a favourable view of the potential benefits of a national register to identify people who are potentially eligible and willing to participate in health related research. It has highlighted a number of issues for the developers to incorporate in the design of research registers.
LaMarche, Kimberley; Tullai-McGuinness, Susan
To examine the level of job satisfaction and its association with extrinsic and intrinsic job satisfaction characteristics among Canadian primary healthcare nurse practitioners (NPs). A descriptive correlational design was used to collect data on NPs' job satisfaction and on the factors that influence their job satisfaction. A convenience sample of licensed Canadian NPs was recruited from established provincial associations and special-interest groups. Data about job satisfaction were collected using two valid and reliable instruments, the Misener Nurse Practitioner Job Satisfaction Survey and the Minnesota Satisfaction Questionnaire. Descriptive statistics, Pearson correlation and regression analysis were used to describe the results. The overall job satisfaction for this sample ranged from satisfied to highly satisfied. The elements that had the most influence on overall job satisfaction were the extrinsic category of partnership/collegiality and the intrinsic category of challenge/autonomy. These findings were consistent with Herzberg's Dual Factor Theory of Job Satisfaction. The outcomes of this study will serve as a foundation for designing effective human health resource retention and recruitment strategies that will assist in enhancing the implementation and the successful preservation of the NP's role.
Fixsen, Alison; Ridge, Damien
Few researchers have explored the clinical experiences of complementary and alternative medical practitioners and students, including the emotion work they perform. In this article, using a constant comparison approach and a heuristic framework (a dramaturgical perspective), we analyze semistructured interviews with 9 undergraduate practitioners in training to examine challenges experienced when students first attend to patients. A feature of students' learning about clinical work concerned performance in a public arena and associated demands placed on the inchoate practitioner. Preliminary patient consultations represented a dramatic rite of passage and initiation into a transitional phase in professional identity. Juggling the roles of student and practitioner within an observed consultation led to anticipatory anxiety, impression management strategies, and conflict with other individuals. Of the coping strategies, participants regarded sharing and feedback from peer groups as most effective in examining and resolving the challenges of becoming a practitioner.
Full Text Available Abstract Background Electronic clinical decision support (CDS is increasingly establishing its role in evidence-based clinical practice. Considerable evidence supports its enhancement of efficiency in e-Prescribing, but some controversy remains. This study evaluated the practicality and identified the perceived benefits of, and barriers to, its future adoption in the West of Ireland. Methods This cross sectional study was carried out by means of a 27-part questionnaire sent to 262 registered general practitioners in Counties Galway, Mayo and Roscommon. The survey domains encompassed general information of individual's practice, current use of CDS and the practitioner's attitudes towards adoption of CDS-eP. Descriptive and inferential analyses were performed to analyse the data collected. Results The overall response rate was 37%. Nearly 92% of respondents employed electronic medical records in their practice. The majority acknowledged the value of electronic CDS in improving prescribing quality (71% and reducing prescribing errors (84%. Despite a high degree of unfamiliarity (73%, the practitioners were open to the use of CDS-eP (94% and willing to invest greater resources for its implementation (62%. Lack of a strategic implementation plan (78% is the main perceived barrier to the incorporation of CDS-eP into clinical practice, followed by i lack of financial incentives (70%, ii lack of standardized product software (61%, iii high sensitivity of drug-drug interaction or medication allergy markers (46%, iv concern about overriding physicians' prescribing decisions(44% and v lack of convincing evidence on the systems' effectiveness (22%. Conclusions Despite favourable attitudes towards the adoption of CDS-eP, multiple perceived barriers impede its incorporation into clinical practice. These merit further exploration, taking into consideration the structure of the Irish primary health care system, before CDS-eP can be recommended for routine
Taylor, Anita; Staruchowicz, Lynda
informed by the experiences of the United States and United Kingdom and for the most part there exists a parallel between the international experience and the Australian experience of nurse practitioners.This review will focus on orthopaedic nurse practitioners in an international context. However the local context of the primary reviewer which informs this review is Australian. Australia has mirrored the trends around nurse practitioner practice found elsewhere. In the last 20 years (post implementation of the 1986 Australian nursing career structure), the debate around advanced nursing practice and nurse practitioners, in an Australian context, has developed. The inaugural 'legal & policy' nurse practitioner framework was developed in New South Wales (NSW) in 1998, with the first Australian nurse practitioner authorised to practise in NSW in 2000. It is posited that evaluation of emerging roles began to be seen in the research literature from 1990 onwards. In response to a need for creative workforce re-engineering and against a context of limited health resources, nurse practitioners in Australia over the last 20 years have emerged as an alternative model of health care delivery. For the last 10 years there has been a proliferation of influential 'reports' written by nurse researchers, generated to review the progress of Australia's nurse practitioners, commissioned by the health departments of respective state governments and other service planners to guide health workforce planning.In a national context the Australian Nursing & Midwifery Council (ANMC) as the peak national nursing body, defines a nurse practitioner as a Registered Nurse (RN) who is educated and authorised to practice autonomously and collaboratively in an advanced and extended clinical role. The ANMC Competency Standards for the Nurse Practitioner encompass three generic standards which are further defined by nine competencies. The competency standards provide a framework for practice and licensure of
Koch-Henriksen, N; Magyari, M; Laursen, B
between a number of different environmental exposures in the past and the subsequent risk of MS. Some of these studies have been able to exonerate suspected risk factors. The other register, the nationwide Danish Multiple Sclerosis Treatment Register, is a follow-up register for all patients who have......There are two nationwide population-based registers for multiple sclerosis (MS) in Denmark. The oldest register is The Danish Multiple Sclerosis Registry (DMSR), which is an epidemiological register for estimation of prevalence and incidence of MS and survival, and for identifying exposures earlier...... received disease-modifying treatments since 1996. It has, in particular, contributed to the knowledge of the role of antibodies against the biological drugs used for the treatment of MS....
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Topp, Monica; Langhoff-Roos, Jens; Uldall, P.
OBJECTIVES: To analyse completeness and validity of data in the Cerebral Palsy Register in Denmark, 1979-1982. METHODS: Completeness has been assessed by comparing data from The Danish National Patient Register (DNPR) with the cases included in the Cerebral Palsy Register (CPR). Agreement between......, but gestational age was subject to a systematic error, and urinary infections in pregnancy (kappa = 0.43) and placental abruption (kappa = 0.52) were seriously under-reported in the CPR. CONCLUSIONS: Completeness of the Cerebral Palsy Register in Denmark, 1979-1982, has been assessed to maximal 85%, emphasizing...
Kruse, Marie; Christiansen, Terkel
Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided...... into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders...
Bolter, R.; Freund, T.; Ledig, T.; Boll, B.; Szecsenyi, J.; Roos, M.
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
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879 1 HELVOET PHARMA INC. PENNSAUKEN NJ 461096 $80 1 FASLOK MILLS INC MURRAT HILL NJ 439625 619 1 HERCULES INC 3 FASRITE LAMINATING CORP WOOD RIDGE...317252 628 HARRIS CORPORATION 1 GENERAL ELECTRIC COMPANY 3 PRO ELECTRONICS DIV WESTBURY NT A 799145 678 CHEMICA . & MEDICAL DIV HASSALL JOHN INC...ELECTRONim CS Ca, IMC V SAYVILLE Ut A 56730 1 sit PARAMaOUNT nACacmnil cO INC DER PARK my 113336 ITS L&UNAMM MFG CORP ROliKONKOMA MY A 58047S I PTO# INC1
This position paper addresses an important question for the discipline of Empirical or Evidence-based Software Engineering (SE), namely ´what information do software engineering practitioners need from the empirical studies´. The paper contributes to answering this question by presenting survey results on two sub-questions: 1) what are the topics that interest practitioners? and 2) what type of information is needed by practitioners? Answering the first question results in a set of SE topics,...
Robotham, Antony John
designers must have more physical contact with engineering products, learn about product quality and how it is achieved, and develop a quality mind-set. They should be challenged to create novel and innovative solutions. Industrial designers require a formal awareness and knowledge of performance qualities...... the design research community needs to face.The paper argues that Design for Quality provides a robust framework, which can be used by the industrial, research, and educational communities as a platform for improving the skills and capability of the practitioners of Design for Quality.If engineering...... and the DFQ framework.Design Research needs to provide deeper insight in to the soft aspects of quality and DFQ, e.g. understanding the quality mind-set and how it is developed, understanding the perception of quality and its relationships to the product characteristics, and what mix of skills and knowledge...
Full Text Available The South African education and training system, through its policy of outcomesbased education and training, has made competency a national priority. In compliance to this national requirement of producing competent learners, the South African Nursing Council ( 1999 B require that the beginner professional nurse practitioners and midwives have the necessary knowledge, skills, attitudes and values which will enable them to render efficient professional service. The health care system also demands competent nurse practitioners to ensure quality in health care. In the light of competency being a national priority and a statutory demand, the research question that emerges is, how competent are the newly qualified registered nurses from a specific nursing college in clinical nursing education? A quantitative, non-experimental contextual design was used to evaluate the competence of newly qualified registered nurses from a specific nursing college. The study was conducted in two phases. The first phase dealt with the development of an instrument together with its manual through the conceptualisation process. The second phase focused on the evaluation of the competency of newly qualified nurses using the instrument based on the steps of the nursing process. A pilot study was conducted to test the feasibility of the items of the instrument. During the evaluation phase, a sample of twenty-six newly qualified nurses was selected by simple random sampling from a target population of thirty-six newly qualified registered nurses. However, six participants withdrew from the study. Data was collected in two general hospitals where the newly qualified registered nurses were working. Observation and questioning were used as data collection techniques in accordance with the developed instrument. Measures were taken to ensure internal validity and reliability of the results. To protect the rights of the participants, the researcher adhered to DENOSA’S (1998
Mohamed-Kaloo, Z; Laher, S
BACKGROUND: Mental health literacy on the part of medical practitioners is an important component of mental healthcare. General practitioners (GPs) are typically the first doctors consulted by a person who is ill. Exploration of their perceptions regarding mental illness, aetiological issues and treatment is important. OBJECTIVE: To investigate perceptions of mental illness in a sample of 10 South African Muslim GPs (five male, five female) in the Lenasia area (Johannesburg, South Africa). ME...
Full Text Available Background: The period of transition from registered nurse to nurse practitioner is often challenging. While adjusting to their autonomous role, nurse practitioners need to create and define a distinct role for themselves within practice contexts that may be unfamiliar, sometimes unwelcoming and inhospitable. During this time of transition, nurses need well developed negotiation skills and personal attributes including resilience, tenacity, fortitude and determination. Purpose of the research: The purpose of the research reported in this paper was to explore the transition experiences of 10 newly endorsed nurse practitioners in Australia during their first year of practice. This paper focuses on power, control and political manoeuvring that negatively impacted the ×³nurse practitioners×³ transition. A qualitative approach using a modified version of Carspecken×³s five stage critical ethnography, informed by focused ethnography, was the methodology selected for this study. Methods included observations of practice, journaling, face to face and phone interviews which were recorded, transcribed and analysed thematically. Results: âThe enemy withinâ emerged as a dominant theme highlighting issues of power, powerlessness and politics dominating the participant×³s experiences. Power struggles amongst nurses, both overt and covert, and the deliberate misuse of power were frequently encountered. Many of the participants felt powerless and ill-prepared to negotiate the challenging situations in which they found themselves. Many lacked the skills needed to address the negative behaviours they experienced. Conclusions: This paper reports on the experiences of 10 newly endorsed nurse practitioners during their transition to the nurse practitioner role. The impact of the political climate at the time of this study had an undeniable influence on many of the participants×³ transition experiences. Competition for the limited numbers of
Nov 1, 2013 ... Instead, the study proposed the concept of medical information therapy – an .... practitioner's obligations, patient autonomy and self-determination ..... Handbook – Guidelines for Good and Ethical Practice in Medicine,.
Diaz, Esperanza; Mbanya, Vivian N; Gele, Abdi A; Kumar, Bernadette
Immigrants' utilization of primary health care (PHC) services differs from that of the host populations. However, immigrants are often classified in broad groups by continent of origin, and the heterogeneity within the same continent may hide variation in use among immigrant groups at a national level. Differences in utilization of PHC between sub-Saharan African immigrants have not received much attention. Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration. African immigrants and their descendants registered in Norway in 2008 (36,366 persons) where included in this study. Using χ 2 test and logistic regression models, we assessed the differences in the use of PHC, including general practitioner (GP) and emergency room (ER) services, and the distribution of morbidity burden for immigrants from Somalia, Ethiopia, Eritrea, and Gambia. For the analyses, we used the number of visits and medical diagnoses from each consultation registered by the physician. Among the total studied population, 66.1% visited PHC within 1 year. The diagnoses registered were similar for all four immigrants groups, regardless of country of origin. Compared to immigrants from Somalia, the age and sex adjusted odds ratios (OR) for use of GP were significantly lower for Ethiopians (OR 0.91; 0.86-0.97), Eritreans (OR 0.85; 0.79-0.91), and Gambians (OR 0.88; 0.80-0.97). Similarly, we also observed lower use of ER among Ethiopians (OR 0.88; 0.81-0.95), Eritreans (OR 0.56; 0.51-0.62) and Gambians (OR 0.81; 0.71-0.92). However, immigrants from Somalia reduced their use of PHC with longer duration of stay in Norway. Differences between groups persisted after further adjustment for employment status. Despite the similarities in diagnoses among the sub-Saharan African immigrant groups in Norway, their use of PHC services differs by country of origin and length of stay. It is important to assess the reasons for the differences
Grimholt, Tine K; Haavet, Ole R; Jacobsen, Dag; Sandvik, Leiv; Ekeberg, Oivind
Background Competence and attitudes to suicidal behaviour among physicians are important to provide high-quality care for a large patient group. The aim was to study different physicians’ attitudes towards suicidal behaviour and their perceived competence to care for suicidal patients. Methods A random selection (n = 750) of all registered General Practitioners, Psychiatrists and Internists in Norway ...
Søndergaard, Grethe; Biering-Sørensen, Sofie; Michelsen, Susan Ishøy
Objective. To examine demographic and socioeconomic characteristics of parents and children in families not participating in preventive child health examinations at the general practitioner in a society with free and easy access to healthcare. Design. Population-covering register linkage study...... free and easy access to the GP, the utilization of preventive child health examinations is lower among the more deprived part of the population....
Frutos-Llanes, R; Jiménez-Blanco, S; Blanco-Montagut, L E
To determine the level of burnout in general practitioners of Avila and the influence of social, occupational and health factors. A descriptive cross-sectional epidemiological study was conducted and aimed at all Primary Care medical staff of Avila during the first half of 2011, using two questionnaires: the Maslach Burnout Inventory and other sociodemographic, health and occupational variables. A response rate of 51.8% was obtained. The mean age was 48.55±8.16, and 52% were male, 77% married, 45% with tenure, 78% worked in rural centres, and, 82% performed out of hours home visits plus clinics. The prevalence of severe burn out was low (16%) in our study was low. A high prevalence (68%) of moderate/severe level of the condition was found. Being married (P=.012), do not guards (P<.0001), working in rural areas (P=.008), and to be an area doctor (p=.03), predisposes to suffer burnout in severe or moderate/severe burnout. A moderate level of burnout was found. Contrary to what many doctors thought, the prevalence of the condition in its severe form was low, but was high when taking the severe and moderate/severe forms together. Therefore, measures should be extended to reduce occupational stress of doctors, in order to improve working practices and professional efficiency. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
Roope, Richard; Parker, Gordon; Turner, Susan
At present, sickness certification is largely undertaken by general practitioners (GPs). Guidance from the Department of Work and Pensions (DWP) is available to help with this task; however, there has been little formal evaluation of the DWP's guidance in relation to day-to-day general practice. To assess GPs' training, knowledge and application of the DWP's sickness certification guidelines. A structured questionnaire was sent to GPs within a (former) primary care trust (PCT). It probed demographics, training and knowledge of sickness certification guidelines. Case histories and structured questions were used to assess current practice. In this group of 113 GPs, there was a low awareness and use of the DWP's guidelines and Website relating to sickness certification. The majority of the GPs (63%) had received no training in sickness certification, and the mean length of time for those who had received training was 4.1 h. Most GPs also felt that patients and GPs have equal influence on the duration of sickness certification. This evidence of variable practice indicates that GPs should have more guidance and education in sickness certification. Closer sickness certification monitoring through existing GP computer systems may facilitate an improvement in practice that benefits patients and employers. The DWP, medical educators and PCTs may all have an additional role in further improving sickness certification practice.
Pop, Rodica S
Nursing philosophy is the foundation of nurse practitioner (NP) training. However, NP practice is based on the medical care model. Thus, the necessity of mediating between these two approaches is often problematic for new NPs who are transitioning into their new roles. Mentoring has been used successfully to facilitate role transition and role understanding for nurses, NPs, and physicians. However, mentoring has been rarely studied in NPs. The purpose of this study was to develop a theory of mentoring for new NPs in a hospital setting. Grounded theory methodology was used. The sampling approach was initially purposive and was then shifted to theoretical to ensure the collection of meaningful data. Semistructuredinterviews were recorded and transcribed into Word documents for analysis. The three-phase analysis developed by Corbin and Strauss was initiated after the second interview. Sixteen participants (eight mentors and eight mentees) were interviewed between February and June 2011. The core category that emerged from the data was "defining self," and the main categories were forming the relationship, developing the relationship, and mentoring outcomes. A well-designed formal mentoring program may greatly improve the transition of NPs into a new role. The theory generated by the data from these study participants provides clearly defined categories that may be operationally defined and utilized to develop evaluation tools for mentoring programs.
Messmer, P R; Parchment, Y
Mary Grant Seacole was born in 1805, in Kingston, Jamaica, to a Jamaican doctress (medicine woman) and a Scottish naval officer. Later Seacole became a doctress, nursing British soldiers during epidemics of cholera, dysentery, and yellow fever in Jamaica, Cuba, and Panama. After refusals by both the British government and Florence Nightingale to be allowed to practice in Scutari, she financed her own way to the scene of the Crimean War and then established the British Hotel to serve both the comfort and medical needs of the wounded soldiers. At night, Seacole worked side by side with Nightingale at Scutari as a volunteer nurse. Seacole's fame grew proportionately after she was seen helping wounded soldiers on the battlefields even while the battles were still raging. Seacole died on May 14, 1881, in London. One hundred years later, many members of the London black community, a few members of the Nurses Association of Jamaica and the Friends of Mary Seacole marched to her grave, honoring her as one of the greatest women of all times. Mary Grant Seacole rose above the barriers of racial prejudice and demonstrated the determinism, compassion, and caring that have became the hallmark of nurse practitioners.
Unique clinical challenges arise with the growing number of patients who possess medical marijuana cards. Medical marijuana patients with mental disorders can have worsening symptoms with marijuana use. Often there is sparse continuity of care between the patient and the medical marijuana practitioner. Lack of communication between the patient's treating practitioners and the practitioner who has authorized the medical marijuana can be problematic. This article is a discussion of the new clinical challenges practitioners are likely to encounter with the growing number of medical marijuana patients. [Full article available at http://rimed.org/rimedicaljournal-2018-02.asp].
... in order to determine the most common routes of administration and type of dosage forms that are used. Registered pharmaceutical products were categorized by route of administration and then sub-categorized by the dosage form. Oral dosage forms were the most common accounting for 73% of all registered products.
Wagstaff, C R D; Gilmore, S; Thelwell, R C
Despite the emergence of and widespread uptake of a growing range of medical and scientific professions in elite sport, such environs present a volatile professional domain characterized by change and unprecedentedly high turnover of personnel. This study explored sport medicine and science practitioners' experiences of organizational change using a longitudinal design over a 2-year period. Specifically, data were collected in three temporally defined phases via 49 semi-structured interviews with 20 sport medics and scientists employed by three organizations competing in the top tiers of English football and cricket. The findings indicated that change occurred over four distinct stages; anticipation and uncertainty, upheaval and realization, integration and experimentation, normalization and learning. Moreover, these data highlight salient emotional, behavioral, and attitudinal experiences of medics and scientists, the existence of poor employment practices, and direct and indirect implications for on-field performance following organizational change. The findings are discussed in line with advances to extant change theory and applied implications for prospective sport medics and scientists, sport organizations, and professional bodies responsible for the training and development of neophyte practitioners. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Cheng, Kevin Y.; Roberts, David A.
Systems, apparatuses, and methods for moving the interconnect protocol configuration registers into the main memory space of a node. The region of memory used for storing the interconnect protocol configuration registers may also be made cacheable to reduce the latency of accesses to the interconnect protocol configuration registers. Interconnect protocol configuration registers which are used during a startup routine may be prefetched into the host's cache to make the startup routine more efficient. The interconnect protocol configuration registers for various interconnect protocols may include one or more of device capability tables, memory-side statistics (e.g., to support two-level memory data mapping decisions), advanced memory and interconnect features such as repair resources and routing tables, prefetching hints, error correcting code (ECC) bits, lists of device capabilities, set and store base address, capability, device ID, status, configuration, capabilities, and other settings.
The aim is to study Registered Nurses' opinions and reflections about their work tasks, competence and organization in acute hospital care. The definition of the role of nurses has changed over time and it is often discussed whether Registered Nurses have a professional status or not. A qualitative research design was used. Data were derived from written reflections on diaries and from focus group interviews. All respondents had difficulties in identifying the essence of their work. It can be argued that being 'a spider in the web' is an important aspect of the nursing profession. Registered Nurses tend to regard their professional role as vague. Managers must be considered key persons in defining the professional role of Registered Nurses. This study contributes to an understanding of the managers' and the importance of nursing education in Registered Nurses professional development.
Cheng, Kevin Y.; Roberts, David A.
Systems, apparatuses, and methods for moving the interconnect protocol configuration registers into the main memory space of a node. The region of memory used for storing the interconnect protocol configuration registers may also be made cacheable to reduce the latency of accesses to the interconnect protocol configuration registers. Interconnect protocol configuration registers which are used during a startup routine may be prefetched into the host's cache to make the startup routine more efficient. The interconnect protocol configuration registers for various interconnect protocols may include one or more of device capability tables, memory-side statistics (e.g., to support two-level memory data mapping decisions), advanced memory and interconnect features such as repair resources and routing tables, prefetching hints, error correcting code (ECC) bits, lists of device capabilities, set and store base address, capability, device ID, status, configuration, capabilities, and other settings.
Background: The knowledge of medical ethics is essential for health care practitioners worldwide. The main objective of this study was to evaluate the knowledge of medical doctors in a tertiary care hospital in Nigeria in the area of medical ethics. Materials and Methods: A cross– sectional questionnaire‑based study ...
Drenth-van Maanen, A. Clara; van Marum, Rob J.; Knol, Wilma; van der Linden, Carolien M. J.; Jansen, Paul A. F.
Background: Optimizing polypharmacy is often difficult, and critical appraisal of medication use often leads to one or more changes. We developed the Prescribing Optimization Method (POM) to assist physicians, especially general practitioners (GPs), in their attempts to optimize polypharmacy in
Nichols, Sue; Cormack, Phil
How does practitioner inquiry impact education? Examining the experiences of practitioners who have participated in inquiry projects, the authors present ways in which this work has enabled educators to be positive change agents. They reveal the difference that practitioner inquiry has made in their professional practice, their understanding of…
Persson, Emil; Mattsson, Joel
The debug register rootkit is a special type of rootkit that has existed for over a decade, and is told to be undetectable by any scanning tools. It exploits the debug registers in Intel’s IA-32 processor architecture. This paper investigates the debug register rootkit to find out why it is considered a threat, and which malware removal tools have implemented detection algorithms against this threat. By implementing and running a debug register rootkit against the most popular Linux tools, ne...
Havelin, Leif I; Robertsson, Otto; Fenstad, Anne M
The Nordic (Scandinavian) countries have had working arthroplasty registers for several years. However, the small numbers of inhabitants and the conformity within each country with respect to preferred prosthesis brands and techniques have limited register research.......The Nordic (Scandinavian) countries have had working arthroplasty registers for several years. However, the small numbers of inhabitants and the conformity within each country with respect to preferred prosthesis brands and techniques have limited register research....
Jugenheimer, Donald W.
A questionnaire survey of 300 advertising practitioners was used to determine the degree of job and career satisfaction among advertising practitioners. The subjects were separated according to whether they worked for advertising agencies, advertisers, or advertising media; 100 subjects in each area were selected from the prestigious directories…
Cox, Rebecca D.
Practitioner-researchers are well-positioned to apply qualitative methods to the study of significant problems of educational practice. However, while learning the skills of qualitative inquiry, practitioners may be compelled by forces outside of qualitative research classrooms to think quantitatively. In this article, the author considers two…
Moyo, Mpatisi; Goodyear-Smith, Felicity A.; Weller, Jennifer; Robb, Gillian; Shulruf, Boaz
Personal and professional values of healthcare practitioners influence their clinical decisions. Understanding these values for individuals and across healthcare professions can help improve patient-centred decision-making by individual practitioners and interprofessional teams, respectively. We aimed to identify these values and integrate them…
Neff, Bonita Dostal; Walker, Gael; Smith, Michael F.; Creedon, Pam J.
Uses data from the national survey described elsewhere in this issue to develop profiles of the desired characteristics of entry-level and advanced-level practitioners, and for educators teaching public relations in undergraduate and graduate programs. Finds unexpectedly strong agreement between educators and practitioners regarding these issues,…
Wong, Cecilia H.M.; Ho, Wing-chung
The effectiveness of social impact assessment (SIA) hinges largely on the capabilities and ethics of the practitioners, yet few studies have dedicated to discuss the expectations for these professionals. Recognising this knowledge gap, we employed the systemic review approach to construct a framework of roles of SIA practitioners from literature. Our conceptual framework encompasses eleven roles, namely project manager of SIA, practitioner of SIA methodologies, social researcher, social strategy developer, social impact management consultant, community developer, visionary, public involvement specialist, coordinator, SIA researcher, and educator. Although these roles have been stratified into three overarching categories, the project, community and SIA development, they are indeed interrelated and should be examined together. The significance of this study is threefold. First, it pioneers the study of the roles of SIA practitioners in a focused and systematic manner. Second, it informs practitioners of the expectations of them thereby fostering professionalism. Third, it prepares the public for SIAs by elucidating the functions and values of the assessment. - Highlights: • We adopt systematic review to construct a framework of roles of social impact assessment (SIA) practitioners from literature. • We use three overarching categorises to stratify the eleven roles we proposed. • This work is a novel attempt to study the work as a SIA practitioner and build a foundation for further exploration. • The framework informs practitioners of the expectations on them thus reinforcing professionalism. • The framework also prepares the public for SIAs by elucidating the functions and values of the assessment
Wong, Cecilia H.M., E-mail: firstname.lastname@example.org; Ho, Wing-chung, E-mail: email@example.com
The effectiveness of social impact assessment (SIA) hinges largely on the capabilities and ethics of the practitioners, yet few studies have dedicated to discuss the expectations for these professionals. Recognising this knowledge gap, we employed the systemic review approach to construct a framework of roles of SIA practitioners from literature. Our conceptual framework encompasses eleven roles, namely project manager of SIA, practitioner of SIA methodologies, social researcher, social strategy developer, social impact management consultant, community developer, visionary, public involvement specialist, coordinator, SIA researcher, and educator. Although these roles have been stratified into three overarching categories, the project, community and SIA development, they are indeed interrelated and should be examined together. The significance of this study is threefold. First, it pioneers the study of the roles of SIA practitioners in a focused and systematic manner. Second, it informs practitioners of the expectations of them thereby fostering professionalism. Third, it prepares the public for SIAs by elucidating the functions and values of the assessment. - Highlights: • We adopt systematic review to construct a framework of roles of social impact assessment (SIA) practitioners from literature. • We use three overarching categorises to stratify the eleven roles we proposed. • This work is a novel attempt to study the work as a SIA practitioner and build a foundation for further exploration. • The framework informs practitioners of the expectations on them thus reinforcing professionalism. • The framework also prepares the public for SIAs by elucidating the functions and values of the assessment.
Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and
Rajeswaran, Lakshmi; Ehlers, Valerie J
In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations. The objective of this descriptive study was to assess registered nurses’ CPR knowledge and skills. A pre-test, intervention and re-test time-series research design was adopted, and data were collected from 102 nurses from the 2 referral hospitals in Botswana. A multiple-choice questionnaire and checklist were used to collect data. All nurses failed the pre-test. Their knowledge and skills improved after training, but deteriorated over the three months until the post-test was conducted. The significantly low levels of registered nurses’ CPR skills in Botswana should be addressed by instituting country-wide CPR training and regular refresher courses
Yen, Laurann; Jowsey, Tanisha; McRae, Ian S
The use of complementary and alternative medicines (CAM) and CAM practitioners is common, most frequently for the management of musculoskeletal conditions. Knowledge is limited about the use of CAM practitioners by older people, and specifically those with other long term or chronic conditions. In 2011 we conducted an Australia wide survey targeting older adults aged over 50 years (n = 2540). Participants were asked to identify their chronic conditions, and from which health professionals they had 'received advice or treatment from in the last 3 months', including 'complementary health practitioners, e.g. naturopath'. Descriptive analyses were undertaken using SPSS and STATA software. Overall, 8.8% of respondents reported seeing a CAM practitioner in the past three months, 12.1% of women and 3.9% of men; the vast majority also consulting medical practitioners in the same period. Respondents were more likely to report consulting a CAM practitioner if they had musculoskeletal conditions (osteoporosis, arthritis), pain, or depression/anxiety. Respondents with diabetes, hypertension and asthma were least likely to report consulting a CAM practitioner. Those over 80 reported lower use of CAM practitioners than younger respondents. CAM practitioner use in a general older population was not associated with the number of chronic conditions reported, or with the socio-economic level of residence of the respondent. Substantial numbers of older Australians with chronic conditions seek advice from CAM practitioners, particularly those with pain related conditions, but less often with conditions where there are clear treatment guidelines using conventional medicine, such as with diabetes, hypertension and asthma. Given the policy emphasis on better coordination of care for people with chronic conditions, these findings point to the importance of communication and integration of health services and suggest that the concept of the 'treating team' needs a broad interpretation.
The need to support people to change diet-related behaviour is widely advocated and how to do this effectively in practice is an expanding area of research. Important factors to consider are how healthcare practitioners communicate with their patients and how that communication may affect diet-related behaviour change and subsequent outcomes. The aim of the present paper is to discuss communication skills for behaviour change (CSBC), focusing predominantly on registered dietitians who are required to communicate effectively and have an important role in supporting patients to change diet-related behaviour. The views of dietitians in relation to CSBC have been investigated and respondents have consistently reported that they perceive these skills to be of vital importance in practice. Patient views have reiterated the importance of good CSBC in one-to-one consultations. However, pre-qualification training of dietitians is thought to deliver practitioners who are competent at a minimum level. The need for ongoing continuous professional development (CPD) in relation to CSBC has been recognised but currently most CPD focuses on updating knowledge rather than improving these essential skills. Measuring CSBC in a consistent and objective manner is difficult and an assessment tool, DIET-COMMS, has been developed and validated for this purpose. DIET-COMMS can be used to support CSBC development, but concerns about logistical challenges and acceptability of implementing this in practice have been raised. Although a suitable assessment tool now exists there is a need to develop ways to facilitate assessment of CSBC in practice.
Koelbel, P W; Fuller, S G; Misener, T R
Job satisfaction influences employee retention, worker productivity, and performance quality. To retain qualified nurse practitioners (NPs), health administrators must identify sources of job satisfaction and dissatisfaction. Herzberg's dual-factor theory of job satisfaction addresses extrinsic and intrinsic work-related factors. Expansion of the model to include global job satisfaction and individual differences provided a broad framework for the assessment of nurse practitioner job satisfaction. The expanded model was used to analyze the job satisfaction of 132 NPs registered with the South Carolina State Board of Nursing in 1988 (final response rate = 90%). Participants completed the Index of Job Satisfaction (IJS), the Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF), and the Personal and Work Background Questionnaire (PWBQ). Although the NPs were moderately satisfied with their overall jobs, extrinsic factors were found to be major sources of dissatisfaction. The optimal combination of variables predicted by regression analysis to influence global job satisfaction were age, number of children, urban locations, achievement, company policies and practices, creativity, independence, and compensation. Implications for health administrators to improve the work environments of NPs are discussed.
Full Text Available The procedure of ship registration is regulated in the Maritime Code of Croatia (2004. This procedure, in comparison with the recently suspended Maritime Code of Croatia (1994, includes substantial changes, especially in the domain of yacht registration. New Maritime Code has founded special yacht-register for yachts and yachts under construction. A yacht which is registered as a Croatian yacht is entitled to the benefits conffered by the Maritime Code of Croatia (right to fly a Croatian flag, etc.. There are two modes proscribed under the provisions of Maritime Code of Croatia (2004 for yacht-registration: 1 mandatory and 2 facultative. Yachts whose owners are Croatian citizens with residence i Republic Croatia or companies which are registered in the Republic of Croatia are obligated to register under the provisions of Maritime Code of Croatia (2004. On the other hand, yacht whose owners are not Croatian citizens or whose owners are Croatian citizens but without the residence in the Republic of Croatia, can be registered in the Republic of Croatia, depending on the will of the owner. Yachts under construction can be registered in special registers for such kind of vessels if they are built in Croatian shipyards (owners can be either Croatian citizens or foreigners. Jurisdiction in this matter belongs to port authorities and all procedure is carried out in accordance with the rules of administrative procedure.
A data register and a processor for data receiving and processing from drift chambers of a device for investigating relativistic positroniums are described. The data are delivered to the register input in the form of the Grey 8 bit code, memorized and transformed to a position code. The register information is delivered to the KAMAK trunk and to the front panel plug. The processor selects particle tracks in a horizontal plane of the facility. ΔY maximum coordinate divergence and minimum point quantity on the track are set from the processor front panel. Processor solution time is 16 μs maximum quantity of simultaneously analyzed coordinates is 16
the currently used drugs, influence of pharmaceutical sales representatives and inadequate training and professional development [2,7]. Other factors include poor communication between health professional and patients regarding the basic information about the use of drugs. Most of the studies done in Tanzania on this ...
By this intensive co- operation we hope to come in future to a more or less. uniform training programme. METHOD OF TEACHING. Apart from some practical courses in the basic sciences during the first years of study, until some time aoo the. 'look and listen' lecture was the only way to pass ~n the knowledge to the student.
Vesicovaginal fistula complicating uterine evacuation: a case report · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. MA Ijaiya, AP Aboyeji, GA Fawole, AAG Jimoh, OO Alabi, AO Olarinoye, OL Akintade, OK Ogah, DNC Nwachukwu, OA Alabi, SA Esuga, ZB Ijaiya, 89-89.
An outbreak of cutaneous Leishmaniasis in a boarding senior secondary school in Sokoto, North Western Nigeria: Clinical Presentation and outcome · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. N M Jiya, H Ahmed, B Jibrin, A O Phillips, 86-89 ...
audio-visual aids and education in colloquia. While lectures, teaching machines and films reaching hundreds of students. need only a few teachers, colloquia require an extensive staff. In Leyden we tried to solve this problem by esta- blishing our so-called peripheral clinic and also in Rotter- dam this method is practised.
The Role of p16 Immunohistochemistry in the Diagnosis of Pre-Invasive Cervical Lesions and its Applications in a Low Resource Setting · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. N Orah, AAF Banjo, 35-38 ...
Antibiograms of Staphylococcus Aureus and Pseudomonas Aeruginosa which Colonise the Conjunctiva of HIV/AIDS Patients in Relation to their CD4 Counts · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. BO Ajayi, FD Otajevwo, E Oghre, 3-12 ...
The Burnout Syndrome and its Intervention Strategies for Physicians · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD ... Awareness and Utilization of Emergency Contraceptives among Female Undergraduate Students of University of Benin, Benin City, Nigeria · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD ...
Pattern of First-Aid Measures Used by Snake-bite Patients and Clinical Outcome at Zamko Comprehensive Health Centre, Langtang, Plateau State · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. JKA Madaki, RE Obilom, BM Mandong, 10-13 ...
Noise-Induced Hearing Loss in Laundry Workers in Lagos · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. SO Elias, GTA Ijaduola, OA Sofola, 1-6. http://dx.doi.org/10.4314/nmp.v44i1.28673 ...
Poliomyelitis: An Assessment of the Knowledge of Women in Jos Nigeria and Implications for its Global Eradication Early 21st Century · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. GTA Jombo, MNO Enenebeaku, AA Salako, L Nimzing, DZ Egah, O Kandakai, 39-44.
Comparative Assessment of Knowledge, Attitude and Practice of Cervical Cancer Screening among Faith Based and Non-Faith Based Women In Surulere LGA, Lagos. EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. N Odeyemi, A Ajogwu, 63-68 ...
The Prevalence of Dental Anxiety and Validation of the Modified Dental Anxiety Scale in a Sample of Nigerian Population · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. AO Coker, ME Sorunke, OO Onigbinde, AO Awotile, OB Ogunbanjo, VO Ogunbanjo ...
Impacts of long-term indwelling urinary catherization on the sexual functions of males low socio-economic country · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. AA Popoola, AA Aderounmu, OS Olajide. http://dx.doi.org/10.4314/nmp.v58i5-6.66775 ...
Epidemiological Survey of Paediatric Ocular Morbidity in North Central Nigeria · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. CO Ojabo, OS Adeniyi, 65-69. How much of the much Professed Primary Health Care is Practiced? EMAIL FULL TEXT EMAIL FULL TEXT
Mothers' Perception of The Need for Social Companionship During Labour in The University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. AJ Umoiyoho, EC Inyang-Etoh, OG Shittu, 62-67.
Overcharging by health practitioners is a difficult issue with few guidelines available for practitioners or patients. For the most part it has not been the subject of disciplinary censure and has been dealt with by conciliation processes. However, during 2013 the Singapore High Court twice addressed the commerciality of the health-practitioner-patient relationship, acknowledging that this is a fundamental attribute of the contemporary dynamic between providers and recipients of health services. In Lim Mey Lee Susan v Singapore Medical Council  SGHC 122, it concluded that the obligation to refrain from overcharging is an inherent ethical responsibility of practitioners and affirmed the suspension for three years of a surgeon with Australian training and tertiary connections for what it classified as grossly excessive charging. In Pang Ah San v Singapore Medical Council  SGHC 266, it observed that medical practitioners have a legitimate right to appropriate levels of remuneration but that the right balance has to be struck between professional virtues and business considerations. The Singapore High Court's decisions raise the question of whether professional associations and practitioner regulators have a responsibility to provide guidelines and, potentially, processes by which practical assistance can be provided to medical and other health care practitioners so that they can avoid unacceptable charging practices.
Winthereik, Anna K; Hjertholm, Peter; Neergaard, Mette Asbjoern
BACKGROUND: Previous studies of associations between home visits by general practitioners and end-of-life care for cancer patients have been subject to confounding. AIM: To analyse associations between general practitioners' propensity to pay home visits and the likelihood of hospitalisation...... and dying out of hospital among their cancer patients. DESIGN: A national register cohort study with an ecological exposure. Standardised incidence rates of general practitioner home visits were calculated as a measure for propensity. Practices were grouped into propensity quartiles. Associations between...... propensity groups and end-of-life outcomes for cancer patients aged 40 or above were calculated. SETTING/PARTICIPANTS: Danish general practitioners and citizens aged 40 or above were included from 2003 to 2012. RESULTS: We included 2670 practices with 2,518,091 listed patients (18,364,679 person...
Mastal, Margaret; Levine, June
Ambulatory care settings employ 25% of the three million registered nurses in the United States. The American Academy of Ambulatory Care Nursing (AAACN) is committed to improving the quality of health care in ambulatory settings, enhancing patient outcomes, and realizing greater health care efficiencies. A survey of ambulatory care registered nurses indicates they are well positioned to lead and facilitate health care reform activities with organizational colleagues. They are well schooled in critical thinking, triage, advocating for patients, educating patients and families, collaborating with medical staff and other professionals, and care coordination. The evolving medical home concept and other health care delivery models reinforces the critical need for registered nurses to provide chronic disease management, care coordination, health risk appraisal, care transitions, health promotion, and disease prevention services. Recommendations are offered for organizational leaders, registered nurses, and AAACN to utilize nursing knowledge and skills in the pursuit of leading change and advancing health.
Aravind, B S; Joy, E Tatu; Kiran, M Shashi; Sherubin, J Eugenia; Sajesh, S; Manchil, P Redwin Dhas
The aim and objective is to evaluate the level of awareness and attitude about radiation hazards and safety practices among general dental practitioners in Trivandrum District, Kerala, India. A questionnaire-based cross-sectional study was conducted among 300 general dental practitioners in Trivandrum District, Kerala, India. Postanswering the questions, a handout regarding radiation safety and related preventive measures was distributed to encourage radiation understanding and protection. Statistical analysis were done by assessing the results using Chi-square statistical test, t -test, and other software (Microsoft excel + SPSS 20.0 trail version). Among 300 general practitioners (247 females and 53 males), 80.3% of the practitioners were found to have a separate section for radiographic examination in their clinics. Intraoral radiographic machines were found to be the most commonly (63.3%) used radiographic equipment while osteoprotegerin was the least (2%). Regarding the practitioner's safety measures, only 11.7% of them were following all the necessary steps while 6.7% clinicians were not using any safety measure in their clinic, and with respect to patient safety, only 9.7% of practitioners were following the protocol. The level of awareness of practitioners regarding radiation hazards and safety was found to be acceptable. However, implementation of their knowledge with respect to patient and personnel safety was found wanting. Insisting that they follow the protocols and take necessary safety measures by means of continuing medical education programs, pamphlets, articles, and workshops is strongly recommended.
Blayney, K D; Wilson, B R; Bamberg, R; Vaughan, D G
Multiskilled practitioners have been in health care settings for a long time. The form multiskilled practitioners have taken has varied with the cultural, socioeconomic, and technological constructs of the times. Some multiskilled practitioners have come and gone while others, such as the medical assistant and physician assistant, have remained. The complexity and sophistication of skills being combined have increased over time as have the degree level and opportunities for dual certification. Skills have been combined both across and within disciplines. There is currently a greater number and variety of formal programs to prepare multiskilled health practitioners in educational institutions and health care facilities, and more informal on-the-job training efforts than ever before--and they are increasing. Employment of multiskilled personnel has become a survival strategy for health care institutions in this current era of cost containment. Multiskilled allied health practitioners with basic nursing skills (ie, LPN level) may also provide one step toward a solution to the nursing personnel shortage being experienced by some health care facilities. The catchword for multiskilled has become not "whether," but "how."15 It is to everyone's benefit to learn from the efforts of those with experience in implementing the multiskilled health practitioner concept for both national and international application. The National Multiskilled Health Practitioner Clearinghouse intends, through its publications, services, and resource files, to serve as the cornerstone upon which the information from those with experience can be reposited and disseminated.
To avoid certain errors in practice, Charles Brenner offered an holistic substitute for the Freudian structural model of the mind. He used the term compromise formation ambiguously to refer to both actions and states, so as to render unnecessary what he considered artificial, judgmental attitudes embodied in images of psychic structures. He believed that a theory of conflicting structures transforms the phenomenological drama of the patient's actual life-world into an artificial drama of contending intrapsychic parties that may reflect the analyst's values. According to Brenner, the meaning of life, with its desires, fears, and regrets, is structured forever in the first articulation of the family drama, and that is all the structure a practitioner should have in mind. In principle, the ambiguity of the term compromise formation allows for observed continuities in human life, and might have inspired an ambitious theoretician to exploit that option for an account of character, but that aspect of theory moves in a direction opposite to Brenner's practical mission. For the same practical reason Brenner refused to acknowledge gradations of mental operation, such as differences in maturity, or style or level of thinking, so the theory cannot say how change can take place, analytic or otherwise. These lacunae in theory were unblinkingly (if implicitly) accepted in pursuit of Brenner's goal, which was not to polish up theory but to cleanse the analyst's mind of concepts that subtly interfere with the essential nondirectiveness of treatment. His theoretical minimalism and exclusive concern with practical consequences can be recognized as a peculiarly North American attitude to psychoanalysis.
This annual product register contains an assessment of resources in Australia; statistical information on mine production of principal minerals; mineral industry statistics; directory of exploration and mining companies; buyers' guide; directory of consultants; list of services and a company index.
The Australian Minings' Product Register 1990-91 contains an industry review, resource assessment, mineral industry statistics, directory of exploration and mining companies, buyers guide and directory of consultants.
Abildstrøm, Steen Z; Torp-Pedersen, Christian; Madsen, Mette
Introduction: The use of the unique personal identification number in the Nordic database systems enables the researchers to link the registers at the individual level. The registers can be used for both defining specific patient populations and to identify later events during follow-up. This rev...... the hospitalisation rate and treatment of cardiovascular disease. The risk of unmeasured factors affecting the results calls for cautious interpretation of the results.......-up. This review gives three examples within cardiovascular epidemiology to illustrate the use of the national administrative registers available to all researchers upon request. Research topics: The hospitalisation rate of acute myocardial infarction (AMI) was expected to be increased and case-fatality rate......-based treatment increased significantly over time and adherence to treatment was high. Finally, use of specific nonsteroidal antiinflammatory drugs by healthy subjects was associated with a dose-dependent increase in cardiovascular risk. CONCLUSION: The nationwide registers have proven very useful in monitoring...
Jan 25, 2012 ... career growth,5,6,9 lack of respect from healthcare professionals,39 competition from ... a reminder was posted in the ADSA monthly newsletter, six weeks ..... research and conduct open interviews with registered dietitians or.
Green, Anders; Sortsø, Camilla; Jensen, Peter Bjødstrup
The Danish National Diabetes Register (NDR) was established in 2006 and builds on data from Danish health registers. We validated the content of NDR, using full information from the Danish National Patient Register and data from the literature. Our study indicates that the completeness in NDR...... is ≥95% concerning ascertainment from data sources specific for diabetes, ie, prescriptions with antidiabetic drugs and diagnoses of diabetes in the National Patient Register. Since the NDR algorithm ignores diabetes-related hospital contacts terminated before 1990, the establishment of the date...... of encounter, has been taken as the date of inclusion in NDR. We also find that some 20% of the registrations in NDR may represent false positive inclusions of persons with frequent measurements of blood glucose without having diabetes. We conclude that NDR is a novel initiative to support research...
Christensen, Kaare; Ohm Kyvik, Kirsten; Holm, Niels V
Introduction: The Danish Twin Registry (DTR) has for more than 50 years been based on surveys and clinical investigations and over the two last decades also on register linkage. Currently these two approaches are merged within Statistics Denmark. Research topics: Here we report on three major...... groups of register-based research in the DTR that used the uniqueness of twinning. First, we focus on the ''long-term prognosis'' of being a twin compared with being a singleton and show that Danish twins have health trajectories in adulthood similar to singletons, which is a result of interest for twins...... illustrate how the co-twin control method in a register setting can be used to control for the effect of rearing environment and genetic factors in studies of the association between exposures and health. CONCLUSION: The spectrum of register-based twin studies is very wide and have changed in accordance...
U.S. Department of Health & Human Services — The National Sample Survey of Registered Nurses (NSSRN) Download makes data from the survey readily available to users in a one-stop download. The Survey has been...
Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui
Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.
Nurul Haswani Embong
Full Text Available Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.
Natalya B. Boyeva-Omelechko
Full Text Available The problem discussed in the article is topical due to the interest of scientists to different types of language variations and especially registers or situational dialects treated by M.A.K. Halliday as use-related varieties of language or varieties used in a particular social setting. As discourse categorization is a very complex problem scholarly consensus has not been reached for the definitions of the term «register». The universal criteria for defining and discriminating registers have not been worked out either. The authors of the article give the review of scientific works devoted to the problem in question especially works by M.A.K. Halliday, R. Quirk, M. Joos, D. Hymes P. Trudgill, E.I. Belyaeva and others and analyze different definitions of the term «register», spectrums of registers and criteria for their discriminating. It enables the authors to come to the conclusion that only registers with the same field (religious, political, business etc. and mode (oral/written, dialogue/monologue can be compared. The difference lies in the sphere of tenor which depends on the degree of formality, distance of power and socio-psychological distance between speakers. The authors believe that it is also necessary to take into account the cooperative/ uncooperative character of conversation and para-verbal and non-verbal components of the speech situation. With this in mind they offer their definition of the register and describe main characteristics of registers in the sphere of oral communication.
Stockton, Rex; Morran, Keith
We offer comments regarding two articles in this issue, one titled "Bridging the Practitioner-Scientist Gap in Group Psychotherapy Research" and a complementary article providing the results of a survey, entitled "A Survey of Canadian Group Psychotherapist Association Members' Perceptions of Psychotherapy Research." We also make several recommendations for collaborative research between practitioners and scientists, such as the inclusion of clinicians on the research team, practice research networks, and improved approaches to communicating clinically relevant research findings. Also discussed are reflections and recommendations from the authors' experience as scientist-practitioners.
Robinson, P A; Epperson, W B
Diagnostic sampling of farm animals by private veterinary practitioners can be an important contributing factor towards the discovery of emerging and exotic diseases. This focus group study of farm animal practitioners in Northern Ireland investigated their use and expectations of diagnostic veterinary laboratories, and elicited their opinions on the role of the private practitioner in veterinary surveillance and the protection of rural public health. The veterinarians were enthusiastic users of diagnostic laboratories, and regarded their own role in surveillance as pivotal. They attached great importance to their veterinary public health duties, and called for more collaboration with their medical general practitioner counterparts. The findings of this research can be used to guide future development of veterinary diagnostic services; provide further insights into the mechanics of scanning surveillance; and measure progress towards a 'One Health' approach between veterinarians and physicians in one geographical region of the UK.
Yuriy V. Voronenko
Full Text Available Continuing medical education (CME is a dynamic system, where distance learning is an important component. In this article, we posit the Promissory Concept of distance learning. The central principle upon which this methodology is based is that the doctor can be located in any place where the information needed for his or her practice is easily available to the patient and where the doctor is able to monitor the development of his or her knowledge and practical skills, and is able to build his or her educational record of accomplishment. The Promissory Concept combines the availability of existing online opportunities with professional self-development which can be put to the test by an external supervisor (a professor or curator, who in turn will be able to identify existing advantages in knowledge, as well as those requiring further improvement, thus helping the learner's professional development. This approach was introduced to general practitioners and nephrologists practising in Ukraine in 2013. From 2014, the Promissory Concept has been associated with the Renal Eastern Europe Nephrology Academy's (REENA annual CME course, which has been accredited by ERA-EDTA (European Renal Association–European Dialysis and Transplant Association for the past 8 years. REENA is controlled by the state organisation of postgraduate education – Shupyk National Medical Academy of Postgraduate Education. The Promissory Concept is supported by printed educational material in the scientific medical Ukrainian journal Kidneys, which is registered in scientific databases (as a Google scholar, etc.. An important characteristic of the Promissory Concept is the active involvement of doctors, who give constructive feedback on the programme. This feedback contributes to the content of the CME learning activity, as well as enhancing compliance in participation. As a result, it helps create motivated adherence and improved professional development.
Palm, Peter; Josephson, Malin; Mathiassen, Svend Erik; Kjellberg, Katarina
We evaluated the intra- and inter-observer reliability and criterion validity of an observation protocol, developed in an iterative process involving practicing ergonomists, for assessment of working technique during cash register work for the purpose of preventing upper extremity symptoms. Two ergonomists independently assessed 17 15-min videos of cash register work on two occasions each, as a basis for examining reliability. Criterion validity was assessed by comparing these assessments with meticulous video-based analyses by researchers. Intra-observer reliability was acceptable (i.e. proportional agreement >0.7 and kappa >0.4) for 10/10 questions. Inter-observer reliability was acceptable for only 3/10 questions. An acceptable inter-observer reliability combined with an acceptable criterion validity was obtained only for one working technique aspect, 'Quality of movements'. Thus, major elements of the cashiers' working technique could not be assessed with an acceptable accuracy from short periods of observations by one observer, such as often desired by practitioners. Practitioner Summary: We examined an observation protocol for assessing working technique in cash register work. It was feasible in use, but inter-observer reliability and criterion validity were generally not acceptable when working technique aspects were assessed from short periods of work. We recommend the protocol to be used for educational purposes only.
Lemon-McMahon, Belinda; Hughes, Diane
This research investigated the terminology used in relation to constriction of the singing voice from a range of practitioner perspectives. It focused on the locality, causes, consequences, management, trends, identification, and vocabulary of constriction. The research aimed to develop a holistic understanding of the term "vocal constriction" from participant experiences and perceptions (N = 10). Data collection occurred through in-depth, semi-structured interviews with a range of voice care professionals. Participants included three professional groups: (1) Ear, Nose, and Throat medical specialists or laryngologists, (2) speech pathologists or speech therapists, and (3) singing teachers. Purposive sampling was used to ensure that the participants from groups 1 and 2 had extensive experience with singers in their practice. The singing teachers were experienced in either classical or contemporary styles, or both. Participant responses highlighted a discrepancy in preferred terminology, with "constriction" being less favored overall. Several anatomical locations were identified including postural, supraglottic (anteroposterior and false fold), articulatory, and in the intrinsic and extrinsic laryngeal musculature; psychological issues were also identified. Primary causes, secondary causes, and influencing factors were identified. Inefficient technique and poor posture or alignment were considered primary causes; similarly, emotion and anxiety or stress were identified as influencing factors by the majority of participants. There was less uniformity in responses regarding other causes. The major findings of this research are the respective participant group distinctions, an uncertainty regarding anteroposterior constriction, and that the location and effects of constriction are individual to the singer and must be considered contextually. A definition is offered, and areas for further research are identified. Copyright © 2018 The Voice Foundation. Published by
Full Text Available Abstract Background In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. Design A quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Methods Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes
Wijers, Nancy; Schoonhoven, Lisette; Giesen, Paul; Vrijhoef, Hubertus; van der Burgt, Regi; Mintjes, Joke; Wensing, Michel; Laurant, Miranda
In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. A quasi experimental study is undertaken at one "general practitioner cooperative" to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality
Leivonen, Susanna; Chudal, Roshan; Joelsson, Petteri; Ekblad, Mikael; Suominen, Auli; Brown, Alan S; Gissler, Mika; Voutilainen, Arja; Sourander, Andre
This is the first nationwide register-based study to examine the relationship between prenatal maternal smoking and Tourette syndrome. A total of 767 children diagnosed with Tourette syndrome were identified from the Finnish Hospital Discharge Register. Each case was matched to four controls. Information on maternal smoking during pregnancy was obtained from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Prenatal maternal smoking was associated with Tourette syndrome when comorbid with ADHD (OR 4.0, 95 % CI 1.2-13.5, p = 0.027 for exposure during first trimester, OR 1.7, 95 % CI, 1.05-2.7, p = 0.031 for exposure for the whole pregnancy). There was no association between maternal smoking during pregnancy and Tourette syndrome without comorbid ADHD (OR 0.5, 95 % CI 0.2-1.3, p = 0.166, OR 0.9, 95 % CI 0.7-1.3, p = 0.567). Further research is needed to elucidate the mechanisms behind the association between prenatal maternal smoking and Tourette syndrome with comorbid ADHD.
Erwin, Paul Campbell; Brownson, Ross C
The requisite capacities and capabilities of the public health practitioner of the future are being driven by multiple forces of change, including public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, globalized travel, and the repercussions of the Affordable Care Act. We describe five critical capacities and capabilities that public health practitioners can build on to successfully prepare for and respond to these forces of change: systems thinking and systems methods, communication capacities, an entrepreneurial orientation, transformational ethics, and policy analysis and response. Equipping the public health practitioner with the requisite capabilities and capacities will require new content and methods for those in public health academia, as well as a recommitment to lifelong learning on the part of the practitioner, within an increasingly uncertain and polarized political environment.
The committee of Teacher Education Policy (COTEP) considers the professional development of practitioners as one way to improve the quality of professional practice. An analysis of the literature on professional development in education ...
Heck, Daniel J.; Tarr, James E.; Hollebrands, Karen F.; Walker, Erica N.; Berry, Robert Q., III; Baltzley, Patricia C.; Rasmussen, Chris L.; King, Karen D.
The NCTM Research Committee developed this article to address a distinctly important activity that links research and practice: writing research-based articles for practitioner journals. Six guiding principles are described. (Contains 6 figures.)
the various security forces, policy reviews and the introduction of a human ...... Military legal practitioners must become experts in the land, air, maritime and cyber- ... private military companies, non-governmental organisations, transnational.
Practitioners do not read journals, and they do not even consider academic knowledge very ... disseminated to the discipline through research journals or academically oriented conferences. (AMA Task ..... European Journal of Marketing ...
Jepsen, Britta; Lomborg, Kirsten; Engberg, Marianne
Background: In many countries, medical authorities are responsible for involuntary admissions of mentally ill patients. Nonetheless, very little is known about GPs' experiences with involuntary admission. Aim: The aim of the present study was to explore GP's experiences from participating....... They felt that sectioning patients was unpleasant, and felt nervous, but experienced relief and professional satisfaction if things went well. The GPs experienced the doctor-patient relationship to be at risk, but also reported that it could be improved. GPs felt that they were not taken seriously...
USA Today, 1984
Medical educators nationwide are questioning the process that leads to the denial of the emotional side of medicine by its practitioners. Emotional dilemmas are often verbally suppressed by most students, but they surface in many ways, such as depression, insomnia, loss of appetite, and anxiety. (RM)
Afzal, Zubair; Pogge, Elizabeth; Boomershine, Virginia
To evaluate the efficacy of a smoking cessation program led by a pharmacist and a nurse practitioner. During a 6-month period, patients attended 7 one-on-one face-to-face smoking cessation counseling sessions with a pharmacist and 1 to 2 one-on-one face-to-face smoking cessation counseling sessions with a nurse practitioner. The primary outcome was smoking cessation point prevalence rates at months 1, 3, and 5 post-quit date. Secondary outcomes included medication adherence rates at months 1, 3, and 5 post-quit date, nicotine dependence at baseline versus program end, and patient satisfaction. Nine (47%) of 19 total participants completed the program. Seven of the 9 patients who completed the program were smoke-free upon study completion. Point prevalence rates at months 1, 3, and 5 post-quit date were 66%, 77%, and 77%, respectively, based on patients who completed the program. Medication adherence rates were 88.6%, 54.6%, and 75% at months 1, 3, and 5 post-quit date, respectively. Based on the Fagerstrom test, nicotine dependence decreased from baseline to the end of the study, 4.89 to 0.33 ( P smoking cessation program can assist patients in becoming smoke-free.
Ryynaenen, Olli-Pekka; Lehtovirta, Jukka; Soimakallio, Seppo; Takala, Jorma
Objectives: To examine general practitioners' attitudes to plain lumbar spine radiographic examinations. Design: A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation. Setting: Finland. Subjects: Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group). Results: The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks. Conclusions: General practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination
van den Berg, N; Meinke, C; Hoffmann, W
According to the AGnES concept (general-practitioner-supporting, community-based, e-health-assisted systemic intervention), general practitioners (GPs) can delegate certain components of medical care in the context of home visits by qualified AGnES employees. Within the framework of six AGnES projects, different telemedical applications have been implemented. Telemedical monitoring of patients was implemented to analyse the feasibility and acceptance within GP practices. One hundred sixty-two patients used a telemedical monitoring system (e.g. scale/sphygmomanometer and intraocular pressure measurement system). Regarding communication in cases of acutely necessary GP consultations, telephone calls and videoconferences between the GP and the AGnES employee were analysed. Unscheduled telephone calls or videoconferences were necessary for only a few home visits; the reasons included pain, anomalous values, and medication problems. The main result of the analysis was that implementation of telemedicine in GP practices is feasible and is accepted both by patients and GPs.
Magyari, Melinda; Koch-Henriksen, Nils; Sørensen, Per Soelberg
Aim of the database: The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the diseasemodifying treatment, and it is an important data source for epidemiological research. Study population: The DMSTR...... includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular visits. Main...... variables: Include age, sex, onset year and year of the diagnosis, basic clinical information, and information about treatment, side effects, and relapses. Descriptive data: Notification is done at treatment start, and thereafter at every scheduled clinical visit 3 months after treatment start...
Juel, K; Helweg-Larsen, K
In 1875 registration of causes of death in Denmark was established by the National Board of Health, and annual statistics of death have since been published. Until 1970 the national statistics were based upon punched cards with data collected from the death certificates. Since then the register has...... been fully computerized and includes individual based data of all deaths occurring among all residents in Denmark dying in Denmark. Furthermore, a microfilm of all death certificates from 1943 and onward is kept in the National Board of Health. The Danish Institute for Clinical Epidemiology (DICE) has...... established a computerized register of individual records of deaths in Denmark from 1943 and onwards. No other country covers computerized individual based data of death registration for such a long period, now 54 years. This paper describes the history of the registers, the data sources and access to data...
Shih, P.; Sicard, D.; Michels, L.
The NUHOMS registered -MP197 cask is an optimized transport design which can be loaded in the spent fuel pool (wet loading) or loaded the canister from the NUHOMS concrete modules at the ISFSI site. With impact limiters attached, the package can be transported within the states or world-wide. The NUHOMS registered -MP197 packaging can be used to transport either BWR or PWR canisters. The NUHOMS registered -MP197 cask is designed to the ASME B and PV Code and meets the requirements of Section III, Division 3 for Transport Packaging. The cask with impact limiters has undergone drop testing to verify the calculated g loadings during the 9m drops. The test showed good correlation with analytical results and demonstrate that the impact limiters stay in place and protect the package and fuel during the hypothetical accidents
In theory, the Medical Council of India (MCI) determines the standards and qualifications of medical schools. It also sanctions curricula and ensures standards. Yet no standards exist on the mode of selection in medical schools, duration of study, course content, student stipends or period of internship. It takes 4.5 years to finish medical school. Students undergo preclinical, paraclinical, and clinical training. Most courses are in English which tends to favor the urban elite. Students cannot always communicate with patients in local languages. Textbooks often provide medical examples unrelated to India. Pedagogy consists mainly of lectures and rote learning predominates. Curricula tend not to provide courses in community health. Students pick up on the elitist attitudes of the faculty. For example, faculty do not put much emphasis on community health, individual health, equity in health care delivery, and teamwork. Further the education system is not patient oriented, but hospital or disease oriented. Faculty should train students in creating sanitation programs, knowing local nutritious foods, and in making community diagnoses. Yet they tend to be practitioners 1st then educators. Further faculty are not paid well and are not always invited to take part in improving curriculum, so morale is often low. Moreover experience in health planning and management issues is not required for administrators. In addition, medical schools are not well equipped with learning aids, libraries, or teaching staff. Tax revenues finance medical education. 75% of graduating physicians set up a private practice. Further many physicians go to urban areas. 34-57% emigrate to other countries. The problems of medical education will not be solved until the political and economic system becomes more responsive to the health needs of the people.
Dowell, J; Norbury, M; Steven, K; Guthrie, B
Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice. The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes. A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries. This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the
Rees, L; Wass, J
Pressures from students and teachers, from professional bodies, and from changes in the way health care is delivered are all forcing a rethink of how medical students should be taught. These pressures may be more intense in London but are not confined to it. The recommendation the Tomlinson report advocates that has been generally welcomed is for more investment in primary care in London. General practitioners have much to teach medical schools about effective ways of learning, but incentives...
Patients with inflammatory bowel disease (IBD) are commonly in their child-bearing years. Maintainance medication, as recommended by international guidelines, is an emotive topic and an anxiety source. This study measures the awareness of patients and primary practitioners of the issues involved.
Raghavan, P.; Lambrechts, A.; Jayapala, M.; Catthoor, F.; Verkest, D.T.M.L.; Corporaal, H.
In current embedded systems processors, multi-ported register files are one of the most power hungry parts of the processor, even when they are clustered. This paper presents a novel register file architecture, which has single ported cells and asymmetric interfaces to the memory and to the
Smith, Devlin V; Stokes, Laura B; Marx, Kayleigh; Aitken, Samuel L
For pharmacists, the first years after graduation are spent developing their knowledge base, advancing as a practitioner, and honing their abilities as healthcare providers and drug information experts. New practitioners encounter many challenges during this time, which for many include publishing original research or reviewing manuscripts for colleagues and medical journals. Inexperience navigating the publication process, from submission to receipt of (and response to) peer review commentary, is often cited as a major barrier to timely publication of resident and new practitioner research. Serving as a peer reviewer in turn provides the new practitioner with insight on this process and can be an enlightening experience used to garner confidence in subsequently submitting their own formal manuscripts. A number of publications describing steps for peer review are available, however, many of these articles address more experienced reviewers or critique the peer review process itself. No definitive resource exists for new pharmacy practitioners interested in developing their peer review skills. The information presented in this summative guide should be used in conjunction with practice opportunities to help new practitioners develop proficiency at peer review.
de Brie, Claire; Piet, Emmanuelle; Chariot, Patrick
Violence for educational purpose refers to a modality of education that includes threats, verbal abuse, physical abuse and humiliations. Twenty European countries, not including France, have abolished corporal punishment through explicit laws and regulations. The position of general practitioners in the screening and care of violence for educational purpose in France is unknown. In this study, we aimed to assess the representations of this form of violence among general practitioners. We have performed semi-directed interviews of general practitioners in the Paris, France region (Île-de-France). Interviews were conducted until data saturation was achieved. Interviews were recorded, transcribed and analysed by two investigators. Interviews were conducted with 20 physicians (November 2015-January 2016). General practitioners considered that physical, verbal or psychological abuse had possible negative consequences on children. Uncertainty regarding the consequences of violence was a cause of tolerance towards violence for educational purpose, depending on the act committed and the context, as perceived by nearly all practitioners. General practitioners expressed interest in the field. They cited their own education and experience as the main obstacles to action. Most of them expressed a feeling of failure when they screened or took care of violence for educational purpose. This study suggests that doctors can participate in supporting the parents in the prevention of violence for educational purpose. Support to parents would need specific medical training as well as a societal change. Copyright © 2018 Elsevier Masson SAS. All rights reserved.