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Medical Practitioners (medical + practitioner)
Kinds of Medical Practitioners Selected AbstractsThe natural history of asthma from childhood to adulthoodINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007M. S. Koh Summary Medical Practitioners are often questioned regarding the prognosis of a child with asthma. We have performed a literature review of the natural history of childhood asthmatics. Factors which affect the natural history and prognosis of childhood asthma are discussed. Current evidence suggests that evolution of asthma severity is fairly predictable. Features of childhood asthma such as severity, duration, atopy, bronchial hyperresponsiveness and exposure to smoking can predict the course of asthma into adulthood. Most children with mild intermittent asthma will outgrow their asthma, or have mild episodic asthma. Early commencement of anti-inflammatory therapy, such as inhaled corticosteroids may prevent the progression of the disease. Most patients with mild asthma have good functional outcome and low healthcare utilisation. [source] Evaluating statistics in clinical trials: Making the unintelligible intelligibleAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 4 2008Stephen J Gilmore SUMMARY Medical practitioners should be familiar with the basic principles of statistical testing and analysis, as the critical evaluation of clinical trials is an essential component to the effective practise of evidence-based medicine. Practitioners also need to be able to identify unethical trial design. The aim of this review is to facilitate an understanding of inferential methodology by introducing some of the basic principles involved in the critical analysis of trial design and interpretation. [source] Nursing and midwifery management of hypoglycaemia in healthy term neonatesINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 7 2005Vivien Hewitt BSc(Hons) GradDipLib Executive summary Objectives The primary objective of this review was to determine the best available evidence for maintenance of euglycaemia, in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. Inclusion criteria Types of studies The review included any relevant published or unpublished studies undertaken between 1995 and 2004. Studies that focus on the diagnostic accuracy of point-of-care devices for blood glucose screening and/or monitoring in the neonate were initially included as a subgroup of this review. However, the technical nature and complexity of the statistical information published in diagnostic studies retrieved during the literature search stage, as well as the considerable volume of published research in this area, suggested that it would be more feasible to analyse diagnostic studies in a separate systematic review. Types of participants The review focused on studies that included healthy term (37- to 42-week gestation) appropriate size for gestational age neonates in the first 72 h after birth. Exclusions ,,preterm or small for gestational age newborns; ,,term neonates with a diagnosed medical or surgical condition, congenital or otherwise; ,,babies of diabetic mothers; ,,neonates with symptomatic hypoglycaemia; ,,large for gestational age neonates (as significant proportion are of diabetic mothers). Types of intervention All interventions that fell within the scope of practice of a midwife/nurse were included: ,,type (breast or breast milk substitutes), amount and/or timing of feeds, for example, initiation of feeding, and frequency; ,,regulation of body temperature; ,,monitoring (including screening) of neonates, including blood or plasma glucose levels and signs and symptoms of hypoglycaemia. Interventions that required initiation by a medical practitioner were excluded from the review. Types of outcome measures Outcomes that were of interest included: ,,occurrence of hypoglycaemia; ,,re-establishment and maintenance of blood or plasma glucose levels at or above set threshold (as defined by the particular study); ,,successful breast-feeding; ,,developmental outcomes. Types of research designs The review initially focused on randomised controlled trials reported from 1995 to 2004. Insufficient randomised controlled trials were identified and the review was expanded to include additional cohort and cross-sectional studies for possible inclusion in a narrative summary. Search strategy The major electronic databases, including MEDLINE/PubMed, CINAHL, EMBASE, LILACS, Cochrane Library, etc., were searched using accepted search techniques to identify relevant published and unpublished studies undertaken between 1995 and 2004. Efforts were made to locate any relevant unpublished materials, such as conference papers, research reports and dissertations. Printed journals were hand-searched and reference lists checked for potentially useful research. The year 1995 was selected as the starting point in order to identify any research that had not been included in the World Health Organisation review, which covered literature published up to 1996. The search was not limited to English language studies. Assessment of quality Three primary reviewers conducted the review assisted by a review panel. The review panel was comprised of nine nurses with expertise in neonatal care drawn from senior staff in several metropolitan neonatal units and education programs. Authorship of journal articles was not concealed from the reviewers. Methodological quality of each study that met the inclusion criteria was assessed by two reviewers, using a quality assessment checklist developed for the review. Disagreements between reviewers were resolved through discussion or with the assistance of a third reviewer. Data extraction and analysis Two reviewers used a data extraction form to independently extract data relating to the study design, setting and participants; study focus and intervention(s); and measurements and outcomes. As only one relevant randomised controlled trial was found, a meta-analysis could not be conducted nor tables constructed to illustrate comparisons between studies. Instead, the findings were summarised by a narrative identifying any relevant findings that emerged from the data. Results Seven studies met the inclusion criteria for the objective of this systematic review. The review provided information on the effectiveness of three categories of intervention , type of feeds, timing of feeds and thermoregulation on two of the outcome measures identified in the review protocol , prevention of hypoglycaemia, and re-establishment and maintenance of blood or plasma glucose levels above the set threshold (as determined by the particular study). There was no evidence available on which to base conclusions for effectiveness of monitoring or developmental outcomes, and insufficient evidence for breast-feeding success. Given that only a narrative review was possible, the findings of this review should be interpreted with caution. The findings suggest that the incidence of hypoglycaemia in healthy, breast-fed term infants of appropriate size for gestational age is uncommon and routine screening of these infants is not indicated. The method and timing of early feeding has little or no influence on the neonatal blood glucose measurement at 1 h in normal term babies. In healthy, breast-fed term infants the initiation and timing of feeds in the first 6 h of life has no significant influence on plasma glucose levels. The colostrum of primiparous mothers provides sufficient nutrition for the infant in the first 24 h after birth, and supplemental feeds or extra water is unnecessary. Skin-to-skin contact appears to provide an optimal environment for fetal to neonatal adaptation after birth and can help to maintain body temperature and adequate blood glucose levels in healthy term newborn infants, as well as providing an ideal opportunity to establish early bonding behaviours. Implications for practice The seven studies analysed in this review confirm the World Health Organisation's first three recommendations for prevention and management of asymptomatic hypoglycaemia, namely: 1Early and exclusive breast-feeding is safe to meet the nutritional needs of healthy term newborns worldwide. 2Healthy term newborns that are breast-fed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids. 3Healthy term newborns do not develop ,symptomatic' hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia, look for an underlying condition. Detection and treatment of the cause are as important as correction of the blood glucose level. If there are any concerns that the newborn infant might be hypoglycaemic it should be given another feed. Given the importance of thermoregulation, skin-to-skin contact should be promoted and ,kangaroo care' encouraged in the first 24 h after birth. While it is important to main the infant's body temperature care should be taken to ensure that the child does not become overheated. [source] Domiciliary medication reviews by fourth year pharmacy students in Western AustraliaINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2004Margaret Boyatzis MPharm candidate ABSTRACT Objective The principal aim of this study was to assess the potential value of final-year undergraduate pharmacy students in domiciliary medication review (DMR). Method Students attended workshops on communication skills, complementary medicines and medication review. Each student contacted 5,10 patients by telephone and asked them to identify from memory all current medications. The student later conducted a DMR in the patient's home and prepared a report for the pharmacist preceptor and the patient's medical practitioner (GP) to review. Results The students recruited 189 patients, 80% of whom were over 60 years of age. The mean number of medications recalled by patients (5.8±2.9) was significantly lower than the number of medications that patients were actually taking (8.5 ± 3.5; P <0.001). Overall, 39% of patients gave incorrect/unknown indications for at least one medication and 17% had expired medicines. Students identified an average of 2.1 ± 1.7 actual or potential medication problems per patient. The mean number of problems endorsed by the pharmacist and GP were 1.1 and 0.9, and an additional 0.4 and 0.2 problems were identified, respectively. Nineteen patients (10%) required changes in therapy. Pharmacists and GPs thought it was appropriate for students to conduct DMRs under supervision and to include DMR as part of the students' training. Conclusion Final-year pharmacy students were capable of collecting and collating medication information for DMRs in the community setting. The programme was acceptable to patients, GPs and pharmacist preceptors. Experience in DMRs should be included in the education of pharmacy students and pre-registration trainees. [source] Supplementary prescribing by community and primary care pharmacists: an analysis of PACT data, 2004,2006JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2008L. Guillaume BA MSc PhD Summary Background and objective:, Pharmacist prescribing is a relatively new intiative in the extension of prescribing responsibilities to non-medical healthcare professionals. Pharmacist supplementary prescribing was introduced in 2003 and allowed prescribing in accordance with a clinical management plan agreed with a medical practitioner and patient to improve patient access to medicines and better utilize the skills of healthcare professionals. The objective of this research was to examine the volume, cost and trends in pharmacist prescribing in community and primary care using Prescription Analysis and Cost (PACT) data and to suggest possible reasons for the trends. Methods:, Using PACT data at national, chapter and subchapter level for 2004,2006 the volume, costs and trends for pharmacist prescribing were obtained. Supplemental data and statistical analysis from other sources, relating to prescribing of individual drugs, were also utilized. Results:, The total number of items prescribed by pharmacists in community and primary care increased from 2706 in 2004 to 31 052 in 2006. In 2006, pharmacist prescribing represented only 0·004% of all prescribing in the community and primary care setting. Cardiovascular medicines were the most frequently prescribed therapeutic class followed by central nervous system, respiratory, endocrine and gastrointestinal medicines. Conclusion:, Pharmacist prescribing is increasing but represents an extremely small proportion of primary care prescribing. PACT data between 2004 and 2006 reflects pharmacist supplementary prescribing alone and has been in the anticipated therapeutic areas of drugs which treat chronic conditions such as hypertension. [source] Possible contraindications and adverse reactions associated with the use of ocular nutritional supplementsOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2005Hannah Bartlett Abstract The role of oxidation in the development of age-related eye disease has prompted interest in the use of nutritional supplementation for prevention of onset and progression. Our aim is to highlight possible contraindications and adverse reactions of isolated or high dose ocular nutritional supplements. Web of Science and PubMed database searches were carried out, followed by a manual search of the bibliographies of retrieved articles. Vitamin A should be avoided in women who may become pregnant, in those with liver disease, and in people who drink heavily. Relationships have been found between vitamin A and reduced bone mineral density, and beta-carotene and increased risk of lung cancer in smoking males. Vitamin E and Ginkgo biloba have anticoagulant and anti-platelet effects respectively, and high doses are contraindicated in those being treated for vascular disorders. Those patients with contraindications or who are considered at risk of adverse reactions should be advised to seek specialist dietary advice via their medical practitioner. [source] Treading with care: foot care, litigation and the expert witnessPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2004JAS Foster BA (Hons) Barrister Abstract This is a practical introduction to acting as an expert witness. The expert's report is an integral part of all litigation concerning allegations of professional negligence. A well-written report, embodying principles of sound academic research, is less likely to be challenged in court than a badly-prepared one. An expert should not hesitate to question his terms of reference if they are unclear or require widening. It is crucial to remember that the report is written for the benefit of the court, not the instructing party. In the witness box, the oath to tell the truth, the whole truth and nothing but the truth is paramount. It should be assumed that the Judge can grasp difficult medical concepts but may require fuller explanation than a fellow medical practitioner. It is important to answer the question that has been asked , but it is in order to disagree with a false premise. Appropriate concessions are more likely to impress the court than posturing. Each question should be treated on its merits. In conclusion, the role of the expert witness is demanding but application of these principles should make it a less daunting experience. Copyright © 2004 John Wiley & Sons, Ltd. [source] Lessons from History: Why Race and Ethnicity Have Played a Major Role in Biomedical ResearchTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2006Troy Duster Ph.D. Before any citizen enters the role of scientist, medical practitioner, lawyer, epidemiologist, and so on, each and all grow up in a society in which the categories of human differentiation are folk categories that organize perceptions, relations, and behavior. That was true during slavery, during Reconstruction, the eugenics period, the two World Wars, and is no less true today. While every period understandably claims to transcend those categories, medicine, law, and science are profoundly and demonstrably influenced by the embedded folk notions of race and ethnicity. [source] A Personal User's View of Functional Electrical Stimulation CyclingARTIFICIAL ORGANS, Issue 3 2002Roger Fitzwater Abstract: Two years of functional electrical stimulation cycling (FESC) as a researcher and subject have given me an insight into the direction that future FESC should take as well as providing me with significant health benefits and an enjoyable and functional ability to cycle. If FESC is to benefit spinal cord injured persons (SCIPs), researchers must turn their attention to making the activity convenient and enjoyable. What follows is a personal view and will be less scientifically rigorous than other presentations but hopefully still of value. It calls upon my experience as a general medical practitioner with a special interest in the value of exercise, a human powered vehicle enthusiast, an amateur FES researcher, but most importantly, an SCIP and FES cyclist. [source] Basal cell carcinoma mistaken for actinic keratosisCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 3 2006Robert J Jacobs PhD MSc(Optom) LOSc FAAO FVCO Increasing age and UV exposure are well-known associations with precancerous and cancerous skin lesions, including actinic (solar) keratosis, and squamous and basal cell carcinomata. This report describes a patient with a facial skin lesion close to an eye that was initially believed to be actinic (solar) keratosis but was subsequently diagnosed as a basal cell carcinoma (BCC). The diagnosis of BCC was helped pre-operatively by manipulation of the surrounding facial skin, which revealed the characteristic rolled edges and telangiectasis. Referral to his general medical practitioner (GP) resulted in surgical excision of the lesion. This procedure was performed inexpensively by the local GP as the lesion was not large and was in an accessible position. The lesion and the course of recovery over four weeks were documented photographically. The lesion was surgically excised and the diagnosis of basal cell carcinoma was confirmed by pathological examination. The wound healed well and the final cosmetic result was excellent. This patient illustrates the importance of careful observation and photo-documentation of suspicious skin lesions. A review of the treatment options for these lesions is included in this report. [source] Testing the effect of including oral health in general health checks for elderly patients in medical practice , a randomized controlled trialCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 1 2007C. Lowe Abstract,,, Aim:, To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. Objectives:, To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting:, Three general medical practices in east Cheshire, UK. Design:, A randomized controlled trial. Method:, Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. Results:, Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. Conclusions:, The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met. [source] ASIA PACIFIC COLUMN: New challenges and opportunities in managing substance abuse in MalaysiaDRUG AND ALCOHOL REVIEW, Issue 5 2006MAHMUD MAZLAN MD Abstract Until recently, Malaysia has lagged behind in the treatment of drug addiction and related disorders, despite experiencing severe drug problems. By the end of 2004, 234 000 heroin users or heroin-dependent individuals had been registered in the official government registry, but other estimates exceed 500 000 for heroin abusers in the country. Amphetamine-type stimulant abuse is also increasing and of considerable public and government concern. Among the population of drug users, HIV and other infectious diseases rates are very high. In the Western Pacific regions, Malaysia has the second highest HIV prevalence (after Vietnam) among adult populations (0.62%) and the highest proportion of HIV cases resulting from injection drug use (76.3%). Drug use and related disorders exert a heavy burden on the country's health care and legal systems. Historically, drug abusers were rehabilitated involuntarily in correctional, rather than health-care, facilities. This primarily criminal treatment approach had limited effectiveness which led to widespread public dissatisfaction and the recent introduction of medical treatments for addiction. Naltrexone was introduced in 1999; buprenorphine was introduced in 2001 and methadone in 2003. Agonist maintenance programmes were embraced rapidly by the medical community in Malaysia. Currently, over 30 000 opiate-dependent patients are treated with agonist maintenance treatments by more than 500 medical practitioners in Malaysia. Despite these recent advances, treatments for amphetamine-type stimulant abuse or dependence are underdeveloped, and diversion of agonist medications is an emerging concern. [source] Does being against euthanasia legislation equate to being anti-euthanasia?INTERNAL MEDICINE JOURNAL, Issue 4 2006C. M. Cartwright Abstract This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti-euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter. [source] Misconduct in medical research: whose responsibility?INTERNAL MEDICINE JOURNAL, Issue 4 2003K. J. Breen Abstract Examples of many types of misconduct in medical research continue to be reported. The true incidence is unknown because there is strong evidence of under-reporting as well as suggestions of increased detection. Risks to research participants may also be increasing, with contributing factors such as increased pressure on researchers to publish and to produce commercialization of their research. Institutions are perceived to typically respond slowly and inadequately to allegations of research misconduct. More could be done to try to prevent such misconduct, such as: (i) educating researchers about research ethics, (ii) assisting and protecting whistleblowers and (iii) instituting processes to adequately and promptly investigate and deal with allegations. In addition, a debate needs to take place as to whether research misconduct allegations should be dealt with at the institutional level or at a national level and whether medical boards should be routinely involved in the more serious breaches of ethical standards by medical practitioners engaged in research. (Intern Med J 2003; 33: 186,191) [source] Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: three case studiesINTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2009B. Pasternak-Jśnior Abstract Aim, To describe three cases of extraoral sinus tracts, related to infected teeth, which were initially misdiagnosed as skin lesions and inappropriately treated. Summary, The extraoral sinus tracts were initially misdiagnosed as skin lesions. Dermatological surgery was performed and antibiotics prescribed but the lesions did not resolve. Then, a dental cause was sought, and identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. Key learning points ,,Dermatologists and other medical practitioners should be aware that dental extraoral sinus tracts can be confused with skin lesions. ,,A dental aetiology, as part of a differential diagnosis, should be kept in mind with oro-facial skin lesions. ,,If an extraoral sinus tract is of endodontic origin, then elimination of infection through effective endodontic treatment will lead to resolution of the sinus tract. ,,Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and/or surgical intervention. [source] Cutting through the statistical fog: understanding and evaluating non-inferiority trialsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2010W. S. Weintraub Summary Every year, results from many important randomised, controlled trials are published. Knowing the elements of trial design and having the skills to critically read and incorporate results are important to medical practitioners. The goal of this article is to help physicians determine the validity of trial conclusions to improve patient care through more informed medical decision making. This article includes a review of 162 randomised, controlled non-inferiority (n = 116) and equivalence (n = 46) hypothesis studies as well as the larger Stroke Prevention using Oral Thrombin Inhibitor in atrial Fibrillation V study and the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial. Evaluation of data from small and large trials uncovers significant flaws in design and models employed and uncertainty about calculations of statistical measures. As one example of questionable study design, discussion includes a large (n = 3922), double-blind, randomised, multicentre trial comparing the efficacy of ximelagatran with warfarin for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and additional stroke risk factors. Investigators concluded that ximelagatran was effective compared with well-controlled warfarin for prevention of thromboembolism. However, deficiencies in design, as well as concerns about liver toxicity, resulted in the rejection of the drug by the US Food and Drug Administration. Many trials fail to follow good design principles, resulting in conclusions of questionable validity. Well-designed non-inferiority trials can provide valuable data and demonstrate efficacy for beneficial new therapies. Objectives and primary end-points must be clearly stated and rigorous standards met for sample size, establishing the margin, patient characteristics and adherence to protocol. [source] Oral self-care habits of dental and healthcare providersINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 4 2008Y Zadik Abstract:, Objective:, To evaluate the self-care level of dental and healthcare providers regarding prevention of oral diseases Methods:, Healthcare providers (dental assistants and surgeons, laboratory personnel, biologists, medics, paramedics, corpsmen, nurses, pharmacists, physicians, physiotherapists, psychologists, social workers, speech therapists, X-ray technicians) and non-health care providing adults (the general population) were asked to respond to a questionnaire regarding their routine measures for maintaining oral health Results:, Three hundred and twenty-six healthcare providers and 95 non-healthcare providers participated in the study. Regarding toothbrushing, flossing, undergoing periodic dental examinations and professional scaling/polishing, dental practitioners have better, but not perfect, maintenance habits than other healthcare providers. Non-dental healthcare providers have better dental habits than the general population, and nurses and medical practitioners have better dental habits than medics, paramedics, corpsmen and para-medical professionals. Among non-dental healthcare providers, nurses have a relatively high frequency of toothbrushing and flossing but a low frequency of periodic examinations and scaling/polishing. Generally, females reported significantly higher frequencies of toothbrushing and flossing than males did. The toothpaste selection of the participants was primarily influenced by dentists' recommendations, the flavour of the toothpaste, and its anti-malodour effect were the most dominant factors. Conclusion:, The compliance of health professionals, especially dental practitioners, with appropriate oral health measures is relatively high. However, the dental team cannot always assume that the dental patient, who also happens to be a healthcare provider, has meticulous oral habits. The dental hygienist and surgeon have to educate and motivate their patients, especially healthcare providers because of the influence of the latter on their own patients. [source] Measuring the shortage of medical practitioners in rural and urban areas in developing countries: a simple framework and simulation exercises with data from IndiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2008Homi Katrak Abstract This paper suggests a simple framework to estimate the shortage of medical practitioners in rural and urban areas in developing countries. Shortages are defined with respect to four main considerations. The overall numbers and also the different categories of practitioners in the rural and urban areas, the relatively greater difficulties of access in the rural areas (which reduce the number of accessible practitioners) and the greater health hazards in those areas (which lead to greater need for medical treatment). The quantitative effect of these factors is examined by undertaking simulation exercises with data for the Ujjain district in Madhya Pradesh state, India and also data for that state. The simulations turned up the following results. The un-weighted total number of practitioners, per head of population, is relatively greater in the rural areas; this is because of the relatively large numbers of the unqualified doctors in those areas. On the other hand, a ,quality adjusted' total, with lower weights for the unqualified doctors, found little overall difference between the rural and urban areas. Third, allowance for rural,urban differences in the difficulties of access showed that the number of accessible practitioners is much lower in the rural areas. Fourth, rural,urban differences in the incidence of health hazards and estimates of the need for medical treatment also showed a marked shortage of practitioners in the rural areas. The main implication of the results is that developmental efforts in the rural areas, including improvements in transport facilities and reduction of health hazards, would help to greatly reduce the shortage of practitioners in those areas. Training programmes to improve the quality of practitioners in the rural areas are also required. Copyright © 2007 John Wiley & Sons, Ltd. [source] Mental health nurse practitioners in Australia: Improving access to quality mental health careINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2005Jacklin E. Fisher ABSTRACT:, Under The Nurses Amendment (Nurse Practitioners) Act 1998, New South Wales became the first state in Australia to legislate for nurse practitioners. Mental health was identified as a priority ,area of practice' for nurse practitioners. Issues surrounding the implementation of the nurse practitioner role in Australia and the potential for the role to address the current crisis in mental health nursing and the mental health sector will be discussed. The potential for partnerships with other health-care providers, in particular medical practitioners, will demonstrate how successful implementation of the role can fulfil consumer demand for primary prevention counselling, improve access to mental health services and early intervention, and provide mental health services that better reflect national priorities. This examination of the Australian context will be contrasted with a review of the overseas literature on mental health nurse practitioners. [source] "Luring Overseas Trained Doctors to Australia: Issues of Training, Regulating and Trading"INTERNATIONAL MIGRATION, Issue 4 2009Robyn Iredale Australia is at a crossroads. Its long history of relying on overseas trained medical practitioners and the last decade's changes, in terms of the introduction of policies to recruit large numbers of temporary doctors, both require examination. Not only is Australia alone in its overt policy initiatives but it also fails to be aware of the consequences for some sending countries. Australia has not entered into the spirit of international attempts to ameliorate the potential effects of developing-to-developed country medical migration and trade. This paper will provide an overview of the current international situation regarding supply and demand, major ethical issues, Australia's immigration policies and regulatory framework and the situation with respect to the labour market integration of overseas trained doctors (OTDs). It will be argued that Australia ,lures' with little concern for the consequences for source countries. [source] Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctorsJOURNAL OF ADVANCED NURSING, Issue 3 2006Miriam Griffin MSc RGN PGCSNP Aim., This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department. Background., The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high-quality and cost-effective care to persons who seek help for non-urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role. Methods., A questionnaire survey was carried out, and a 29-item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open-ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004. Findings., An overall response rate of 74·8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff. Conclusion., There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries. [source] Ethical issues in biotechnologies and international tradeJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 5 2002Joseph H Hulse Natural and physical sciences are based on determinable facts. What is ethical, as distinct from illegal, is largely a matter of opinion. Scientific and industrial activities related to ancient and modern biotechnologies are among the most critically scrutinised for ethical probity by social activists and journalists. The practices and products of biotechnologies should be judged both deontologically , by motivation and intention, and teleologically , by determinable consequence. Bioethical criteria have been proposed by governments, medical practitioners and philosophers for many centuries. During the past decade, various scientifically competent organisations, national and international, have formulated comprehensive protocols by which to determine effectiveness and safety of novel foods, pharmaceuticals and other biologicals, including those derived from genetically modified organisms. Means and opportunities by which to satisfy the health and nutritional needs of impoverished nations and communities differ significantly from those who enjoy greater affluence. It is distinctly unethical for Europeans and North Americans, whose food and health securities are not at risk, to impose their ethical predilections on poorer nations. Equally reprehensible are the diverse tariff and non-tariff barriers to equitable international trade, and acts of biopiracy inflicted upon poorer nations. As a wise Asian sage has observed, the planet's resources and scientific ingenuity are sufficient to satisfy everyone's need, but not everyone's greed. Present and predictable world-wide demand for bioscientists and bioengineers exceeds best estimates of supply. Systematically planned, long-term investments by governments and bioindustries to generate adequate qualified men and women are urgently needed. © 2002 Society of Chemical Industry. [source] Psychotherapy in Australia: Clinical psychology and its approach to depressionJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2007David J. Kavanagh In Australia, clinical psychology training is dominated by cognitive and behavioral treatments (CBTs), although there is exposure to other theoretical orientations. Since 2001, over 20% of general medical practitioners (GPs) have received training in CBT, and psychiatry training increasingly incorporates CBT elements. Psychotherapy by medical practitioners is financially supported by universal health care funding with supplementation by patients and their private health insurance. Federally funded health benefits for up to 12 psychology consultations per year are provided on referral from GPs and psychiatrists, and initial takeup has been very strong. Mrs. A would be a typical patient for such a referral. However, she would not fulfill criteria for priority access from state-funded mental health services. Mrs. A would probably consult a GP and receive antidepressants, although she may also access a range of other community support programs. Access to and acceptance of psychotherapy would be greater in urban areas, and if she were of Anglo-Saxon and nonindigenous origin. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 725,733, 2007. [source] The rationale of value-laden medicineJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2002Michael H. Kottow MA(Soc) MD Abstract Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health-enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived-body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value-laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services. [source] Control of Environmental Lighting and Its Effects on Behaviors of the Alzheimer's TypeJOURNAL OF INTERIOR DESIGN, Issue 2 2002Melinda La Garce M.F.A. ABSTRACT The study investigates environmental lighting interventions designed to control the natural daylight effects of the setting sun and resultant behavior change. The purpose of this study was to determine if the frequency of disruptive behaviors of the Alzheimer's type that are defined across the literature to include wandering, anxiousness, combativeness, negative verbalizations, pilfering/hoarding, inappropriate sexual behavior, inappropriate emotional behavior, attention seeking, repetitive statements, and behaviors that are apparently precipitated and/or intensified by the effects of the setting sun i.e., changes in color, angles, and intensity of daylight, can be altered by environmental lighting interventions designed to control the daylight effects of the setting sun. This learning/practice partnership brought together the diverse expertise of research team members and provided new ways of examining research questions. Subjects were evaluated by medical practitioners to determine the probable presence of Alzheimer's disease. Disruptive behaviors were identified by trained observers reviewing 100 hours of videotaped observation, and videotaped observations of the subjects continued as subjects rotated monthly for four months between two apparently identical environments,one controlled and one experimental using environmental lighting interventions. Trained observers made double blind observation of subjects and recorded the frequency of disruptive behaviors on behavior observation checksheets. Tabulations of the disruptive behaviors were made, and percentage of change was calculated. A drop of 41% in the disruptive behaviors of subjects, while in the experimental environment, was demonstrated in the first rotation cycle, and an 11 % drop in disruptive behaviors was found in a second cycle. Inter-rater reliability across all tapes was 70%. Individuals exhibiting the highest frequencies of disruptive behaviors also demonstrated the most dramatic decreases in these behaviors while in the experimental environment. Environmental lighting interventions designed for this study appear to lessen the detrimental behavioral| effects of the setting sun on the behaviors of individuals with Alzheimer's disease. [source] Some implications for nurses and managers of recent changes to the processing and hearing of medical negligence claimsJOURNAL OF NURSING MANAGEMENT, Issue 3 2000DIPLAW, Fletcher BA, MPHIL Aim This paper considers some possible implications for individual nurses and their managers of moves to delegate tasks formerly undertaken by medical practitioners to nurses, in the light of recent changes in the legal process, relating to the funding and the hearing of cases of medical negligence. Background It is suggested that the introduction of a system of conditional fees, under which lawyers will only recover their costs if they win cases, may lead to a more specialist approach to negligence claims and to greater scrutiny of medical evidence. The implications of the recent ,Bolitho' judgement, when judges for the first time subjected expert medical testimony to their own independent analysis, are also explored. Findings It is suggested that in the light of the disparities in the training of medical and nursing personnel and in their disciplinary processes, and in view of the lack of consensus about what training is necessary for those who will substitute for junior doctors, or represent themselves as ,practitioners', ,specialists', or ,consultants', that nurses may in the future find themselves more directly involved in civil proceedings. [source] Emergency department attendances associated with drug-related problems in paediatricsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2003KL Easton-Carter Objectives: To determine the frequency and characteristics of paediatric emergency department attendances associated with drug-related problems (DRP) at three Victorian hospitals. Methods: All paediatric medical patients attending the emergency department of the Royal Children's Hospital, Geelong Hospital or Box Hill Hospital were considered for inclusion. The investigator and attending medical practitioners screened eligible patients. A multidisciplinary panel reviewed collated data. Causality, preventability and clinical significance classifications were established by the panel. Results: Combining data from the three hospitals, over 18 weeks of data collection, a total of 8601 patients met the eligibility criteria. Of these, 280 (3.3%, 95% CI 2.9,3.7%) were determined to have emergency department attendances associated with DRP. Of the 187 cases assessed for preventability, 51.3% were judged to be preventable. Conclusions: Emergency department attendances are associated with DRP in paediatrics. Given that the need to prevent DRP in adults is recognized, it is now time to act to reduce the consequences of DRP in paediatrics. [source] Resources Used by General Practitioners for Advising Travelers from New ZealandJOURNAL OF TRAVEL MEDICINE, Issue 2 2000Peter A. Leggat Background: The risks of the destination and any specific requirements for travel health advice may be obtained from a variety of resources. This study was designed to investigate the usefulness of various resources available in New Zealand for providing travel health advice and the extent to which GPs used these resources in providing travel health advice. Methods: Four hundred GPs (400/2830) were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. Results: Three hundred and thirty-two (332/400, 83%) GPs responded. The usefulness of various resources was reported, including Health Advice for Overseas Travellers (277/289, 96%), New Ethicals (256/278, 92%), New Zealand Public Health Report (79/164, 48%), International Travel and Health (41/144, 28%), computerized databases (6/122, 5%), journals (14/130, 11%), and other resources (44/139, 32%). Health Advice for Overseas Travellers was regarded as significantly more useful than International Travel and Health (x2= 4,68, df = 1, p < .05). Only 23% (70/309) of respondents indicated that they always used these resources in their practice of travel medicine. Fifty percent (154/309) of respondents indicated that they usually used these resources, while 27% (83/309) of respondents indicated that they used these resources sometimes. Only 1% (2/309) of GPs did not use resources at all for their practice of travel medicine. Conclusion: The most useful resource was Health Advice for Overseas Travellers, which outlines the New Zealand recommendations for medical practitioners providing travel health advice. It may be useful for GPs to gain access to and training in association with a greater range of specialist resources to use in conjunction with the provision of travel health advice. These might include international guidelines, journals, and access to computerized databases and the internet. With the recent introduction of a widely accessible computerized database in New Zealand, follow-up studies could be instituted to determine if GPs' use of computerized databases becomes more widespread and whether access to and use of these computerized databases influences the provision of travel health advice by GPs. Further studies are needed to examine the appropriateness of the advice provided by the various resources used by GPs in New Zealand. [source] Helicobacter pylori and dyspepsia: physicians' attitudes, clinical practice, and prescribing habitsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2002H. J. O'Connor Background: Consensus guidelines have been published on the management of Helicobacter pylori infection and it is assumed that these guidelines are adhered to in clinical practice. Aim: To assess the changing attitudes of medical practitioners to H. pylori, and the impact of H. pylori infection on everyday clinical practice and prescribing patterns. Methods: Data for this review were gathered up to December 2000 from detailed review of medical journals, the biomedical database MEDLINE, and relevant abstracts. Results: Physician surveys show widespread acceptance of H. pylori as a causal agent in peptic ulcer disease. Gastroenterologists adopted H. pylori therapy for peptic ulcer earlier and more comprehensively than primary care physicians. Despite a low level of belief in H. pylori as a causal agent in nonulcer dyspepsia and gastro-oesophageal reflux disease (GERD), H. pylori therapy is widely prescribed for these conditions. Proton pump inhibitor-based triple therapy is the eradication regimen of choice by all physician groups. In routine clinical practice, there appears to be significant under-treatment of peptic ulcer disease with H. pylori therapy, but extensive use for nonulcer indications. Prescription of H. pylori treatment regimens of doubtful efficacy appears commonplace, and are more likely in primary care. Despite the advent of H. pylori therapy, the prescription of antisecretory therapy, particularly of proton pump inhibitors, continues to rise. Conclusions: Publication of consensus guidelines per se is not enough to ensure optimal management of H. pylori infection. Innovative and ongoing educational measures are needed to encourage best practice in relation to H. pylori infection. These measures might be best directed at primary care, where the majority of dyspepsia is managed. [source] "I Never Wanted to Be a Quack!"MEDICAL ANTHROPOLOGY QUARTERLY, Issue 2 2010The Professional Deviance of Plaintiff Experts in Contested Illness Lawsuits: The Case of Multiple Chemical Sensitivities When medical practitioners act as expert witnesses for the plaintiff in contested illness lawsuits, they can be stigmatized by their professional community. Drawing on ethnographic research surrounding the condition multiple chemical sensitivities (MCS) in Australia, this article focuses on: how plaintiff experts specialize; their rationale for deviance from the professional norm; and structural constraints to medical advocacy. By diagnosing and treating the condition as organic, these experts oppose the accepted disease paradigm of the medical community and therefore face professional isolation and peer pressure. They rationalize their continued advocacy within a moral discourse, which includes a professional aspiration toward altruism, an ethical commitment to "truth," and the explicit emphasis that financial gain is not a motivation. For their deviance the experts have been confronted with professional disillusionment and emotional drain. Ultimately, the medical profession is disenfranchising experts who may be vital characters in the quest for understanding about environmental illnesses. [source] |