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Community Practice (community + practice)

Distribution by Scientific Domains

Medical Sciences	73%
Psychology	15%

Selected Abstracts

The Cultural Mainstreaming Clause of Article 151(4) EC: Protection and Promotion of Cultural Diversity or Hidden Cultural Agenda?

EUROPEAN LAW JOURNAL, Issue 5 2006
Evangelia Psychogiopoulou
The cultural cross-sectional clause of Article 151(4) EC, by calling for a reshaping of EC decision-making in other policy areas, which have to give due consideration to the impact they might have on cultural matters, enables the attainment of cultural objectives under EC headings other than Article 151 EC. In an attempt to inquire into this less-widely discussed facet of EC cultural action, the analysis highlights the principal characteristics of Article 151(4) EC and explores the influence it has exerted on both judicial and legislative Community practice. [source]

Electrocardiogram Differentiation of Benign Early Repolarization Versus Acute Myocardial Infarction by Emergency Physicians and Cardiologists

ACADEMIC EMERGENCY MEDICINE, Issue 9 2006
Samuel D. Turnipseed MD
Abstract Objectives: ST-segment elevation (STE) related to benign early repolarization (BER), a common normal variant, can be difficult to distinguish from acute myocardial infarction (AMI). The authors compared the electrocardiogram (ECG) interpretations of these two entities by emergency physicians (EPs) and cardiologists. Methods: Twenty-five cases (13 BER, 12 AMI) of patients presenting to the emergency department with chest pain were identified. Criteria for BER required four of the following: 1) widespread STE (precordial greater than limb leads), 2) J-point elevation, 3) concavity of initial up-sloping portion of ST segment, 4) notching or irregular contour of J point, and 5) prominent, concordant T waves. Additional BER criteria were 1) stable ECG pattern, 2) negative cardiac injury markers, and 3) normal cardiac stress test or angiography. AMI criteria were 1) regional STE, 2) positive cardiac injury markers, and 3) identification of culprit coronary artery by angiography in less than eight hours of presentation. The 25 ECGs were distributed to 12 EPs and 12 cardiologists (four in academic medicine, four in community practice, and four in community academics [health maintenance organization] in each physician group). The physicians were informed of the patients' age, gender, and race, and they then interpreted the ECGs as BER or AMI. Undercalls (AMI misdiagnosed as BER) and overcalls (BER misdiagnosed as AMI) were calculated for each physician group. Results: Cardiologists correctly interpreted 90% of ECGs, and EPs correctly interpreted 81% of ECGs. The proportion of undercalls (missed AMI/total AMI) was 2.8% for cardiologists (95% confidence interval [CI] = 0.09% to 5.5%) compared with 9.7% for EPs (95% CI = 4.8% to 14.6%) (p = 0.02). The proportion of overcalls (missed BER/total BER) was 17.3% for cardiologists (95% CI = 11.4% to 23.3%) versus 27.6% for EPs (95% CI = 20.6% to 34.6%) (p = 0.03). The mean number of years in practice was 19.8 for cardiologists (95% CI = 19 to 20.5) and 11 years for EPs (95% CI = 10.5 to 12.0) (p < 0.001). Conclusions: Although correct interpretation was high in both groups, cardiologists, who had significantly more years of practice, had fewer misinterpretations than EPs in distinguishing BER from AMI electrocardiographically. [source]

Children speak about neighborhoods: using mixed methods to measure the construct neighborhood

JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2008
Nicole NicoteraArticle first published online: 18 MAR 200
This study contributes to the knowledge base of community practice and research by examining the construct neighborhood from qualitative and quantitative perspectives. Mixed methodology was employed to explore the associations and discrepancies between a census measure of neighborhood based in social disorganization theory and a qualitative measure based on the voices of children (N=59). Qualitative results indicate nine dimensions of the construct neighborhood that are not found in census-based measures of the construct. Mixed methods results demonstrate that children in both higher and lower socially disorganized neighborhoods express the presence of neighborhood resources and neighborly affiliations as well as negative neighborhood experiences. Expressions of fear, needs for safety, and qualities of unsavory characters distinguish the two types of neighborhoods. © 2008 Wiley Periodicals, Inc. [source]

Integrating pediatric hospitalists in the academic health science center: Practice and perceptions in a canadian center,,

JOURNAL OF HOSPITAL MEDICINE, Issue 4 2010
FRCPC, Sanjay Mahant MD
Abstract BACKGROUND: The integration of hospitalists in academic settings has been identified as a challenge to the hospitalist movement. The Division of Pediatric Medicine, Hospital for Sick Children, Toronto, was established in 1981, providing a rich resource to examine this field in the academic context and inform academic program development. OBJECTIVES: To explore the characteristics, practice, perceptions, and contributions of pediatric hospital medicine in an academic health science center (AHSC). METHODS: A cross-sectional survey of physicians attending on the pediatric medicine inpatient unit (PMIU) (n = 20). RESULTS: Clinical activity included attending on the PMIU, consultation and comanagement outside the PMIU, and outpatient care of "hospital intense" patients. There was a high level of engagement in research, education, and quality improvement activities. Perceived advantages to a career as a hospitalist included: working in a team; generalist approach to care; stability relative to community practice; intellectually stimulating and rewarding work; and growing area for scholarship. Perceived disadvantages to a career as a hospitalist included: burnout; recognition and respect; and lack of long-term relationships with patients. Themes regarding barriers to establishing a career as a hospitalist in an AHSC were as follows: burnout; time and skills to develop an academic niche; balance between clinical and academic priorities; and system for career advancement. CONCLUSIONS: The contributions of pediatric hospitalists to the academic mission were diverse. Fellowship training, faculty development, and balance between time allocated to direct patient care and academic pursuits should be defined. This will help ensure career development, viability, and realization of excellence in the academic context. Journal of Hospital Medicine 2010;5:228,233. © 2010 Society of Hospital Medicine. [source]

,You tell all the stories': Using narrative to explore hierarchy within a Community of Practice1

JOURNAL OF SOCIOLINGUISTICS, Issue 5 2006
Emma Moore
Recent discussion of the Community of Practice (CofP) (Davies 2005) has suggested that there are certain limitations to the approach with regard to how it accounts for internal hierarchy and community membership. Eckert and Wenger (2005: 588) have suggested that the only way to evaluate such criticism (and avoid building an inappropriately rigid conception of power into CofP theory) is to explore how hierarchies operate within CofPs. This paper offers such an exploration. Using data from a long-term ethnographic study of a high school in the north-west of England, this paper will use narrative analysis (drawing upon the work of Labov and Waletsky [1967] 1997 amongst others) to explore the interactional space in which speakers actively negotiate their personal and community behaviour. The analysis focuses upon the role individuals play as narrators of community practice and illustrates that status inequalities between individual CofP members do not necessarily result in inequitable allocation of control within the CofP. [source]

Superficial community-acquired skin infections: prevalence of bacteria and antibiotic susceptibility in France

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 12 2009
G Lorette
Abstract Objective, Evaluation of the susceptibility to currently used antibiotics of bacteria, particularly S. aureus isolated from superficial community- acquired skin infection and to compare results with those from an earlier study. Methods, Every dermatologist in community practice participating in the study was asked to include the first two patients consulting them for superficial cutaneous bacterial infection. Swab specimens collected from the skin infection were sent to a central laboratory. Results, The dermatologist enrolled 390 patients in the study. The rate of positive culture was 49%, 259 bacterial strains were isolated. S. aureus was the major species (56.8% of all isolated strains). S. aureus was resistant to methicillin in 4%. All strains of S. aureus were susceptible to pristinamycin and mupirocin. Conclusions, The results of the two epidemiological studies of superficial community acquired skin infections with a comparable methodology at a 6-year interval demonstrated that the prevalence of CA-MRSA skin infection remained low in this setting. [source]

Treatment considerations for clinicians in applying evidence-based practice to complex presentations in child trauma,

JOURNAL OF TRAUMATIC STRESS, Issue 4 2007
Lisa Amaya-Jackson
Professionals in the child trauma field, eager to bring best practices to children and their families who have suffered from traumatic life events, have developed a number of evidence-based treatments (EBTs) and promising practices available for adoption and implementation into community practice. Clinicians and researchers alike have raised questions about "if, when, and how" these EBTs can be applied to some of the more complex trauma presentations seen in real world practice. The authors take an evidence-based practice approach, including critical appraisal of clients' unique needs and preferences, utilizing applicable trauma treatment core components and current EBTs, and emphasizing monitoring strategies of client progress, particularly when needing to adapt EBTs for select clients. [source]

Doctors' perspectives on their innovations in daily practice: implications for knowledge building in health care

MEDICAL EDUCATION, Issue 10 2008
Maria Mylopoulos
Context, When individuals adapt their practice in order to solve novel or unexpected problems of practice, they are creating new knowledge. This form of innovation development is understood as a core competency of adaptive expertise and the basis for knowledge building community practice. However, little is known about the ways in which this knowledge, produced through daily, innovative problem solving, is developed, identified and shared by health care professionals. Methods, Following this line of inquiry, we conducted semi-structured interviews with a saturation sample of 15 clinical faculty staff at the University of Toronto. Results, A grounded theory analysis of the results showed that our participants held the view that innovation was focused on outcomes, developed through research practice and diffused for adoption in the broader community. As a result, their own individual improvements to daily practice were excluded from this view of innovation. Furthermore, their perceptions of innovation limited participants' engagement in the sort of collaborative process that is central to the practice of knowledge-building communities. Conclusions, This research demonstrated that thinking about innovation and innovative practice must be changed in order to foster the development of knowledge-building communities in medicine. [source]

A Qualitative Case Study Review of Role Transition in Community Nursing

NURSING FORUM, Issue 4 2007
Joyce Zurmehly PhD
PURPOSE.,This paper aims to describe existing community nursing practices and to explore factors that are associated with the transition of clinical practice from acute care settings to community care settings. METHOD.,This qualitative case study assessment described existing community nurse practices and explored factors that were associated with the transition to community practice from acute care settings. The 48 participants in this case study were registered nurses who were working in community care nursing during the interview process. CONCLUSIONS.,The results of this investigation revealed themes derived from data collection, including autonomy, client and family, education, and community as nursing work. This study indicated that making the transition to community-based nursing includes conceptual as well as emotional adjustments. Community nursing practice was seen by the participants as nursing that captures a holistic approach incorporating multiple dimensions from psychological, sociological, economic, and physical to spiritual aspects that provides services in interaction between the community nurse, the client, and the family. The findings indicate a need for additional supportive preparation strategies incorporated into nursing orientation and continuing education programs. Future research investigating agency culture and socialization would provide a more definitive survey of perceptions and competencies needed for role. [source]

A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role

OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2008
Justin J. Needle
Abstract Purpose:, Recent changes in medicines legislation in the UK have broadened the opportunities for optometrists to use and supply therapeutic drugs. We set out to investigate the current therapeutic practice of UK optometrists and to elicit their views on an extended prescribing role. Methods:, Members of the College of Optometrists were invited via email to take part in an online survey. The survey questions covered four areas: mode of practice, proximity and relationship to other providers of eye care, scope of current therapeutic practice and future plans regarding prescriber training. Results:, Of the 1288 responses received (response rate 24%), over 90% were from optometrists working in community practice. Common, non-sight-threatening conditions were managed frequently or occasionally by between 69 and 96% of respondents. Blepharitis and dry eye were the most common (managed routinely by >70%). In terms of therapeutic agents used, large numbers of optometrists reported that they commonly supplied or recommended over-the-counter (non-prescription) drugs, particularly lubricants and anti-allergic agents. However, fewer respondents supplied antibiotics (only 14% supplying chloramphenicol or fusidic acid frequently). Overall, relatively few respondents (14%) expressed no interest in undertaking further training for extended prescribing, although several barriers were identified, including cost and time taken for training, lack of remuneration and fear of litigation. Conclusion:, Significant numbers of community optometrists are currently managing a range of common ocular conditions using a limited formulary. Enabling optometrists to train as independent prescribers will further develop this role, allowing greater use of their skills and providing patients with quicker access to medicines. [source]

Antibiotic utilisation in community practices: guideline concurrence and prescription necessity,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2005
Susan Jelinski PhD
Abstract Purpose To evaluate the indications, concurrence with prescribing guidelines and potential necessity for antibiotic (AB) prescriptions written in community practice. Methods We reviewed the charts of all patients with infection-related illnesses seen by family physicians during two random days of regular practice between 1 Oct 1997 and 30 Jan 1998. Guideline concurrence of AB prescribing was assessed using regional AB prescribing guidelines. Likelihood of AB indication for respiratory tract infections was assessed using published clinical practice guidelines for determination of likely viral versus bacterial etiology. Results Of 4218 visits captured, 949 (22%) were for newly acquired infections. Sixty four percent (n,=,604) of consultations for newly acquired infections resulted in an AB prescription. Based on the doctors' diagnoses, 61% of AB prescriptions were concurrent with prescribing guidelines, 10% were for the wrong drug, 20% were not indicated and in 10% of cases a lower line AB was available. For respiratory tract infections, 12% of these infections were likely bacterial, whereas the physicians determined that 56% were bacterial. Conclusions A large proportion of ABs administered in community practices were not in concurrence with community AB prescribing guidelines. Improvements can be made in AB choice and in decisions about likely viral etiology for respiratory tract infections. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Evaluation of Culture and Antibiotic Use in Patients With Pharyngitis,

THE LARYNGOSCOPE, Issue 10 2006
Justin B. Rufener MD
Abstract Objectives: The objectives of this study were to evaluate practice patterns for treatment of patients with pharyngitis with regard to testing for group A beta hemolytic streptococcal (GABHS) infection, frequency of antibiotic use, and appropriate choice of antibiotics. Study Design: The authors conducted a retrospective review of billing data for 10,482 office visits for pharyngitis. Methods: The 2004 billing database for a tertiary institution was queried for outpatient visits for pharyngitis or tonsillitis, group A Streptococcus tests (GAST), and antibiotic prescriptions filled after the visit. Patients were separated by age group and analyzed for the proportion of patients that received a GAST and proportion prescribed an antibiotic. Antibiotic prescriptions were also analyzed to determine whether they were appropriate for treatment of GABHS. Results: A total of 68.7% of all patients and 82.2% of pediatric patients were tested for GAST. A total of 47.1% of adult patients and 44.9% of pediatric patients received an antibiotic. For adult patients for whom GAST was obtained, 48.6% were prescribed an antibiotic versus 53.6% of those not tested. Streptococcus testing was a significant predictor of antibiotic use (P < .0001), whereas age was not (P = .22). A total of 82.1% of all antibiotics prescribed were recommended for treatment of GABHS. Conclusions: Most patients seen for pharyngitis were tested for GABHS, but pediatric patients were tested more frequently than adults. Patients who received a GAST were less likely to receive antibiotics. The rates experienced in our tertiary academic institution are higher than previously quoted for community practice. When antibiotics were prescribed, they were usually appropriate for the treatment of GABHS based on current recommendations. [source]

Combination therapy with fludarabine and rituximab followed by alemtuzumab in the first-line treatment of patients with chronic lymphocytic leukemia or small lymphocytic lymphoma

CANCER, Issue 6 2008
A phase 2 trial of the Minnie Pearl Cancer Research Network
Abstract BACKGROUND The purpose of the current study was to evaluate the efficacy and toxicity of the combination of fludarabine and rituximab, followed by alemtuzumab, as first-line treatment for patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). METHODS In a nonrandomized phase 2 trial, 41 patients who had previously untreated CLL or SLL and required treatment received 4 cycles of the fludarabine and rituximab combination followed 5 weeks later by 4 weeks (12 doses) of intravenous alemtuzumab therapy. The response to treatment was evaluated after completion of treatment with fludarabine and rituximab, and again after the completion of alemtuzumab consolidation. RESULTS Initial treatment with the combination of fludarabine and rituximab was well tolerated, and produced a 71% overall response rate (13% complete response). Thirty-four patients began treatment with intravenous alemtuzumab, but this drug was relatively poorly tolerated when given at a short interval after fludarabine and rituximab, and only 20 patients (49% of total) were able to complete the prescribed course. Five patients had an improvement in their response with alemtuzumab; the final complete response rate was 21%. The median progression-free survival for the entire group was 42 months. Toxicity with alemtuzumab included infusion-related toxicity, myelosuppression, and opportunistic infections. CONCLUSIONS The intravenous schedule of alemtuzumab employed in the trial was relatively poorly tolerated in this community-based trial. The relatively low complete response rates after treatment with the combination of fludarabine and rituximab and after the completion of treatment suggest that these abbreviated courses may compromise efficacy. The generalized use of alemtuzumab as consolidation therapy cannot yet be recommended for community practice. However, optimization of the route of administration, duration of treatment, and interval after completion of induction therapy may improve efficacy, and further investigation is ongoing. Cancer 2008. © 2008 American Cancer Society. [source]

Screening mammography performance and cancer detection among black women and white women in community practice

CANCER, Issue 1 2004
Karminder S. Gill M.S.P.H.
Abstract BACKGROUND Despite improvement in mammography screening attendance, black women continue to have poorer prognosis at diagnosis than white woman. Data from the Carolina Mammography Registry were used to evaluate whether there may be differences in mammography performance or detected cancers when comparing black women with white women who are screened by mammography. METHODS Prospectively collected data from community-based mammography facilities on 468,484 screening mammograms (79,397 in black women and 389,087 in white women) were included for study. Mammograms were linked to a pathology data base for identification of cancers. Sensitivity, specificity, positive predictive value, and cancer detection rates were compared between black women and white women. Logistic regression methods were used to control for covariates associated with performance characteristics. Differences in cancer characteristics were compared between black women and white women using chi-square statistics. RESULTS Screening mammography performance results for black women compared with white women were as follows: sensitivity, odds ratio (OR) = 1.07 (95% confidence interval [95% CI], 0.83,1.39); specificity, OR = 1.02 (95% CI, 0.98,1.06); and positive predictive value, OR = 1.07 (95% CI, 0.94,1.23). Among women with no previous screening, black women had a larger proportion of invasive tumors that measured , 2 cm (38% vs. 26%; P = 0.04). The cancer detection rate was highest among black women who reported symptoms at screening (13.9 per 1000 black women vs. 7.9 per 1000 white women). Invasive cancers in black women were poorer grade (P = 0.001), and more often had negative estrogen receptor status and progesterone receptor status (P < 0.001). CONCLUSIONS Overall, screening mammography performed equally well in black women and white women controlling for age, breast density, and time since previous mammogram. Black women who reported symptoms had larger and higher grade tumors compared with white women. Educational efforts need to be strengthened to encourage black women to react sooner to symptoms, so that the tumors detected will be smaller and black women will have a better prognosis when they appear for mammography. Cancer 2004;100:139,48. © 2003 American Cancer Society. [source]

International Emergency Medicine and the Role for Academic Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 5 2007
Kumar Alagappan MD
International emergency medicine continues to grow and expand. There are now more than 30 countries that recognize emergency medicine as a specialty. As the field continues to develop, many physicians are reaching across borders and working with their colleagues to improve patient care, education, and research. The future growth and success of the specialty are based on several key components. These include faculty development (because this is the key driver of education), research, and curriculum development. Each country knows what resources it has and how best to utilize them. Countries that are developing the specialty can seek consultation from successful countries and develop their academic and community practice of emergency medicine. There are many resources available to these countries, including distance learning and access to medical journals via the Internet; international exchanges by faculty, residents, and medical students; and physicians who are in fellowship training programs. International research efforts require more support and effort to be successful. This report discusses some of the advantages and hurdles to such research efforts. Physicians have a responsibility to help one another succeed. It is the hope of the authors that many more emergency physicians will lend their skills to further global development of the specialty. [source]

Acute Coronary Syndrome in the Elderly

CLINICAL CARDIOLOGY, Issue 11 2009
Madhan Shanmugasundaram MD
The spectrum of acute coronary syndrome (ACS) including unstable angina, non,ST-elevation myocardial infarction and ST-elevation myocardial infarction accounts for increasing numbers of deaths among persons age , 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardial medications as an early-invasive approach among this population. Copyright © 2009 Wiley Periodicals, Inc. [source]

Expectations and motivations of Hondurans migrating to the United States

JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 3 2007
Jana Sladkova
Abstract This study explores the expectations and decision-making processes of potential migrants at a community in Honduras. Hondurans have become one of the fastest growing populations in New York. Yet, although approximately 80,000 Hondurans try to reach the US annually, only 25 per cent succeed. To reach the United States they must undergo a dangerous journey across Guatemala and Mexico, a process to date under-researched by social sciences. As new undocumented migrant streams continue to expand within the global economies, scholars and practitioners who work on their behalf should understand the pre-migration values and expectations because they shape the way migrants adjust to and develop new cultural patterns in the receiving countries. Drawing on immigration and narrative theory, I hypothesize that narratives of migration from media, prior migrants, coyotes and community practices play an important role in the construction of potential migrant expectations. To represent narratives across several individual and community domains, the research design includes individual interviews, analysis of local newspapers, participant observations and teaching English classes. Analysis across these data reveals complex dilemmas potential migrants face as they weigh the costs and benefits of migration. Copyright © 2007 John Wiley & Sons, Ltd. [source]