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The view of delivery by practitioners in routine episiotomy: a qualitative Study
Soghra Khani,Marjan Ahmad Shirvani,Masoomeh Bagheri Nesami
Journal of Mazandaran University of Medical Sciences , 2009,
Abstract: (Received 21 Aug, 2008; Accepted 14 Jan, 2009)AbstractBackground and purpose: Many studies have determined desirable outcomes of elective episiotomy. However, the clinical practice is not based on results in many hospitals. For this reason, the present study assessed the view of practitioners regarding routine episiotomy.Materials and methods: This qualitative study was done by content analysis. A through semi-structured interview was done with obstetricians, midwives and midwifery trainers. After gathering information, common points of interviews were coded and stratified. Continuous comparison was done to obtain confidence of internal constancy in coding. For validity and reliability, three members of group coded the interviews independently, followed by defining the final theme. Themes were then returned to participants for confidence of their accuracy.Results: Twenty-four participants were assessed. Factors that influence the usage of routine episiotomy included 5 total concepts. Also, some partial concepts appeared as subcategory of total concepts. They were: 1. delivery agent (personal experience, skill, deficit of agents, fatigue and impatience, low knowledge, ability of communication with mother, and agent's role); 2. Mother (prevention and decline of injuries, anatomical differences, culture, not cooperating and, diseases); 3. Fetus (prevention and decline of trauma, conditions); 4. Legal problems (mother's complaints, remonstrance by seniors). 5. Method of management (non availibity of advanced technology, non usage of new methods for delivery, Mothers not being prepared).Conclusion: In a prolonged clinical practice, such as routine episiotomy, change is difficult. As studies recommend the limited use of episiotomy, intervention is necessary for changing practitioners' attitude and practice. Training of delivery agents, students and pregnant women are basic.
How the relationships between general practitioners and intensivists can be improved: the general practitioners' point of view
Bérengère Etesse, Samir Jaber, Thibault Mura, Marc Leone, Jean-Michel Constantin, Pierre Michelet, Lana Zoric, Xavier Capdevila, Fran?ois Malavielle, Bernard Allaouchiche, Jean-Christophe Orban, Pascale Fabbro-Peray, Jean-Yves Lefrant, the AzuRéa Group
Critical Care , 2010, DOI: 10.1186/cc9061
Abstract: An anonymous questionnaire was mailed to 7,239 GPs. GPs were asked about their professional activities, postgraduate intensive care unit (ICU) training, the rate of patient admittance to ICUs, and their relationships with intensivists. Relationship assessment was performed by using a graduated visual analogue scale (VAS) ranging from 0 (dissatisfaction) to 100 (satisfaction). A multivariate analysis with stepwise logistic regression was performed to isolate factors explaining dissatisfaction (VAS score, < 25th percentile).Twenty-two percent of the GPs (1,561) responded. The median satisfaction score was 57 of 100 (interquartile (IQ), 35 to 77]. Five independent factors of dissatisfaction were identified: no information provided to GPs at patient admission (odds ratio (OR) = 2.55 (1.71 to 3.80)); poor quality of family reception in the ICU (OR = 2.06 (1.40 to 3.02)); the ICU's family contact person's identity or function or both is unclear (OR = 1.48 (1.03 to 2.12)), lack of family information (OR = 2.02 (2.48 to 2.75)), and lack of discharge report (OR = 3.39 (1.70 to 6.76)). Three independent factors prevent dissatisfaction: age of GPs ≤45 years (OR = 0.69 (0.51 to 0.94)); the GP is called at patient ICU admission (OR = 0.44 (0.31 to 0.63)); and GP involvement in treatment decisions (OR = 0.17 (0.07 to 0.40)).Considerable improvement in GP/intensivist relationships can be achieved through increased communication measures.Because the general practitioner (GP) is a cornerstone of the daily life of the patient and all specialties of the hospital, he or she should be a main communicator with ICU physicians. At patient admission, the GP is the sole medical practitioner who knows the patient's history and his or her way of life. This information could be of particular interest for therapeutic and ethical decisions. In intensive care units (ICUs), GP involvement in the process of family communication is an independent factor of satisfaction among patients' relatives exper
Media Effect into Conflict Management: A Comparative Study on Israel and Palestine Media Practitioners View Point
Ibrahim T. I. Ukka, Hong Yu, Bienmali Kombate
Open Access Library Journal (OALib Journal) , 2019, DOI: 10.4236/oalib.1105984
The paper aimed to test the media effect limited theory versus the media non-limited effect theory and to understand the implication and impact of political will through media into a conflict management. Israel and Palestine conflict was used as a case study and a sample of 153 respondents (including 67 from Israel and 86 Palestinians) was collected and the survey questionnaire was administered through online, however, the study participants were extracted through a population of media practitioners based on convenient sampling method. The study finding concluded that the theory limited effect of media is verified. Media are influenced by political leaders in their report during the conflict.
On Classification from Outlier View  [PDF]
C. A. Hsiao
Computer Science , 2009,
Abstract: Classification is the basis of cognition. Unlike other solutions, this study approaches it from the view of outliers. We present an expanding algorithm to detect outliers in univariate datasets, together with the underlying foundation. The expanding algorithm runs in a holistic way, making it a rather robust solution. Synthetic and real data experiments show its power. Furthermore, an application for multi-class problems leads to the introduction of the oscillator algorithm. The corresponding result implies the potential wide use of the expanding algorithm.
General practitioners' experience and benefits from patient evaluations
Hanne N Heje, Peter Vedsted, Frede Olesen
BMC Family Practice , 2011, DOI: 10.1186/1471-2296-12-116
Abstract: A patient evaluation survey of 597 voluntarily participating GPs was performed by means of the EUROPEP questionnaire. Evaluation results were fed back to the GPs as written reports at a single feedback meeting with group discussions of the results. Between 3 and 17 months after the feedback, the 597 GPs received a questionnaire with items addressing their experience with and perceived benefit from the evaluations.79.4% of the GPs responded. 33% of the responding GPs reported that the patient evaluation had raised their attention to the patient perspective on the quality of general practice care. Job satisfaction had improved among 26%, and 21% had developed a more positive attitude to patient evaluations. 77% of the GPs reported having learnt from the evaluation. 54% had made changes to improve practice, 82% would recommend a patient evaluation to a colleague and 75% would do another patient evaluation if invited. 14% of the GPs had become less positive towards patient evaluations, and job satisfaction had decreased among 3%.We found a significant impact on the GPs regarding satisfaction with the process and attitude towards patient evaluations, GPs' attention to the patients' perspective on care quality and their job satisfaction. Being benchmarked against the average seemed to raise barriers to the concept of patient evaluations and difficulties interpreting the results may have formed a barrier to their implementation which was partly overcome by adding qualitative data to the quantitative results. The GPs' significant willingness to share and discuss the results with others may have served as a facilitator.Patient evaluations have become an integral part of the quality assessment of health care. By basing the methods for patient evaluations on studies of patients' priorities regarding the quality and by singling out aspects of care that are particularly important from their perspective, patients become a crucial source of information in quality improvement effor
Income development of General Practitioners in eight European countries from 1975 to 2005
Madelon W Kroneman, Jouke Van der Zee, Wim Groot
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-26
Abstract: Data were collected for Belgium, Denmark, Germany, Finland, France, the Netherlands, Sweden and the United Kingdom. Written sources, websites and country experts were consulted. The data for the years 1995 and 2000 were collected in 2004–2005. The data for 2005 were collected in 2006–2007.During the period 1975–1990, the income of GPs, corrected for inflation, declined in all the countries under review. During the period 1995–2005, the situation changed significantly: The income of UK GPs rose to the very top position. Besides this, the gap between the top end (UK) and bottom end (Belgium) widened considerably. Practice costs form about 50% of total revenues, regardless of the absolute level of revenues. Analysis based on income per patient leads to a different ranking of countries compared to the ranking based on annual income. In countries with a relatively large supply of GPs, income per hour is lower. The type of remuneration appeared to have no effect on the financial position of the GPs in the countries in this study. In countries with a gate-keeping system the average GP income was systematically higher compared to countries with a direct-access system.There are substantial differences in the income of GPs among the countries included in this study. The discrepancy between countries has increased over time. The income of British GPs showed a marked increase from 2000 to 2005, due to the introduction of a new contract between the NHS and GPs.The remuneration of doctors in general and General Practitioners in particular is an issue that has the attention of policy makers in many countries. During the past decades, in several countries health care reforms have affected the income of GPs (e.g. in France, the Netherlands and the UK). To what extent these developments are comparable with trends in other European countries is unknown. The aim of this paper is therefore to provide insight into the development of the incomes of General Practitioners (GPs) during the l
A view from the watershed
H. L. Penman, H. C. Pereira, J. E. Nash,M. Nixon
Hydrology and Earth System Sciences (HESS) & Discussions (HESSD) , 2007,
Abstract: Papers by H. L. Penman, H. C. Pereira, J. E. Nash and M. Nixon presented at a one-day Symposium to mark the opening of the Institute of Hydrology's new building in 1973 and reprinted from Institute of Hydrology Report No. 20.
View Synthesis from Schema Mappings  [PDF]
Diego Calvanese,Giuseppe De Giacomo,Maurizio Lenzerini,Moshe Y. Vardi
Computer Science , 2010,
Abstract: In data management, and in particular in data integration, data exchange, query optimization, and data privacy, the notion of view plays a central role. In several contexts, such as data integration, data mashups, and data warehousing, the need arises of designing views starting from a set of known correspondences between queries over different schemas. In this paper we deal with the issue of automating such a design process. We call this novel problem "view synthesis from schema mappings": given a set of schema mappings, each relating a query over a source schema to a query over a target schema, automatically synthesize for each source a view over the target schema in such a way that for each mapping, the query over the source is a rewriting of the query over the target wrt the synthesized views. We study view synthesis from schema mappings both in the relational setting, where queries and views are (unions of) conjunctive queries, and in the semistructured data setting, where queries and views are (two-way) regular path queries, as well as unions of conjunctions thereof. We provide techniques and complexity upper bounds for each of these cases.
Patient beliefs and attitudes towards the acceptability of receiving alcohol use enquiry from general practitioners: a literature review  [PDF]
Louis Leong,Chun Wah Michael Tam
PeerJ , 2015, DOI: 10.7287/peerj.preprints.439v1
Abstract: Background: Routine use of alcohol screening questionnaires is recommended in primary care, but patient beliefs and attitudes towards the acceptability of receiving alcohol enquiry from general practitioners (GPs) are unclear.
Far from easy and accurate - detection of metabolic syndrome by general practitioners
Eeva-Eerika Helminen, Pekka M?ntyselk?, Irma Nyk?nen, Esko Kumpusalo
BMC Family Practice , 2009, DOI: 10.1186/1471-2296-10-76
Abstract: Twenty-six health centres around Finland were randomly selected for the purpose of identifying, over a two-week period in April 2005, patients meeting the inclusion criteria of coronary heart disease or one of its risk factors. GPs and identified patients (n = 1880) were asked to complete surveys that included a question about the patient's MetS status. A trained nurse conducted health checks (n = 1180) of the identified patients, utilising criteria of MetS modified from the National Cholesterol Program. Data from the GPs' survey were compared with those from the health check to establish the extent of congruence of identification of MetS.Almost half (49.4%) of the patients met the criteria of MetS as established by objective measures. However, in the GPs' survey responses, only 28.5% of the patients were identified as having MetS. Additionally, these groups of MetS patients were not congruent. The sensitivity of the GPs' diagnosis of MetS was 0.31 with a specificity of 0.73. Only 7.1% of the study patients stated that they were suffering from MetS.Detection of MetS is inaccurate among GPs in Finland. Most patients were not aware of having MetS. The practical relevance of MetS in primary care should be reconsidered.Because of the epidemic of overweight and sedentary lifestyle, the prevalence of metabolic syndrome (MetS) is increasing worldwide [1], and the syndrome has become a major public health challenge [2]. General practitioners (GPs) play a key role in recognising MetS, but it is rarely recorded as a diagnosis in clinical practice [3]. Despite several efforts to make diagnosis feasible for clinicians, the syndrome often remains undiagnosed in primary health care [4].During the last decade, various medical organizations have published their criteria of metabolic syndrome [5]. However, only the two most recent definitions are suitable for the primary care framework. In 2001 the National Cholesterol Education Program (NCEP) published a working definition of the s
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