1,721,043 research outputs found
sj-pdf-1-wso-10.1177_17474930231190745 – Supplemental material for Usability and feasibility of PreventS-MD web app for stroke prevention
No full textSupplemental material, sj-pdf-1-wso-10.1177_17474930231190745 for Usability and feasibility of PreventS-MD web app for stroke prevention by Valery L Feigin, Rita Krishnamurthi, Oleg Medvedev, Alexander Merkin, Balakrishnan Nair, Michael Kravchenko, Shabnam Jalili-Moghaddam, Suzanne Barker-Collo, Yogini Ratnasabapathy, Luke Skinner, Mayowa Owolabi, Bo Norrving, Perminder S Sachdev, Bruce Arroll, Michael Brainin, Amanda Thrift and Graeme J Hankey in International Journal of Stroke</p
The effect of reaccreditation on general practice in New Zealand
No full textThe Reaccreditation Programme of the Royal New Zealand College of General Practitioners (RNZCGP) became compulsory for all members in 1994. Ongoing reaccreditation of medical specialists is a new, but rapidly growing trend on which little research has been done. The aim of this thesis is to investigate the effects of reaccreditation on general practice in New Zealand in the first three years of the programme.
The history and current status of reaccreditation programmes throughout the world is summarised. The requirements of the RNZCGP Reaccreditation Programme are described and contrasted with the requirements of other programmes.
A basic assumption of the Reaccreditation Programme that general practitioners can accurately identify their own areas of deficiency, is tested and found to be incorrect. A very low correlation between general practitioners' self assessments of knowledge on a given topic, and their results on a written objective test was found.
The attitudes of general practitioners to the Reaccreditation programme, both shortly before it began and three years post-implementation are tested using a validated semantic differential questionnaire. Initial acceptance was reasonably high, but this decreased with time.
Qualitative and quantitative studies of the ways in which general practitioners have altered their educational activities because of the programme showed improvements in the quality of the activities selected, but little increase in overall time spent.
Analysis of the effects of the compulsory audit aspect of the Reaccreditation Programme showed that this activity has resulted in significant improvements to patient care.
The effects of the programme on general practice are analysed in the light of current change theories and finally recommendations are made regarding the possible future development of the RNZCGP Reaccreditation Programme
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Mental disorders in general practice
No full textBackground:
There is a high rate of mental disorders among general practice attendees that is associated with substantial morbidity, disability and global burden. As a consequence GPs play a pivotal role in ensuring that patients with mental disorders are recognised and optimally treated. While there is little doubt of the role GPs play in managing mental illness in general practice the literature suggests a proportion of patients will go unrecognised or else be inadequately diagnosed and in some instances inadequately treated by their GP. The known problems of under diagnosis of mental disorders has been seen until recently to be a problem of GP knowledge and skill, which has led to the close scrutiny of GP performance in this field. In response to this close scrutiny has been the development of a wide range of physician education programs aimed to improving the clinical performance of GPs. However, more recently it has been acknowledged that reasons for low recognition and inadequate treatment of mental disorders in general practice is not only the GPs lack of skill and knowledge, but instead involves a complex interplay of GP, patient and systemic factors unique to GPs, their patients and the general practice setting. Therefore there is a growing interest in research to not only explore ways to improve the clinical performance of GPs, but to also gain a better understanding of the range of issues that GPs are confronted with when managing mental disorders in general practice.
Aim: There were two aims of this research: 1) examine GP attitudes, reported confidence and behaviour pertaining to the detection, diagnosis and management of mental illness in general practice (Study One); and 2) describe the epidemiology of depression in general practice and investigate symptom attribution styles as it relates to depression (Study Two).
Methodology: In Study One 800 randomly selected rural and urban GPs in the North Island were invited to complete the Attitudes, Reported Confidence and Behaviour Questionnaire Revised (ARCBQ-R). The ARCBQ-R had been previously piloted and reliability and validity issues addressed and published elsewhere. In Study Two, 15 general practices were randomly selected from a database of Auckland General Practices, of which 35 consecutive general care attendees were recruited from each of the 15 general practices. Consenting patients completed a self report questionnaire on mood and health and a computerised version of the Composite International Diagnostic Interview (CIDI) questionnaire (depression module only).
Results:
Study One: Four hundred and sixteen (52%) GPs completed the ARCBQ-R. GPs are confronted with a wide range of mental disorders in their day-to-day practice, with a predominance of depression and anxiety. GPs were most confident in detecting, diagnosing and treating depression and were most confident in prescribing antidepressants, particularly SSRIs for depression and anxiety. GP confidence in detection, diagnosis and treatment of mental illness was influenced by a number of GP factors such as: interest in mental health, previous mental health training, gender and exposure to mental disorders in their practice. Systemic and patients factors were also reported to influence the way in which GPs recognise and manage mental disorders in their practice. Only a small proportion of GPs reported to use solely DSM-IV or ICD-10 classifications when making a diagnosis, and the majority relied on informal ways to diagnose mental disorders in their patients, which raises questions about the appropriateness of formal diagnostic classifications in general practice. Training needs for this group of GPs involved both treatment and diagnostic issues pertaining to more complex disorders. GPs believed that shared care of mental disorders is the most effective way to provide optimal care for patients. However a number of issues pertaining to availability and assessibility of secondary mental health services along with structural issues such as cost, time and extended consultations in general practice must be addressed before this model of care can work to its full potential.
Study Two: A total of 475 general practice attendees agreed to take part in this study. Approximately 20% of general practice attendees met DSM-IV criteria for major depression in the last 12 months and 12% for major depression with a recency of '1 month to less than 2 weeks'. Just under 5% of the sample met DSM-IV criteria for dysthymia, of which 80% had comorbid major depression. A greater proportion of participants who were divorced or separated, unemployed or looking for work, younger in age, of Maori ethnicity and had a history of mental illness met criteria for DSM-IV major depression. Compared to non-depressed participants, depressed participants in this study reported significantly more missed work or social activity in the last year due to emotional problems. With the aid of two screening questions for depression, GPs in this study accurately identified 75% of depressed general practice attendees. The most common attribution style amongst general practice attendees was a normalising attribution style. Patient attribution styles was not found to influence the level of depression detection by GPs, instead past and current illness profiles influenced GP detection rates of depression.
Conclusion: The current research findings report figures and trends consistent with overseas studies, not only demonstrating the high prevalence of mental illness, particularly that of depression present in general practice attendees, but the many issues that shape mental health care in general practice. Inline with Klinkman's 'Competing Demands Model' GPs perform three important functions: 1) to identify mental disorders in the community; 2) directly provide mental health care to patients; and 3) a referral agent to secondary mental health services. Like Klinkman's model, results derived from the two studies suggest GPs attitudes towards mental health will shape the level of involvement across these three functions. Results derived from 'Study One' and 'Study Two' extends on Klinkman's model to incorporate 'shared care' as a potential model for managing more severe complex disorders. However, before such a model of 'shared care' can be implemented it is essential that accessibility and communication channels between primary and secondary sectors are improved, and structural funding arrangements including the appropriate remuneration for GPs time is addressed. In reality not all GPs will be interested in managing mental illness in their practice and therefore will not have the motivation to acquire and maintain a level of knowledge sufficient to work with patients with mental illness, whether it be in the capacity of 'shared care' or solely the responsibility of the GP. However, it is not unreasonable to expect GPs to have the necessary skills and ability to at least detect and diagnose mental illness in their patient population, and if necessary refer patients on to secondary mental health services. Prerequisite training in mental health, training in diagnostic classifications along with considerations around their appropriateness in general practice, a sound knowledge of patient risk factors for mental illnesses and established networks with secondary mental health services is necessary before GPs can successfully fulfill these roles
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Reciprocal role modelling: A constructivist grounded theory
No full textInformation use by practice nurses in New Zealand has not been widely described in the literature. Practice nurses in New Zealand, the United Kingdom and Australia are usually employed by general practitioners. Compared with their peers in the United Kingdom, there is little evidence to suggest that New Zealand practice nurses provide the same autonomous nurse-led services. Providing nurse-led services is contingent on knowledge and skills and the ability to source and use contemporary information. In 2008, a New Zealand Ministry of Health programme of supporting new graduate hospital placements through finance and mentorship expanded to include primary health care, and a number of new graduate nurses were placed in general practice. This research sought to investigate information use by practice nurses in general practice in New Zealand. Using a constructivist grounded theory design, the author’s own general practice was the site of an initial ethnographic phase. Theoretical sensitivity was heightened by observing, conversing and documenting field notes in this environment. Following the ethnographic period, data were elicited from eleven practice nurses using an unstructured, in-depth interview technique. Of these participants, five were new graduates and six were experienced practice nurses. Reciprocal role modelling is the constructed grounded theory of this thesis. Within supportive multi-disciplinary environments, new graduate nurses (all from the Millennial generation) and experienced practice nurses (Generation X or Baby Boomers) become willing to enter into a relationship. Once they feel confident with their mentors, new graduate nurses subsequently deploy their unconscious expertise at sourcing information. Experienced practice nurses are then realising potential in the new graduates, the second category of the theory. Following this realisation, a mutual reciprocal arrangement follows where the new graduate nurse learns clinical and communication skills and knowledge of the community, while the experienced practice nurse discovers Internet sources of best practice information. This information is subsequently embedded into their practice and alternate avenues of continuing professional development to encourage their critical thinking. The final category of becoming better practitioners is the outcome of reciprocal role modelling. This theory has widespread implications for the thorny issue of getting evidence into general practice in New Zealand and elsewhere
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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