01. Januar 2012
Mothers’ perceptions of introducing solids to their infant at six months of age: Identifying critical belief-based targets to promote adherence to current infant feeding guidelines.J Health Psychol. 2012 Jan;17(1):121-31Authors: Hamilton K, Daniels L, Murray N, White KM, Walsh AAbstract
We investigated critical belief-based targets for promoting the introduction of solid foods to infants at six months. First-time mothers (N = 375) completed a Theory of Planned Behaviour belief-based questionnaire and follow-up questionnaire assessing the age the infant was first introduced to solids. Normative beliefs about partner/spouse (? = 0.16) and doctor (? = 0.22), and control beliefs about commercial baby foods available for infants before six months (? = -0.20), predicted introduction of solids at six months. Intervention programs should target these critical beliefs to promote mothers’ adherence to current infant feeding guidelines to introduce solids at around six months.
PMID: 21672964 [PubMed - in process]
Veröffentlicht in J Health Psychol | Comments Off
01. Januar 2012
General practitioners’ adherence to evidence-based guidelines: a multilevel analysis.Health Care Manage Rev. 2012 Jan-Mar;37(1):67-76Authors: Fantini MP, Compagni A, Rucci P, Mimmi S, Longo FAbstract
BACKGROUND: The growing burden of chronic diseases encourages health care systems to shift services and resources toward primary care. In this sector, general practitioners (GPs) play a key role, and several collaborative organizational models have been implemented in the attempt to improve the clinical effectiveness of GPs, their adherence to evidence-based guidelines, and their capacity to work in multiprofessional teams. However, evidence of the impact of different organizational models is sparse, and little is known about the contribution of these models to the good management of chronic diseases.
PURPOSE: The aim of this study was to examine the relationship of individual sociodemographic characteristics of GPs and collaborative organizational models with the adherence of physicians to evidence-based guidelines for four major chronic diseases (diabetes, heart failure, stroke, and post-acute myocardial infarction).
METHODOLOGY: Evidence-based indicators for the management of the selected chronic diseases were identified on the basis of the most recent international guidelines. Multilevel logistic regression models were used to identify the correlates of adherence to guidelines, taking into account patient characteristics and comorbidities.
FINDINGS: Participation in group practice was associated with different indicators of adherence to guidelines for the management of diabetes and one indicator of post-acute myocardial infarction, whereas other organizational arrangements were linked to GPs’ clinical behavior to a lesser degree. Female gender and younger age of GPs were associated with good management of diabetes.
PRACTICE IMPLICATIONS: The relative impact of efforts at organizational design in primary care should be evaluated in more detail before further investments are made in this direction. Our findings suggest that the professional attitude of GPs (of which gender and age can be considered proxies) is equally, if not more, important than their organizational arrangement. Hence, attention should be paid to how organizations and managerial tools can support the consolidation and spread of this attitude.
PMID: 21712723 [PubMed - in process]
Veröffentlicht in Health Care Manage Rev | Comments Off
01. Januar 2012
Species sensitivity distribution evaluation for selenium in fish eggs: considerations for development of a Canadian tissue-based guideline.Integr Environ Assess Manag. 2012 Jan;8(1):6-12Authors: DeForest DK, Gilron G, Armstrong SA, Robertson ELAbstract
A freshwater Se guideline was developed for consideration based on concentrations in fish eggs or ovaries, with a focus on Canadian species, following the Canadian Council of Ministers of the Environment protocol for developing guideline values. When sufficient toxicity data are available, the protocol recommends deriving guidelines as the 5th percentile of the species sensitivity distribution (SSD). When toxicity data are limited, the protocol recommends a lowest value approach, where the lowest toxicity threshold is divided by a safety factor (e.g., 10). On the basis of a comprehensive review of the current literature and an assessment of the data therein, there are sufficient egg and ovary Se data available for freshwater fish to develop an SSD. For most fish species, Se EC10 values (10% effect concentrations) could be derived, but for some species, only no-observed-effect concentrations and/or lowest-observed-effect concentrations could be identified. The 5th percentile egg and ovary Se concentrations from the SSD were consistently 20?µg/g dry weight (dw) for the best-fitting distributions. In contrast, the lowest value approach using a safety factor of 10 would result in a Se egg and ovary guideline of 2?µg/g dw, which is unrealistically conservative, as this falls within the range of egg and ovary Se concentrations in laboratory control fish and fish collected from reference sites. An egg and ovary Se guideline of 20?µg/g dw should be considered a conservative, broadly applicable guideline, as no species mean toxicity thresholds lower than this value have been identified to date. When concentrations exceed this guideline, site-specific studies with local fish species, conducted using a risk-based approach, may result in higher egg and ovary Se toxicity thresholds.PMID: 21735542 [PubMed - in process]
Veröffentlicht in Integr Environ Assess Manag | Comments Off
01. Januar 2012
Impact of cardiovascular disease guideline dissemination on provider knowledge.Am J Med Sci. 2012 Jan;343(1):56-60Authors: Heppe DB, Bucher-Bartelson B, Estacio RO, Krantz MJAbstract
INTRODUCTION: : Provider characteristics associated with higher cardiovascular disease (CVD) knowledge and learning through clinical practice guidelines (CPG) dissemination are not well understood.
METHODS: : A baseline knowledge survey was distributed to licensed primary care practitioners. A CPG was then distributed following 6-weeks later by a repeat survey to assess proportion reading the CPG and changes in an aggregate knowledge score. The authors examined provider characteristics as predictors of CPG review and knowledge. Changes in CVD knowledge and specific CVD knowledge deficits were assessed.
RESULTS: : Of 1415 providers, 59% (830) completed the initial survey, 46% (651) completed the survey after CPG dissemination and 37% (523) completed both. The weighted percentage of CPG review was 51% (95% CI: 47%-55%) and was higher among midlevel providers (63% versus 44%, P < 0.001) and those in practice >5 years (53% versus 40%, P=0.017). Overall, baseline knowledge score was 71.2% and improved to 72.2% (P=0.038). Improvement in knowledge score was greater among midlevel providers (mean increase 2.4%, 95% CI: 1.0%-4.0%). Paradoxically, those in practice >5 years exhibited a trend toward lower improvements (2.2% versus 1.1%, P=0.08).
CONCLUSIONS: : Direct dissemination of a CPG resulted in a moderate rate of review, yet only small improvements in knowledge. This suggests that CPG dissemination alone is inadequate to substantively improve provider knowledge, although midlevel providers were more likely to read the CPG and increase their knowledge score. Multicomponent education strategies tailored to provider characteristics may be more effective improving knowledge.
PMID: 21817880 [PubMed - in process]
Veröffentlicht in Am J Med Sci | Comments Off
01. Januar 2012
EMQN best practice guidelines for the laboratory diagnosis of osteogenesis imperfecta.Eur J Hum Genet. 2012 Jan;20(1):11-9Authors: van Dijk FS, Byers PH, Dalgleish R, Malfait F, Maugeri A, Rohrbach M, Symoens S, Sistermans EA, Pals GAbstract
Osteogenesis imperfecta (OI) comprises a group of inherited disorders characterized by bone fragility and increased susceptibility to fractures. Historically, the laboratory confirmation of the diagnosis OI rested on cultured dermal fibroblasts to identify decreased or abnormal production of abnormal type I (pro)collagen molecules, measured by gel electrophoresis. With the discovery of COL1A1 and COL1A2 gene variants as a cause of OI, sequence analysis of these genes was added to the diagnostic process. Nowadays, OI is known to be genetically heterogeneous. About 90% of individuals with OI are heterozygous for causative variants in the COL1A1 and COL1A2 genes. The majority of remaining affected individuals have recessively inherited forms of OI with the causative variants in the more recently discovered genes CRTAP, FKBP10, LEPRE1,PLOD2, PPIB, SERPINF1, SERPINH1 and SP7, or in other yet undiscovered genes. These advances in the molecular genetic diagnosis of OI prompted us to develop new guidelines for molecular testing and reporting of results in which we take into account that testing is also used to ‘exclude’ OI when there is suspicion of non-accidental injury. Diagnostic flow, methods and reporting scenarios were discussed during an international workshop with 17 clinicians and scientists from 11 countries and converged in these best practice guidelines for the laboratory diagnosis of OI.
PMID: 21829228 [PubMed - in process]
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Veröffentlicht in Eur J Hum Genet | Comments Off
01. Januar 2012
Guidelines for the evaluation of dementia and age-related cognitive change.Am Psychol. 2012 Jan;67(1):1-9Authors:Abstract
Dementia in its many forms is a leading cause of functional limitation among older adults worldwide and will continue to ascend in global health importance as populations continue to age and effective cures remain elusive. The following guidelines were developed for psychologists who perform evaluations of dementia and age-related cognitive change. These guidelines conform to the American Psychological Association’s (APA’s) “Ethical Principles of Psychologists and Code of Conduct”. The term guidelines refers to statements that suggest or recommend specific professional behavior, endeavors, or conduct for psychologists. (PsycINFO Database Record (c) 2012 APA, all rights reserved).PMID: 21842971 [PubMed - in process]
Veröffentlicht in Am Psychol | Comments Off
