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Perrone, Christophe. "Le statut juridique de la médecine non conventionnelle en France : une intégration possible dans le droit de la santé ?" Electronic Thesis or Diss., Université Côte d'Azur, 2024. http://www.theses.fr/2024COAZ0007.
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La médecine non conventionnelle occupe une place particulière au sein de la société française. Ce fait sociologique atteste de l'ampleur du phénomène et amène légitimement à penser qu'une appropriation du sujet par les pouvoirs publics est à l'œuvre. Or, il n'en est rien officiellement. Les praticiens de soins non conventionnels se retrouvent dans une zone de non-droit, ne bénéficiant d'aucune forme de reconnaissance légale et demeurent ainsi passibles d'exercice illégal de la médecine. Cette affirmation souffre toutefois d'une exception notable. Les professions d'ostéopathe et de chiropracteur jouissent d'un statut de professions « autonomes » et réglementées vis-à-vis du corps médical. Le « médicament non conventionnel » hérite quant à lui d'un statut morcelé entre le produit de santé, le complément alimentaire et le produit cosmétique. Dans le domaine de la médecine complémentaire, séparer le bon grain de l'ivraie n'est pas chose aisée. Qu'il s'agisse de thérapies du corps, de l'esprit, ou de traditions de soins ancestrales à l'image de la médecine traditionnelle chinoise, un tri doit s'opérer afin de ne conserver que les pratiques les plus éprouvées au plan scientifique. Toute méthode dangereuse ou sectaire doit être rejetée avec la plus grande vigueur. Parallèlement, l'appréhension de la médecine non conventionnelle comme « objet juridique » ne pourra se faire qu'après un travail préalable visant à identifier les différents niveaux d'intégration au sein de notre système de santé. Si le délit d'exercice illégal de la médecine continue d'être caractérisé envers des praticiens non médecins qui se livreraient à des actes médicaux (diagnostic, traitement), l'hétérogénéité des condamnations révèle une conception fluctuante dans l'application de la règle de droit par le juge. Le renforcement du mouvement en faveur des droits créances, notamment dans le domaine de la santé, plaide pour une action dirigée envers la médecine non conventionnelle. Ce nouveau pilier normatif se traduira par des propositions concrètes relevant du « droit dur » et du « droit souple » et la défense d'une certaine vision de la santé. À savoir la consécration d'un droit naturel pour l'ensemble des usagers à pouvoir accéder à la forme de soin la plus appropriée et la garantie de la pleine et entière effectivité juridique au sein de notre système de santéNon-conventional medicine occupies a special place within French society. This sociological fact testifies to the scale of the phenomenon, and legitimately leads us to believe that the public authorities are taking ownership of the subject. However, this is not officially the case. Non-conventional practitioners find themselves in a lawless zone, without any form of legal recognition and thus remain liable to the illegal practice of medicine. There is, however, one notable exception to this assertion. The professions of osteopath and chiropractor enjoy the status of "autonomous", regulated professions vis-à-vis the medical profession. As for "non-conventional medicines", their status is divided between health products, dietary supplements and cosmetics. In the field of complementary medicine, separating the wheat from the chaff is no easy task. Whether we're talking about therapies for the body, mind or spirit, or ancestral healing traditions such as traditional Chinese medicine, a careful selection must be made to ensure that only the most scientifically-proven practices are retained. Dangerous or sectarian methods must be rejected with the utmost vigor. At the same time, the understanding of non-conventional medicine as a "legal object" can only be achieved once the various levels of integration within our health system have been identified. While the offence of illegal practice of medicine continues to be characterized in relation to non-medical practitioners who perform medical acts (diagnosis, treatment), the heterogeneity of convictions reveals a fluctuating conception of the application of the rule of law by the judge. The strengthening of the movement in favor of claims rights, particularly in the field of health, argues in favour of action directed towards non-conventional medicine. This new normative pillar will translate into concrete proposals for "hard law" and "soft law", and the defense of a certain vision of health. This means enshrining a natural right for all users to access the most appropriate form of care, and guaranteeing full legal effectiveness within our healthcare system
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Heard, Sharon D. "Evaluation of Bureau Practice for Illegal Drugs Use Among Teens." Thesis, Walden University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3617568.
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The Bureau of Substance Abuse Treatment Recovery and Prevention, which oversees drug intervention services for Detroit residents, has found the city's illegal drug use among teens to mirror national rates. Illegal drug use is associated with addiction, major health problems, and stigma. Incorporating evidence-based screening during all teen health care visits would decrease missed opportunities to identify at-risk behaviors, the number of teens that do not receive intervention, and the stigma associated with screening. The purpose of this project was to develop evidence-based policy and practice guidelines for teen screening services for illegal drug use. The Plan-Do-Study-Act (PDSA) model was used to guide the project. An interdisciplinary team of direct service and administrative staff selected questions based on 6 key words—car, relax, alone, forget, friends, and trouble (CRAFFT)—to screen teens for illegal drug use. The interdisciplinary team also developed a teen screening policy along with practice guidelines for the screening policy, implementation plan, and project evaluation. A review of the literature provided support for the project methods. Two experts in the field of substance abuse provided content validity for the policy and practice guidelines, and concluded that the CRAFFT screening questions were valid for evidence-based screening for illegal drug use among teens, that the PDSA model was effective to guide the project, and that an interdisciplinary team approach was effective to address the issue. These findings may improve identification of at-risk teens, decrease missed screening opportunities, decrease stigma, and align the Bureau with current trends in substance abuse treatment.
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Heard, Sharon D. "Evaluation of Bureau Practice for Illegal Drugs Use Among Teens." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1126.
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The Bureau of Substance Abuse Treatment Recovery and Prevention, which oversees drug intervention services for Detroit residents, has found the city's illegal drug use among teens to mirror national rates. Illegal drug use is associated with addiction, major health problems, and stigma. Incorporating evidence-based screening during all teen health care visits would decrease missed opportunities to identify at-risk behaviors, the number of teens that do not receive intervention, and the stigma associated with screening. The purpose of this project was to develop evidence-based policy and practice guidelines for teen screening services for illegal drug use. The Plan-Do-Study-Act (PDSA) model was used to guide the project. An interdisciplinary team of direct service and administrative staff selected questions based on 6 key words---car, relax, alone, forget, friends, and trouble (CRAFFT)---to screen teens for illegal drug use. The interdisciplinary team also developed a teen screening policy along with practice guidelines for the screening policy, implementation plan, and project evaluation. A review of the literature provided support for the project methods. Two experts in the field of substance abuse provided content validity for the policy and practice guidelines, and concluded that the CRAFFT screening questions were valid for evidence-based screening for illegal drug use among teens, that the PDSA model was effective to guide the project, and that an interdisciplinary team approach was effective to address the issue. These findings may improve identification of at-risk teens, decrease missed screening opportunities, decrease stigma, and align the Bureau with current trends in substance abuse treatment.
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Blackwelder, Reid B. "Alternative Medicine Family Practice." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/6997.
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Plews, Kai Ronald. "Illegal art : photography in the age of the Ag Gag." Thesis, University of Iowa, 2016. https://ir.uiowa.edu/etd/3165.
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Where does your food come from?
This is a simple question that many people ask but don't truly want to have to answer to. We have some idea of the concept of farming that is cobbled together from images taken from the media and advertisements. The vision of a small pastoral farm where animals roam around in outdoor pens or live in stately wooden barns is the idea that comes to mind when we think of farming.
This concept could not be further from the actual truth. This difference between your perception and the reality is due to a widespread effort to block images of modern farming practices from public view. Those orchestrating this deception are so powerful that they have pushed censorship laws onto nineteen different states in the United States. These laws are collectively called the Ag Gag.
This series of photographs was created to shed light on modern farming practices and to bring awareness to the overreach of agricultural corporations in dictating laws limiting individual free speech. In this work you see images of what modern large scale animal farming actually looks like. You will also see what impacts this has on the environment and learn about the benefits and problems with this type of farming.
In the end the most important question I want you to ask yourself is:
Is this where I want my food coming from?
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Bayard, Max, Cathy Peoples, Jim Holt, and David Daniel. "An Interactive Approach to Teaching Practice Management to Family Practice Residents." Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/6492.
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Three years ago, our residency program began a new approach to teaching practice management to our second- and third-year residents. The underlying principles for the new curriculum involved a realization that our residents lacked basic business understanding and that they would likely learn more effectively through a hands-on approach.The newcurriculum, which we describe in this article, is in large part built around the establishment of a mockpractice during thesecond year ofresidency. Although the curriculum is still evolving, initial response and evaluation have been encouraging.
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Bayard, Max, Jim Holt, Cathy Peoples, and Bendik Clark. "An Innovative Practice Management Curriculum." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/6504.
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Blackwelder, Reid B. "Review of Complementary Medicine and Clinical Practice." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6912.
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Reviews the book, Complementary medicine and clinical practice edited by David P. Rakel and Nancy Faass (2006). Complementary and alternative medicine, or CAM, as it is known, has been an important and controversial topic for allopathic medicine. Although the majority of the patients in this country will use one or more forms of complementary medicine, and spend more out-of-pocket money on CAM techniques and practitioners than on allopathic ones, there is still a great deal of uncertainty among practicing physicians about what exactly CAM consists of. This book goes a long way toward helping to clarify this diverse and changing topic. Overall, each of the topics in the book emphasizes a refreshing focus on health compared with the antidisease focus of many more traditional medical articles and books. Each of the chapters integrates the technique and philosophy of the topic explored into an overall health-oriented approach to patient care. Rakel and Faass's book creates a template for a new model of medicine. Given its broad scope, it is ideal for family physicians to consider as we envision the evolution of our practices.
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Smith, Luisa J. "Evidence-based medicine in equine clinical practice." Thesis, University of Glasgow, 2006. http://theses.gla.ac.uk/5004/.
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The principles of Evidence-Based Medicine (EBM) have been well documented in the medical literature, with many examples of the successful application of these principles to the clinical environment. Despite this widespread acceptance of these principles throughout the medical profession, there has been resistance to adopt such an approach in the veterinary profession. To date, there are. few examples in the literature of the application of the principles of evidence-based medicine to either clinical or scientific research. The aim of this study was to design a series of investigations of equine diseases, and implement them at three private equine hospitals. A variety of study designs were used, providing different classes of evidence when using the classification system proposed by Yusuf et al. (1998). The main focus of this investigation was to ascertain whether it was possible to apply the ethos of EBM to the veterinary profession, and provide good quality research and evidence form private practice. It was found that 85.6% of horses (95% c.l. 81.3 to 89.3) treated for septic arthritis were successfully discharged from the hospital, with 65% of these horses (95% C.l. 57.9 to 71.6) able to return to their previous level of athletic function. When considering those horses treated for septic digital tenosynovitis, 87.8% survived to be discharged from the hospital. However, the prognosis for future soundness was poorer than that achieved following resolution of septic arthritis, with only 50% of horses treated for septic digital tenosynovitis able to return to their previous level of athletic function. Racing Thoroughbreds, both neonates and mature horses, were identified as an important subset of the population. It was found that the occurrence of septic arthritis in neonatal Thoroughbreds significantly reduced the likelihood of those foals going on to make at least one start on a racecourse, with those foals being 3.5 times less likely to start on a racecourse when compared to their siblings. In contrast, when considering mature Thoroughbred racehorses it was found that the occurrence of septic arthritis did not affect the likelihood that they would make at least one start on a racecourse when compared to their siblings, or be able to achieve an Official Rating awarded by the British Horseracing Board's handicappers equal to, or higher than, either the highest rating achieved prior to the onset of sepsis in cases in which horses had raced previously, or equal to the highest rating achieved by their siblings. In a controlled, randomised trial it was found that 31.6% (95% c.l. 17.5 to 48.7) of horses wearing a belly band following an exploratory laparotomy developed incisional complications, compared with 76.6% (95% c.I. 62.0 to 87.7) of horses where no belly band was used. If a belly band was used following an exploratory laparotomy, the risk of developing post-operative incisional complications was reduced by 45% compared to those cases where no belly band was used. Following a clinical audit of elective surgical procedures at three private equine hospitals, there was found to be a higher rate of post-operative complications, when compared to results reported in both the medical and small animal veterinary literature. It was concluded that it was possible to apply the ethos of EBM to the veterinary profession, and provide good quality research and evidence from research performed in private practice. However, in order to be able to achieve sufficient case numbers to provide answers that are directly relevant to practice-based clinical situations, multi-centre studies are likely to be the best way forward.
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Holt, Jim. "Addressing Childhood Obesity in Primary Care Practice." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/6508.
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Zaid, Zaid Ali. "Illegal immigration in international law and practice in selected countries : the case of Libya and Italy." Thesis, Glasgow Caledonian University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.443243.
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Moorhead, Robert George. "Communication skills training for general practice." Title page, contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09MD/09mdm825.pdf.
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Bibliography: leaves 554-636. Examines aspects of teaching medical students communication skills at a time when they are entering their clinical years. Integrates reports of 12 data-gathering exercises centred on medical student communication skills with the international literature, and with the author's reflections as an experienced educator and G.P. Recommends that communication skills training in a general practice setting should be a crucial factor in all future training of medical students.
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Polaha, Jodi. "Practice Transformation in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6665.
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This session will describe the evolution of the Pediatric Primary Behavioral Health Model in one clinic including the integration of behavioral health and social services into a residency training clinic. The implementation strategy used to develop this model will be described.
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Polaha, Jodi. "Gun Violence Prevention in Pediatric Practice." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6658.
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Polaha, Jodi. "Gun Violence Prevention in Pediatric Practice." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6662.
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Bartlam, Bernadette. "Counselling in reproductive medicine : research, ethics and practice." Thesis, Keele University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.398911.
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Calhoun, McKenzie L. "Discussion on Interprofessional Education and Practice." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6886.
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Holt, Jim. "New Payment Models Within a Virtual Practice." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6452.
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Hughes, Siobhan Victoria. "Developing clinical practice : personal therapy and supervision." Thesis, University of Hull, 2010. http://hydra.hull.ac.uk/resources/hull:3477.
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This portfolio thesis comprises of four parts: a systematic literature review paper, an empirical paper, a reflective statement and appendices.Part one is a systematic literature review which examines whether personal therapy is an effective method of professional development for therapists. Quantitative and qualitative literature is critically reviewed. A model of the reported benefits of personal therapy for therapists is proposed. Implications for clinical practice are discussed.Part two is an empirical paper examining the relationship between stage of development and behaviour in clinical supervision for trainee clinical psychologists. Forty trainee clinical psychologists, from three years of a training course, completed a questionnaire (the SLQ-R[A]) measuring their stage of development as supervisees. A subsample submitted DVD-recordings of their supervision sessions which were coded using the Teacher's PET to analyse the supervision behaviours. Comparisons were made between the supervision behaviour of first (n = 8) and third (n = 3) year trainee clinical psychologists and their supervisors. Correlations between questionnaire responses and supervision behaviours were examined. Results are discussed in the context of the Integrated Developmental Model of Supervision. Implications for clinical practice are highlighted.Part three is a reflective statement which considers the process of conducting the research and developing this portfolio thesis.Part four is the appendices.
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Calhoun, McKenzie L. "Advancing Pharmacy Practice Expert Panel." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6883.
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Fennessy, Gabrielle Ann 1968. "Knowledge management in evidence based practice : study of a community of practice." Monash University, School of Information Management and Systems, 2002. http://arrow.monash.edu.au/hdl/1959.1/8023.
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Jeyaretnam, Joseph S. "Occupational hazards and radiation safety in veterinary practice including zoo veterinary practice in Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1306.
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This thesis contains reviews and research on the occupational hazards of zoo veterinary practitioners in Australia. Although occupational hazards have long been recognised in the veterinary profession, little information is available on the number and magnitude of injuries to veterinarians in Australia, the United Kingdom or the United States. Apart from anecdotal accounts and some limited data, most of the available information is on occupational zoonoses, generally well recognized by veterinarians. Other occupational hazards to which veterinarians are exposed have received scant attention. The veterinary practitioner in a zoo environment has to treat a range of captive wild species which are much more unpredictable and dangerous than domesticated animals. A comprehensive study on occupational hazards sustained by veterinarians in zoological gardens has not been undertaken in Australia. Only one study had been undertaken in the US amongst zoo veterinarians, while comprehensive may not be able to be transposed to zoos in Australia as the species held in Australian zoos differ from those in the US. Personal communication with some senior veterinarians in the zoological gardens in Australia, have elicited further information on the prevalence of occupational hazards sustained by the zoo and wildlife park veterinarians. The prevalence of physical hazards including radiation, chemical and biological hazards reported by veterinary practitioners and the author's own experience as a veterinary practitioner, chairman of the safety committee, member of the animal ethics committee and manager, research In the zoological gardens in Perth, Western Australia have demonstrated a need for a comprehensive study on occupational hazards prevalent among zoo veterinarians. To investigate the occupational hazards including radiological hazards amongst zoo veterinarians in Australia, a self-administered 14-page comprehensive questionnaire comprising 58 questions was mailed to 27 practising zoo veterinarians in Australia. The questionnaire focused on physical injuries, chemical exposures, allergic and irritant reactions, biological exposures, radiological hazards including problems encountered with x-ray machines, use of protective gear and ancillary equipment for radiography, personnel involved in x-ray procedures and in restraining animals, compliance with the Australian National Health and Medical Research Council (NHMRC) Code of Practice (1982), Radiation Safety Regulations (1988) and National Standard for Limiting Occupational Exposure to Ionising Radiation (1995) The result of the study revealed that 60% of the participants sustained physical injuries such as crushes, bites and scratches inflicted by a range of species with some Injuries requiring medical treatment. Also, 50% of the participants suffered from back injuries while 15% reported fractures, kicks, bites necessitating hospitalization. Ninety percent of the participants sustained needlestick injuries ranging from one to 16+ times. Other significant findings include: necropsy injuries, animal allergies, formaldehyde exposure, musculoskeletal Injuries and zoonotic infections. The survey also identified that veterinary practitioners and their staff were exposed to radiation by not complying with the National Health and Medical Research Council (NHMRC) Australian Code of Practice for the Safe Use of Ionising Radiation (1982) which has been framed to minimize exposure to ionising radiation. The majority of the veterinarians in the study group indicated that radiation exposure Is a major occupational hazard to the veterinary profession. Subsequent to the review and research, discussions were held with few senior zoo veterinarians, the Registrar of the Veterinary Surgeons Board and a number of practising senior veterinarians In Australia to collect information on occupational hazards. Additional information was obtained on occupational injuries sustained by the zoo veterinarians through formal discussions with the Director and the two senior veterinarians In the zoological gardens in Sri Lanka. The discussions with the veterinary practitioners in government and private practice revealed that veterinarians experienced a range of occupational hazards including exposure to rabies. Discussions with the dean and the professor of the animal science department focused on the nature of injuries and preventive strategies. In order to obtain information on occupational hazards in the health care industry, the professor of anatomy of the faculty of medicine and a senior surgeon in Sri Lanka were interviewed. This study identified that the zoo veterinarians are routinely exposed to a wide range of occupational hazards. The literature review among veterinary practitioners In US, UK, Australia and Canada have also identified numerous occupational hazards sustained by the veterinarians. The discussions held in Sri Lanka with the professionals in veterinary and health care industry showed that occupational injuries have been common amongst them and they do not have appropriate preventive guidelines in place. This thesis has incorporated recommendations in the form of preventive strategies for minimizing occupational hazards among veterinary practitioners both in zoological gardens and veterinary practices In Australia and in the developed and developing countries.
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Cape, John Donald. "General practice consultations with patients with psychological problems." Thesis, King's College London (University of London), 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309361.
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McNeill, Sheelagh C. "Acupuncture : clinical practice and effectiveness in physiotherapy." Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288826.
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Hurst, Keith. "Approaches to problem solving in nursing practice." Thesis, Sheffield Hallam University, 1990. http://shura.shu.ac.uk/20727/.
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One of the requirements for high quality individualised nursing care is that nurses must recognise and attempt to solve patients' health problems. It is generally agreed that this needs a problem-solving approach. It was decided to investigate the perceptions and understanding of problem solving in nursing using a model derived from the general literature. This model, from an analysis of 55 studies, consists of 5 phases which happen to be similar to the 4 or 5 stages in discussions of the nursing process. Insight into nurses' perceptions of problem solving was obtained by presenting 120 nurses, in individual interviews, with 7 specially constructed and validated vignettes of clinical problem solving. Deliberately, only one of the vignettes was complete, containing all 5 elements of the derived model. The remaining vignettes had one or more of the elements missing. The nurses were encouraged to comment on each vignette and the protocols were analysed in detail. Analysis revealed that the phase model was generally understood by all types of informants, but a number failed to detect the missing phases in some vignettes, in particular, problem identification, planning and evaluation. On the other hand, problem assessment and implementation almost always attracted comment. There did not appear to be a relationship between informants' nursing experience and the recognition or non-recognition of phases. Another finding was that informants were not always systematic in their analysis of the vignettes; that is, some did not begin their analysis with problem identification and conclude with evaluation. Overall, the findings lend support to a stages model as a theoretical basis for problem solving in nursing. The theoretical basis of problem solving in nursing is also discussed in relation to problem solving in allied professional disciplines. Finally, the implications of the study for nursing education and practice are explained and recommendations made for further study.
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Gardiner, Andrew A. "Small animal practice in British veterinary medicine 1920-1956." Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532236.
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Chung, Sim Wee. "Comparative effectiveness in medicine: analysis of episiotomy practice patterns." Thesis, Monterey, California. Naval Postgraduate School, 2011. http://hdl.handle.net/10945/10582.
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Approved for public release; distribution is unlimitedThis thesis provides empirical evidence to demonstrate or disprove claims that findings from a major systematic review published in 2005, have led to further declines in practices of episiotomy. The study uses data from the Healthcare Cost and Utilization Project: State Inpatient Databases (HCUP SID) and American Hospital Association (AHA) annual surveys. The sample consists of 648,141 patients from 897 hospitals between 2003 and 2008. Both fixed and random effects models are specified to estimate the effects of the JAMA publication, hospital characteristics including interaction terms and patient compositions on episiotomy rates. In addition the study analyzes variation of practice patterns to examine whether the JAMA publication has the desirable impact on clinical practices. The results show that the declining episiotomy trends accelerate marginally after the JAMA publication. Hospitals do not also appear to respond differentially to the JAMA publication for most hospital characteristics, except for hospital sizes, maternity ward turnover and ownership structure. The analysis of practice pattern variation suggests that practice variations by volumes are declining but variances of episiotomy rates remain substantial. More effective strategies should be formulated to reach out to different audiences to bridge the gap between research evidences and clinical practices on episiotomy.
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Polaha, Jodi, Leigh Johnson, Millie Wykoff, J. Montgomery, S. Peace, D. Sloan, and Reid Blackwelder. "Champion Teams: An Implementation Strategy to Drive Practice Improvement." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6561.
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Developing collaborative practice is an ongoing process requiring frequent upgrades as team members and processes are added. Recently, faculty in ETSU’s Department of Family Medicine have been experimenting with a mechanism for iterative upgrades to team care practice known as Champion Teams. Champion Teams are based on the Institute of Medicine’s "learning health care system" approach in which practitioners develop an internal strategy for implementing new evidence based practices on an ongoing basis. In this presentation, our interprofessional team will describe team-based education and practice at ETSU as it relates to the Champion Team concept including its origins, evidence-base, and the logistics of how it functions. We will provide examples of four Champion Team projects including: 1) integrating behavioral health, 2) increasing attendance at medical visits, 3) increasing vaccination rates, and 4) a transition to a new pharmacological regimen for congestive heart failure patients. The exemplars will demonstrate how quality improvement data informed progressive changes and confirmed implementation outcomes. During discussion, we will encourage participants to identify their own targets for champion teams.
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Calhoun, McKenzie L., and Micah Cost. "Nuts and Bolts of Collaborative Pharmacy Practice." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6903.
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Collaborative pharmacy practice rules went into effect on February 20, 2017. With these rules come new opportunities for pharmacists to work with prescribers to improve patient outcomes and increase access to pharmacist-provided care. This one-hour webinar, presented live by the Tennessee Pharmacists Association on March 9, 2017, provides information about how to properly implement collaborative pharmacy practice in pharmacy settings.
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James, Rachel. "A portfolio of study, practice and research : volume one." Thesis, University of Surrey, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.300460.
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Jones, Kevin Peter. "Studies in the care of asthma in general practice." Thesis, University of Southampton, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316443.
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Hepburn, Mary. "The role of antenatal inpatient care in obstetric practice." Thesis, University of Edinburgh, 1986. http://hdl.handle.net/1842/19839.
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Clifford, Julie Veronica. "Computers in general practice consultations : impact on doctor-patient relationships /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmc637.pdf.
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Usatine, Richard, Jim Holt, Miranda Lu, and Alexandra Verdieck. "Dermoscopy: Expanding ‘Scope’ of Practice and Preventing Skin Cancer Deaths." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6446.
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In this hands-on preconference workshop, we will introduce dermoscopy, a proven adjunctive tool that increases sensitivity and specificity of melanoma detection and improves diagnostic accuracy for basal and squamous cell carcinomas. Participants will learn how to use a dermatoscope in clinical practice and learn the two-step algorithm to diagnose unknown skin lesions and determine the need for biopsy. Biopsy techniques will be taught with a handson evidence-based approach that can be applied at one’s home institution. Participants will leave with fundamental competence in the use of dermoscopy for early skin cancer detection, improved understanding of biopsy techniques, tools to train others, free apps, Dermoscopedia, online resources, and online and in-person courses.
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Jenkins, Mary M. "Occupational therapy : perspectives on the effectiveness of practice." Thesis, University of Ulster, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242146.
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Ekerstad, Niklas. "Micro Level Priority Setting for Elderly Patients with Acute Cardiovascular Disease and Complex Needs : Practice What We Preach or Preach What We Practice?" Doctoral thesis, Linköpings universitet, Medicinsk teknologiutvärdering, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-67639.
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Demographic trends and other factors are expected to continue widening the gap between health care demands and available resources, especially in elder services. This growing imbalance signals a need for priority setting in health care. The literature has previously described problems in constructing useable means of priority setting, particularly when evidence is sparse, when patient groups are not satisfactorily defined, when interpretation of the term patient need is unclear, and when uncertainty prevails on how to weigh different ethical values. The chosen study object illustrates these problems. Moreover, the Swedish Government recently stated that care for elderly persons with complex health care needs remains underfunded. The general aim of this thesis is: to study micro-level priority setting for elderly heart patients with complex needs, as illustrated by those with non-ST-elevation myocardial infarction (NSTEMI); to relate the findings to evidence-based priority setting, e.g. guidelines for heart disease; and to analyse how complex needs could be appropriately categorised from a perspective of evidence-based priority setting. Paper I presents a register study that uses data from the Patient Register to describe inpatient care utilization, costs, and characteristics of elderly patients with multiple diseases. Paper II presents a confidential survey study from a random sample of 400 Swedish cardiologists. Paper III presents a prospective, clinical, observational multicentre-study of elderly patients with myocardial infarction (NSTEMI). Paper IV presents a questionnaire study from a purposeful, stratified sample of Swedish cardiologists. The results from Paper I show that elderly patients with multiple diseases have extensive and complex needs, frequently manifesting chronic and intermittently acute disease and consuming health care at various levels. A large majority have manifested cardiovascular disease. Results from Paper II indicate that although 81% of cardiologists reported extensive use of national guidelines in their clinical decision-making generally, the individual clinician’s personal clinical experience and the patient’s views were used to a greater extent than national guidelines, when making decisions about elderly multiple-diseased patients. Many elderly heart disease patients with complex needs manifest severe, acute or chronic, comorbid conditions that constitute exclusion criteria in evidence-generating studies, thereby limiting the generalisability of evidence and applicability of guidelines for these patients. This was indicated in papers I-IV. Paper III reports that frailty is a strong independent risk factor for adverse, short-term, clinical outcomes, e.g. one-month mortality for elderly NSTEMI patients. Particularly frail patients with a high comorbidity burden manifested a markedly increased risk. In the future, prospective clinical studies and registries with few exclusion criteria should be conducted. Consensus-based judgments based on a framework for priority setting as regards elderly patients with complex needs may offer an alternative, estimating the benefitrisk ratio of an intervention and the time-frame of expected benefits in relation to expected life-time. Such a framework, which is tentatively outlined in this thesis, should take into account comorbidity, frailty, and disease-specific risk.
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Mojsa, Janet Elizabeth. "Non-duality and psychotherapeutic practice : a phenomenological study of psychotherapist experiences of non-duality and implications for psychotherapeutic practice." Thesis, Bournemouth University, 2012. http://eprints.bournemouth.ac.uk/20754/.
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The thesis in part describes a research journey of a psychotherapy practitioner engaging in research development. It details, narrates and values the synchronistic events that enabled the ‘story’ to emerge. The central enquiry draws on embodied phenomenological research methods and poetic experiencing to explore the experiences of psychotherapists who have an understanding of nonduality and the perceived impact of this on their psychotherapeutic work. Nondual experiencing is also studied following a synchronistic research visit to Pakistan. Here, embodied spirituality is explored, using video and the concept of ‘Therao’ is studied and utilised as an aspect of skilful practice. These are drawn together and compiled as a summary of skilful means in psychotherapeutic practice. Additionally, as a Doctorate in Professional Practice two studies are presented as part of the practice development component. Both used creative video and performance as part of research presentation. The first, a project based on the Mandala with people living with HIV. The second ‘Beyond Statistics’ is an enquiry into the lifeworld experiences of gay men living with the co-infection of HIV and HCV. The thesis strongly articulates the significance of practice based research as a basis for humanising practice and the development of tacit and pathic knowledge. It identifies 10 key qualities present in practitioners who have a spiritual understanding of nonduality and the positive impact of these on depth connection with client work. The thesis also acknowledges, in line with current developments, the importance of including the cultivation of these depth relational qualities within a psychotherapy training curriculum.
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Daoud, Janet Barbara. "Recognising and appreciating the artistry in professional practice : a means to researching and developing practice through insider practitioner research." Thesis, Bournemouth University, 2004. http://eprints.bournemouth.ac.uk/385/.
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This study explores professional practice and examines an approach to research that could be useful for the practitioner in developing and extending their practice. The existence of artistry is recognised within professional practice (Schon 1983), and is important in making professional judgements (Fish and Coles 1998, pp. 28-53, de Cossart and Fish 2005). Therefore, as in the methodology proposed by Fish (1998), the artistic/holistic paradigm was adopted because this specifically enables the exploration of professional artistry and is suited to insider practitioner research. The study critically appraised the use of the proposed artistic/holistic paradigm. A case study approach was used in which the researcher was the case. A portrait of an episode in clinical practice was produced, followed by a critical appraisal of this portrait. These then became the portrait of research practice, which was equally appraised. This mirrors the process seen within the arts in which critical appreciation is a reflective process, deriving its rigour from the discipline and connoisseurship of the critic. The results demonstrate that the artistic/holistic paradigm is well suited to continuing professional development, both individually and corporately. The proposed paradigm does enable the recognition and exploration of professional artistry, both within clinical and research practice. Professional practice has a moral foundation and it was shown that this must be openly recognised if meaningful professional development is to occur. Evidencebased medicine, which is founded on the technical-rational view of practice, was shown to be insufficient for the professional's ongoing development. This, and similar work, will impact and contribute to the ongoing evolution of the traditions of the profession.
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Polaha, Jodi, and Karen Schetzina. "A Collaborative Practice Model for Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6670.
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Jabareen, Hussein Mohammad. "Skill mix development in general practice : a mixed method study of practice nurses and general practitioners." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/632/.
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General practice has undergone considerable change in the last two decades. New roles for nurses working in general practice have extended to include tasks that were previously delivered by general practitioners, in particular chronic disease management, and the development of new, advanced roles such as independent nurse prescribing. There have been few research studies investigating the impact of these changes, especially after the introduction of the new General Medical Services contract in April 2004. The overall aim of the work presented in this thesis was to examine the emerging roles of practice nurses, the forces influencing that development, and the effects of these changes on doctor-nurse skill mix in general practice within NHS Scotland. The work employed a mixed methods approach, with three inter-linked studies. The first study was a quantitative, desk-based analysis of workload and clinical activities of doctors and nurses working in 37 practices across Scotland for the year 2002. The second study was a postal questionnaire to all practice nurses working within NHS Greater Glasgow (n=329), conducted in autumn 2005 and achieving a 61% response rate. The third study was a qualitative study, consisting of eighteen interviews with a doctor and nurse inform each of nine general practices. The interviews were conducted between January and July 2006 and practices were selected according to the number of partners and the deprivation status of the practice population. Analysis of workload data showed that practice nurses and general practitioners dealt with 27.5% and 72.5% of total face-to-face encounters, respectively. Many of the encounters with nurses involved chronic disease management, with 20% of such encounters appearing similar in content to the work of GPs. The postal survey found that one third of practice nurses were aged over 50, and will be approaching retirement within 10 years. The majority worked in small teams of nurses, although 31% worked alone. This may have contributed to the finding that 52% (n=103) reported feeling isolated in their workplace. Many had attended CPD training on chronic conditions, but identified minor illness treatment as an area for future training. The qualitative study showed that the Quality and Outcomes Framework of the 2004 contract had been a key driver of changes in general practice service delivery. This has led to an increasing shift in routine care from doctors to nurses. As new roles for practice nurses have evolved, GPs have been able to focus on treating complex morbidities that need medical diagnosis and intervention. The incentivised targets of the new contract have made chronic disease management a predominant activity for practice nurses, with treatment room and non-incentivised activities featuring less and increasingly being provided by new, lower grade nurses or nurse replacements such as Health Care Support Workers (HCSW). There was no consensus between interview participants in terms of the most appropriate use of doctor-nurse skill mix in general practice. Nor did they agree on the merit of advanced roles for practice nurses. However, respondents did emphasise that nurses who wanted to have an independent/advanced role in the practice would need to combine three competencies (independent nurse prescribing, triaging, and minor illness treatment). Most practice nurses interviewed were concerned with obtaining a fair financial return to match their increasing responsibilities, especially after the introduction of the nGMS contract. GPs, however, tended to believe that nurses were appropriately remunerated for the level of responsibility they had within the practice. The continuing role of the GP as the employer of practice nurses was problematic for some nurses and many felt there would be advantages to being employed on Agenda for Change terms and conditions. However, the majority of nurses interviewed preferred being employed by a GP rather than the Health Board. There was little support amongst either nurses or GPs for the notion of nurse partners within practices. Overall, these studies provide lessons which will be of value in planning the future training and development of practice nurses. It suggests that practice nurses should obtain proper training and support in order to meet their individual needs and to carry out new responsibilities and roles. In addition, the impending shortage of practice nurses due to retirement, lack of retention and potential recruitment difficulties needs to be addressed urgently at the level of primary care policy and manpower planning.
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Blackwelder, Reid B. "How to Work Efficiently with Medical Students in Your Practice." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6946.
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Rees, Sharon. "The role of nurses in general practice: general practitioners' and practice nurses' perceptions." University of Southern Queensland, Faculty of Sciences, 2004. http://eprints.usq.edu.au/archive/00001489/.
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The role of nurses in general practice: General Practitioners' and Practice Nurses' perceptions is a study that identifies the beliefs of Practice Nurses (PNs) and General Practitioners (GPs) of the PN role and how those roles impact on the general practice. Ethnographic techniquess were used for this study, with data collected through interviews, observation and questionnaires. Interviews were conducted with four PNs and four GPs in practices that employed nurses in an increased role similar to that described in the Nursing in General Practice Fact Sheets (Royal College of Nursing Australia, 2002). Two practices were observed to identify work practices and the nurses' interaction within the practice. The main finding of the study was the importance placed on the general practice team. Both GPs and PNs believed that working as a team was vital. They indicated that working together provided holistic care and enabled the practice to provide quality care. The role of the PN in this study was consistent with other studies in Australia. However, the nurses in this study appeared to have more autonomy in regard to care of people with chronic illness and the aged. Continuing education was considered important for the further development of the PN role. However, participants believed that the PN also needed to have considerable and varied experience together with good people skills. To further develop the PN role innovative ways of providing education to PNs should be investigated to ensure nurses have the necessary skills to undertake their role. Payment issues in general practice should also be examined and addressed to ensure that PNs are able to be employed, and receive remuneration appropriate for their experience and job description.
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Kiemle, Gundi. "Reflective practice and continuing professional development among qualified clinical psychologists." Thesis, University of Hull, 2008. http://hydra.hull.ac.uk/resources/hull:6695.
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Reflective Practice (RP) and Continuing Professional Development (CPD) have become key concepts in the post-qualification education and training of healthcare professionals, linked to maintaining and improving competence and fitness to practice in a modernised health service. There is little empirical research about this in relation to clinical psychologists. This qualitative study explored how clinical psychologists experience RP and CPD and apply this to their professional practice. A focus group generated the topics for 16 semi-structured interviews with a diverse range of qualified clinical psychologists practising in a Strategic Health Authority Region in England. Using Interpretative Phenomenological Analysis, four higher-order themes and associated sub-themes emerged: (1) clinical psychologists as reflective practitioners, including the understanding of reflection, influences on development, and reflection and professional identity; (2) the reflective space, including supervision, enablers and obstacles in reflective practice; (3) functions of CPD and reflection, including quality and enhanced service provision, safety and clinical governance, and professional requirements; and (4) linking reflection and CPD, including the link between reflection and action, reflective practice as CPD, and CPD and life-long learning. Seven second interviews were conducted for member-validation, and a final focus group was convened for triangulation and validation of the thematic analysis. The findings are related to the existing literature, and to learning theory and attachment theory. The relevance of this research is discussed in relation to clinical psychology practice and the implications for training and CPD. The importance of the present findings to the issue of the professional identity of clinical psychologists is outlined, and suggestions for future research are proposed.
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Burger, Adrian. "Paediatric procedural sedation current practice and challenges in Cape Town." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2857.
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Includes bibliographical references.Children often present to the Emergency Centre (EC) with painful injuries, or conditions which require painful or upsetting interventions to diagnose or treat. Procedural sedation and analgesia (PSA) refers to the pharmacologic technique of managing the child’s pain and anxiety. The appropriate management of pain and anxiety in the EC is a significant facet of emergency care for all patients, especially in paediatric patients.1 This is achieved partly by the administration of sedative, dissociative, or analgesic drugs which alter awareness, completely sedate the patient, reduce or eliminate pain.2,3,4 PSA is an essential component of Emergency Medicine practice and is a core skill acquired in Emergency Medicine training programs. There is good evidence that proactively addressing pain and anxiety may improve quality of care and patient satisfaction by facilitating interventional procedures and minimizing patient suffering.5
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Click, Ivy A., Jeri Ann Basden, and Fred Tudiver. "Does Structured Quality Improvement Training for Residents Increase QI in Practice?" Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6397.
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East Tennessee State University implemented quality improvement (QI) training for second-year family medicine residents in 2009. Results in 2011 indicated training increased scores in QI skill assessments as well as self-efficacy in QI. With residents who completed the training now in practice, does the increase in knowledge and skill translate to increased QI in practice? A survey of graduates compares frequency of QI cycles and self-assessment of QI skills among graduating classes, those receiving QI training and those graduating before training began. Residents that completed the QI curriculum rated their training higher; however residents that did not receive training were more involved in QI in practice. We suggest that this is due to QI involvement increasing with practice. Results will guide curriculum improvements to strengthen future resident training.
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Polaha, Jodi. "Innovation in Clinical Psychology Practice: Getting Our Help Where It’s Needed." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6695.
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Fox, Beth A., Jodi Polaha, and Ivy A. Click. "Implementation of Team Care Training and Team Care Practice." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6376.
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Ung, Oi Lam. "Integration of traditional medicinecomplementary medicine products into pharmacy practice :the Australian experiences." Thesis, University of Macau, 2017. http://umaclib3.umac.mo/record=b3690813.
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Wigg, Rowan Sarah. "Enhancing reflective practice among clinical psychologists and trainees." Thesis, University of Warwick, 2009. http://wrap.warwick.ac.uk/3264/.
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The role of the Clinical Psychologist has developed to incorporate that of the reflective practitioner. This thesis aims to consider how reflective practice is incorporated into personal and professional development by clinical psychologists and trainees, and what impact it may have upon clinical practice. The first chapter of the thesis reviews the relevant literature from the past 10 years relating to the use of personal therapy among therapists and the links to reflective practice. The findings suggest that a number of studies demonstrate some benefits of personal therapy for therapists. However, the literature lacks a unified theoretical explanation of the processes that occur during personal therapy and of their influence on the development of reflective practice. This chapter offers a critique of the literature and proposes a potential model for understanding the development of reflexivity through personal therapy. Chapter Two is an exploratory study of clinical psychologists’ experiences of personal development groups whilst in training. The study adopts an interpretive phenomenological approach to the analysis and results are presented through four super-ordinate themes. The results suggest that personal development groups are seen as an effective method of developing reflective practice by participants. The processes which encourage and hinder this are also explored. The research suggests that engaging in reflective practice may become a luxury after training in some cases and this may result in an increased strain on the therapist. The clinical and research implications of the study are discussed. Chapter Three provides a reflective account of the author’s experience of the research process including; choosing the research topic, developing the research question, relationship to the research and personal experiences of personal development groups. The paper comments on the presence of bias within the research, the impact of conducting the study on the researcher and reflections on themes arising from the empirical paper.
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Scarfe, Amy Clare. "From theory to practice : running kinematics of triathletes." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1687/.
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Triathlon comprises of three disciplines: swimming, cycling and running. Of these, running performance has been found to be most strongly related to race success. Studies investigating the effect of long term multidisciplinary training on running technique are limited. This thesis set out to further explore these chronic adaptations and apply this theoretical understanding to investigate training modification in triathlon. Results of the first two experiments showed that long term kinematic adaptations to running, present in both male and female triathletes. This is most likely due to the volume of cycling undertaken and the subsequent effect it has on the hip musculature. Consequently, a hip flexibility programme was designed and implemented. However, despite improvements in static flexibility, this programme did not affect running technique. In a subsequent study, flexibility training combined with running technique drills also failed to bring about any modifications in running kinematics. Findings of a longitudinal case study demonstrated that, in addition to chronic and acute running technique adaptations, intermediate changes linked to varying training demands also exist showing the level of variability of the running technique. It is concluded that adaptations to cycling are the cause of differences in running technique between triathletes and runners and that these modifications are difficult to reverse. However, the additional intermediate variations observed demonstrate technique can be changed as a result of training requirements.