Concern About Guidelines

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 544-544
Author(s):  
Chuck Lallier
Keyword(s):  
Primary Care ◽  
Practice Guidelines ◽  
Treatment Options ◽  
The Individual ◽  
Primary Care Pediatricians

I enjoyed reading Dr Paul Young's article "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines" in the May 1995 issue of Pediatrics. It seems we, as general pediatricians, are barraged with an increasing number of "guidelines" for the management of everything from fever to hyperbilirubinemia. These guidelines are very useful in helping one think of diagnostic/treatment options, but need to leave a lot of room for variation with the individual patient.

Practice and Guidelines

PEDIATRICS ◽  
1996 ◽  
Vol 97 (4) ◽  
pp. 604-605
Author(s):  
John T. Benjamin
Keyword(s):  
Primary Care ◽  
Otitis Media ◽  
Practice Guidelines ◽  
Primary Care Pediatricians

As a former practicing pediatrician turned academic, I found the article entitled "The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison with Published Practice Guidelines"1 interesting if not disturbing. Three case scenarios were sent to 194 pediatricians: a 3-week-old infant with fever, a 2-month-old infant with rales and bilateral otitis media, and a 20-month-old infant with fever. Ninety-four pediatricians responded and their workups and approaches to treatment compared to ‘practice guidelines" developed by Baraff et al.2

The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 623-627 ◽  
Author(s):  
Paul C. Young
Keyword(s):  
Primary Care ◽  
Practice Guidelines ◽  
Laboratory Tests ◽  
Blood Count ◽  
Response Rate ◽  
Expert Panel ◽  
Complete Blood Count ◽  
Age Groups ◽  
Design Case ◽  
Primary Care Pediatricians

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines. Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies. Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants. Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.

Pediatricians Will Speak Up for Themselves!

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 893-894
Author(s):  
Glenn Austin
Keyword(s):  
Primary Care ◽  
Infant Mortality ◽  
Psychosocial Problems ◽  
Children's Health ◽  
Children’S Health ◽  
The Past ◽  
The Individual ◽  
Speak Up ◽  
Primary Care Pediatricians

The majority of us in pediatrics are primary care pediatricians who take care of children and young families on a day-to-day basis. All of us are proud that over the past decades we have managed to keep more and more children out of hospitals, that we have reduced infant mortality to an all-time low, and that we have managed to contribute in a very positive and meaningful way to the lives of the patients and parents we serve, as witnessed by the affection and esteem in which we are held by the individual families in our practices. They manifest their belief that we are the best equipped of all professionals to handle most of their children's health and psychosocial problems by the fact that 83% of reimbursements for care in pediatricians' offices are paid for "out of pocket" by young and generally nonaffluent families.1

Can the Development of Practice Guidelines Safeguard Patient Values?

1995 ◽  
Vol 23 (1) ◽  
pp. 75-81 ◽  
Author(s):  
Jodi Halpern
Keyword(s):  
Practice Guidelines ◽  
Health Care Organization ◽  
Treatment Options ◽  
Abnormal Uterine Bleeding ◽  
Care Organization ◽  
Model Of Care ◽  
Medical Treatments ◽  
Patient Values ◽  
The Individual ◽  
The Impact

In response to increasing use of practice guidelines in medicine, physicians have focused their attention on how these guidelines can restrict their medical practices. However, guidelines not only restrict physician discretion, but they also limit the treatment options available to patients. As a result, treatments which patients consider beneficial may not be recommended; for example, some hysterectomies for abnormal uterine bleeding, and cataract surgery in patients with dementia. When guidelines are used to determine which medical treatments a health care organization or insurer will cover, these recommendations become restrictions. Thus far, guidelines have been developed without adequate attention to the impact that their restrictive use has on diverse patient values.Two significant tensions in current medical ethics relate to the inclusion of patient values in practice guidelines. First, a tension exists between the traditional paternalistic model of care, in which the physician judges unilaterally which treatments will benefit the patient, and the more recent autonomy model, in which the physician elicits the individual patient's health values to determine which treatments will be beneficial.

Few primary care pediatricians screen for psychosis but many are willing

2021 ◽  
Vol 232 ◽  
pp. 65-67
Author(s):  
Alexander B. Moxam ◽  
Emily J. McClellan ◽  
Consuelo Cagande ◽  
Monica E. Calkins ◽  
Daniel H. Wolf ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Pediatricians

scholarly journals Clinical practice guidelines and principles of care for people with dementia: a protocol for undertaking a Delphi technique to identify the recommendations relevant to primary care nurses in the delivery of person-centred dementia care

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044843
Author(s):  
Caroline Gibson ◽  
Dianne Goeman ◽  
Mark William Yates ◽  
Dimity Pond
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Dementia Care ◽  
Care Nurse ◽  
Primary Care Nurse ◽  
People With Dementia ◽  
Primary Care Nurses

IntroductionNationally and internationally it is well recognised that dementia is poorly recognised and suboptimally managed in the primary care setting. There are multiple and complex reasons for this gap in care, including a lack of knowledge, high care demands and inadequate time for the general practitioner alone to manage dementia with its multiple physical, psychological and social dimensions. The primary care nurse potentially has a role in assisting the general practitioner in the provision of evidence-based dementia care. Although dementia-care guidelines for general practitioners exist, evidence on resources to support the primary care nurse in dementia care provision is scarce. The ‘Australian Clinical Practice Guidelines and Principles of Care for People with Dementia’ provides 109 recommendations for the diagnosis and management of dementia. This protocol describes a Delphi study to identify which of the 109 recommendations contained in these multidisciplinary guidelines are relevant to the primary care nurse in the delivery of person-centred dementia care in the general practice setting.Methods and analysisUsing a Delphi consensus online survey, an expert panel will grade each of the recommendations written in the ‘Clinical Practice Guidelines and Principles of Care for People with Dementia’ as high-to-low relevance with respect to the role of the primary care nurse in general practice. To optimise reliability of results, quality indicators will be used in the data collection and reporting of the study. Invited panel members will include Australian primary care nurses working in general practice, primary care nursing researchers and representatives of the Australian Primary Health Care Nurses Association, the peak professional body for nurses working in primary healthcare.Ethics and disseminationThis study has been approved by The University of Newcastle Human Research Ethics Committee (HREC) (H-2019-0029).Findings will be published in a peer-reviewed journal and presented at scientific conferences.

Education for the Post?

PEDIATRICS ◽  
1978 ◽  
Vol 61 (6) ◽  
pp. 938-939
Author(s):  
Richard J. Gluckman
Keyword(s):  
Primary Care ◽  
Current Trend ◽  
Hospital Setting ◽  
View Point ◽  
Family Practitioners ◽  
Primary Care Pediatricians

Having read the commentary "Primary Care: We Need All the Help We Can Get!" (Pediatrics 59:315, March 1977), I agree with Dr. Haggerty and oppose Dr. White's view-point. I agree with Dr. Hoekelman that we need to "develop partnerships with family practitioners and others if we are to succeed" in providing "optimal primary care." The current trend in many pediatric training centers is not directed toward this goal. As has been stated many times, we are training more primary care pediatricians using sick patients in a hospital setting.

Pediatric Plastic and Reconstructive Surgery for Primary Care

2020 ◽  
Author(s):  
Keyword(s):  
Primary Care ◽  
Reconstructive Surgery ◽  
Plastic And Reconstructive Surgery ◽  
Reconstruction Surgery ◽  
Primary Care Pediatricians ◽  
Comprehensive Coverage

With contributions from the leading experts, Pediatric Plastic and Reconstructive Surgery for Primary Care provides primary care pediatricians and other professionals who care for children comprehensive coverage of both common and rare congenital and acquired pediatric conditions. https://shop.aap.org/pediatric-plastic-and-reconstruction-surgery-for-primary-care-paperback/

scholarly journals Principles of Valgus Intertrochanteric Osteotomy (VITO) after Femoral Neck Nonunion

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
D. Banaszek ◽  
D. Spence ◽  
P. O’Brien ◽  
K. Lefaivre
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Proximal Femur ◽  
Treatment Options ◽  
Intertrochanteric Osteotomy ◽  
Valgus Osteotomy ◽  
Challenging Problem ◽  
The Individual ◽  
Technical Considerations

Nonunion is a relatively rare, yet challenging problem after fracture of the femoral neck. Risk factors include verticality of the fracture line and presence of comminution of the posteromedial calcar, as well as quality of reduction. Treatment options consist of valgus intertrochanteric osteotomy versus arthroplasty. Treatment should be tailored to the individual patient, taking into account patient age and activity demands. This review outlines the principles and technical considerations for valgus osteotomy of the proximal femur in the setting of femoral neck nonunion.

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