Study Objective: To investigate resident physician knowledge about sexual abuse prevalence and understanding about potential perpetrators. Design: Questionnaires were mailed to program directors in family practice, obstetrics and gynecology, and pediatric residency programs. Participants: The questionnaires were distributed to senior residents in their final months prior to graduation. Interventions: Residents were asked to fill out the questionnaire anonymously and return it to our institution in the prepaid envelope provided. Main Outcome Measures: Demographic characteristics and knowledge of sexual abuse prevalence and perpetrator characteristics were assessed. Chi-square contingency table analysis was used to compare responses of the three specialties. Results: The overwhelming majority (98.8%) of residents correctly identified a family member as the individual most likely to sexually abuse a child. Approximately half of the residents knew the correct prevalence of sexual abuse among females and among males. There was a weak understanding of the potential youthfulness of juvenile offenders. Conclusion: We believe that resident understanding of sexual abuse prevalence and about the youthfulness of juvenile offenders can be improved in all three specialties.

The Doctor of Nursing Practice (DNP) Family Nurse Practitioner (FNP) curriculum was developed to incorporate learning outcomes and experiential opportunities for students to attain the core FNP knowledge for doctoral education. Historically, challenges related to developing clinical skills in blended/online programs has been problematic. The appeal of online FNP education has challenged educators to develop new ways to provide students opportunities to experience hands-on clinical skills within the subspecialties of the DNP, FNP role. With limited clinical sites, and now with more clinical access constraints imposed by the COVID-19 pandemic, it is imperative that new models of instruction provide students opportunities for skills training. The purpose of this project is to describe use of scaffolding methodology to design student skills learning activities using synchronous online and on-ground sessions during DNP intensives. Student and faculty input identified the types of practice skills and procedures needing improvement, such as suturing, electrocardiogram, etc. An intensive task force was organized to evaluate curricular elements; content was then mapped to analyze gaps. The first step included aligning advanced practice nursing skills sessions in each intensive with the related clinical courses offered within that semester. Then, students were organized into a skills rotation plan based on their date of admission and place within their program of study. Modifications required by COVID-19 on-ground restrictions necessitated re-thinking intensive skills sessions. Student satisfaction scores significantly improved after the intensive sessions were restructured. Faculty continue to seek feedback from the students to provide beneficial practice opportunities during the DNP intensives.

Introduction: I am a general practitioner in solo practice in Athlone. I work closely with a qualified nursing sister. Many of the patients we attend to have non-insulin dependent diabetes mellitus. Aim: To implement change in the management of our patients with diabetes by developing a protocol for future improved care. Objective: To assess the quality of care provided to patients with (NIDDM), by a doctor - nurse team in private general practice. Method : The study was quantitative and qualitative and consisted of 3 sections : 1) an internal audit based on the retrospective examination of patients' medical records, 2) a questionnaire which was administered to determine patients' knowledge of their disease and 3) a focus group interview which centred around patients' experience of the disease and feelings about the service provided. The interview was audio taped. Findings: Problem areas identified were sub-optimal record keeping; poor attendance and infrequent eye and foot examinations; patients' knowledge of their disease was limited; certain aspects of doctor-patient and patient-family relationships that may impact negatively on care; fears and anxieties relating to the disease and perceptions oflocus of control as external.

No description available.

The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.

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No description available.

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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.

1.The prevalence of hypertension in the Stonechurch Family Health Centre (S.F.H.C.) was 18%. This is higher than the prevalence of 15% for Ontario (p-value <0.05).22 Using logistic regression analysis, age was highly significant (p-value <0.0001), while sex was not (p-value = 0.584). Another 10% had raised B.P. readings. While no patient had hypertension under the age of 30, the prevalence of hypertension rose dramatically to approximately 50% at age 70. 2. 34% of patients with diagnosed hypertension (and receiving medication) were not controlled. This is higher than values reported in other studies (27% & 19%).32,38 3. The controlled rate for treated patients 60 and older (64%) was higher than the rate for untreated patients 60 and older (22%) (p-value = 0.025). In particular, 80% of women under 60 were controlled compared with 53% for those 60 and older (higher, p-value = 0.046). 88% of the uncontrolled hypertension in the 60 and older group, was isolated systolic hypertension (I.S.H.). It appears that the clinic did not have a consistent policy for the management of I.S.H. in the elderly. Women were particularly affected. 4. 80% of women under 60 were controlled, compared to 57% for men under 60 (higher, p-value = 0.108). Strategies for improved surveillance and management are needed for men under the age of 60. 5. The implementation of health maintaining interventions for men appears problematic. 75% of women attended at least once in 1994, compared to only 64% of men (higher, p-value <0.05). Women attended much more (83%) during their child-bearing and child-rearing age. They visited more often, 3.9 visits/year compared to 2.9/year for men (higher, p-value< 0.05). During child-rearing age, the rate was 4.7 for women. While women attend for health maintenance (e.g. breast examinations, Pap smears, and contraception), there are no significant gender specific interventions for men. 6. 19% of men never had their B.P. taken, compared to only 8% of women (higher, p-value < 0.05). Using logistic regression analysis, both age and sex were highly significant (p-value < 0.0001). In the previous five years, at age 20, 54% of men and 18% of women, did not have their B.P. taken. 7. In the previous year only 44% of the practice had their B.P. taken (within two years: 61%; and five years: 80%). The clinic's 44% coverage for B.P. readings is lower than the 70-75% reported by others.29,32,33 Dunn reported that 83% of patients who visited their doctor in two years had their B.P. taken.34 8. While 82% of Canadians reported visiting a G.P. in the previous year, 70% of the S.F.H.C.'s patients visited in a year.22 There is a turnover of 84% in two years and 96% in five years. Therefore in general, opportunistic interventions could be run at two or five year cycles (coverage of 84% and 96% respectively). 9. 70% of patients used 100% of the services (visits) in a 1994. 27% of patients accounted for 70% of all visits to the S.F.H.C. 10. Recommendations are made to improve both provider and patient compliance. A Hypertension Flow Chart with accompanying management protocols derived from the Canadian Consensus on Hypertension Management 1984-1992, and a Coronary Artery Disease Risk Prediction Chart, are provided.25 It is an accessible up-to-date instrument for consistent and effective management. Family physicians are in the best possible position for on-going population surveillance, opportunistic intervention, early diagnosis, and management of hypertension. / Thesis / Master of Science (MS)