Can we import quality tools? a feasibility study of European practice assessment in a country with less organised general practice

<p>Abstract</p> <p>Background</p> <p>Quality is on the agenda of European general practice (GP). European researchers have, in collaboration, developed tools to assess quality of GPs. In this feasibility study, we tested the European Practice Assessment (EPA) in a one-off project in Belgium, where general practice has a low level of GP organisation.</p> <p>Methods</p> <p>A framework for feasibility analysis included describing the recruiting of participants, a brief telephone study survey among non-responders, organisational and logistic problems. Using field notes and focus groups, we studied the participants' opinions.</p> <p>Results</p> <p>In this study, only 36 of 1000 invited practices agreed to participate. Co-ordination, administrative work, practice visits and organisational problems required several days per practice. The researchers further encountered technical problems, for instance when entering the data and uploading to the web-based server. In subsequent qualitative analysis using two focus groups, most participant GPs expressed a positive feeling after the EPA procedure. In the short period of follow-up, only a few GPs reported improvements after the visit. The participant GPs suggested that follow-up and coaching would probably facilitate the implementation of changes.</p> <p>Conclusion</p> <p>This feasibility study shows that prior interest in EPA is low in the GP community. We encountered a number of logistic and organisational problems. It proved attractive to participants, but it can be augmented by coaching of participants in more than a one-off project to identify and achieve targets for quality improvement. In the absence of commitment of the government, a network of universities and one scientific organisation will offer EPA as a service to training practices.</p

Paleoclimatic Variability At Frequencies Ranging From 1 Cycle Per 10000 Years To 1 Cycle Per 1000 Years - Evidence for Nonlinear Behavior of the Climate System

The paleoclimatic variability at frequencies ranging from 10/sup -4/ cycle per year (cpy) to 10/sup -3/ cpy is investigated using a set of three deep-sea cores from the Indian Ocean. Three frequency bands of high paleoclimatic variability are first defined using upper and lower limits of the significant spectral power concentrations: the bands are centered around the spectral maxima located at 10.3, 4.7, and 2.5 kyr. The localization of spectral lines is then refined by high-resolution spectral analysis. Some of the resulting lines have frequencies which are close to those previously detected in other paleoclimatic records, including the precessional peak at 19 kyr. Additional lines are also in good correspondence with the response of a nonlinear climatic oscillator forced by insolation variations, including peaks at 13 kyr, 10.4 kyr and 9.4 kyr. This correspondence suggests orbital forcing. Moreover, for the Indian Ocean which is influenced by the monsoon circulation, it is plausible that the precessional contribution of the forcing interacts strongly with the precipitation-temperature feedback used in the model, thus emphasizing the nonlinearity of the response.Anglai

Use of the orthogonal projection approach (OPA) to monitor batch processes

The orthogonal projection approach (OPA) and multivariate curve resolution (MCR) are presented as a way to monitor batch processes using spectroscopic data. Curve resolution allows one to look within a batch and predict on-line real concentration profiles of the different species appearing during reactions. Taking into account the variations of the process by using an augmented matrix of complete batches, the procedure explained here calculates some prediction coefficients that can afterwards be applied for a new batch.</p

EFFET DE 300 MG DE RANITIDINE, DE 800 MG DE CIMETIDINE ET D'UN PLACEBO ADMINISTRES APRES LE REPAS DU SOIR SUR LE pH GASTRIQUE DE 24 HEURES CHEZ L'ULCEREUX DUODENAL

Twenty-four-hour intragastric pH monitoring was performed in 20 patients with duodenal ulcer in order to compare the results obtained with placebo, ranitidine 300 mg and cimetidine 800 mg administered one hour (7 PM) after evening meal (6 PM). During each 24 h period (8 AM-8 AM), gastric pH was continuously monitored in standardized dietary conditions. Treatment was started the evening (7 PM) before the test. Median acidity was calculated and percent of time of recording at or above any pH unit was graphically represented. Median acidity and areas under the curves were submitted to statistical comparison. The values were computed for the 24-h period, for the 8 AM-8 PM period, for the 8 PM-8 AM period. In these three periods studied gastric acidity decreased more with ranitidine than with cimetidine. No statistical difference was found between cimetidine and placebo for the 8 AM-8 PM period.SCOPUS: re.jinfo:eu-repo/semantics/publishe

COMPARAISON DU PH GASTRIQUE DE 24 HEURES CHEZ DES TEMOINS, DES ULCEREUX DUODENAUX ET DES MALADES ATTEINTS DE GASTRITE ATROPHIQUE

Twenty-four intragastric acidity was measured by continuous recording using intragastric glass electrodes in 16 normal controls, 18 inactive duodenal ulcer patients and 7 patients with atrophic gastritis. Median pH for the 24 h period, for the 8 AM-8 PM period, and for the 8 PM-8 AM period were significantly lower in duodenal ulcer patients than in controls (1.19 vs. 1.78; 1.17 vs 2.05; 1.27 vs 1.64). Median pH for these 3 periods were significantly higher in patients with atrophic gastritis than in controls (3.90; 3.72; 3.81). The median pH for the 24 h period was higher than the lower quartile value of the control group in 33 per cent of duodenal ulcer patients. During the night (24 h-3 h), duodenal ulcer patients had significantly lower median pH (1.03) than controls (1.51). Antisecretory treatment should be directed to decrease this period of unbuffered acidity.SCOPUS: ar.jinfo:eu-repo/semantics/publishe