Older Practitioners Research Articles

Ontario Chiropractors' Knowledge, Attitudes, and Beliefs About Intimate Partner Violence Among Their Patients: A Cross-Sectional Survey

Objective This study assessed chiropractors' attitudes, beliefs, knowledge, and experience about intimate partner violence (IPV) and identified if any differences exist between age groups, sex, and year of graduation of respondents. Methods Five hundred five Ontario chiropractors were sampled from the Canadian Chiropractic Association membership using a randomization program. This study used a cross-sectional survey. The sample was mailed an introductory postcard and 3 subsequent Provider Surveys, demographic forms, and information letters depending on nonresponse. The data were analyzed using descriptive statistics, Kruskal-Wallis analyses of variance and Mann-Whitney U tests. Results A response rate of 61% was attained. Of the respondents, 88% reported that IPV was rare or very rare in their practice. Significant sex differences were identified. Female respondents were almost twice as likely to strongly disagree with victim-blaming statements and were almost twice as concerned for their safety as male chiropractors when broaching the topic with batterers. Older practitioners were significantly more likely to inquire about IPV depending on symptoms, blame victims, have less fear of offending victims, and have fewer safety concerns. Earlier graduates were significantly more likely to inquire about IPV depending on clinical presentation but were also more likely to blame victims. Conclusions Ontario chiropractors have very little experience identifying IPV. Chiropractors would benefit from educational programs that would enable them to better identify and manage patients experiencing IPV. Sex, age, and experience were important modifiers in Ontario chiropractors' perceptions and behaviors regarding IPV among their patients.

Tactile acuity in experienced Tai Chi practitioners: evidence for use dependent plasticity as an effect of sensory-attentional training

The scientific discovery of novel training paradigms has yielded better understanding of basic mechanisms underlying cortical plasticity, learning and development. This study is a first step in evaluating Tai Chi (TC), the Chinese slow-motion meditative exercise, as a training paradigm that, while not engaging in direct tactile stimulus training, elicits enhanced tactile acuity in long-term practitioners. The rationale for this study comes from the fact that, unlike previously studied direct-touch tactile training paradigms, TC practitioners focus specific mental attention on the body's extremities including the fingertips and hands as they perform their slow routine. To determine whether TC is associated with enhanced tactile acuity, experienced adult TC practitioners were recruited and compared to age-gender matched controls. A blinded assessor used a validated method (Van Boven et al. in Neurology 54(12): 2230-2236, 2000) to compare TC practitioners' and controls' ability to discriminate between two different orientations (parallel and horizontal) across different grating widths at the fingertip. Study results showed that TC practitioners' tactile spatial acuity was superior to that of the matched controls (P < 0.04). There was a trend showing TC may have an enhanced effect on older practitioners (P < 0.066), suggesting that TC may slow age related decline in this measure. To the best of our knowledge, this is the first study to evaluate a long-term attentional practice's effects on a perceptual measure. Longitudinal studies are needed to examine whether TC initiates or is merely correlated with perceptual changes and whether it elicits long-term plasticity in primary sensory cortical maps. Further studies should also assess whether related somatosensory attentional practices (such as Yoga, mindfulness meditation and Qigong) achieve similar effects.

Use of operating telescopes with multifocal corrective lenses.

Many older practitioners who wear spectacles with multifocal lenses for surgery work have been told that they cannot use flip-up magnifying telescopes with these owing to the difficulty of positioning them over the appropriate part of the lens and therefore must resort to normal bifocals. They thereby lose the advantages of clear vision at all distances which multifocals give. This article describes a way of overcoming this problem.

Clio's Dream; or, Has the Muse Departed from the Temple? Implications for Library History

The Education of Historians for the Twenty-first Century. By Thomas Bender, Philip M. Katz, Colin Palmer, and the Committee on Graduate Education (AHA). Champaign: University of Illinois Press, 2004. 200 pp. $35.00. ISBN 0-252-02898-8. The desire to reflect upon the past may be as old as humanity itself—how are we to know? After all, the recent epistemologically driven forays into the raison d'être of history and historical practice speak to a certain anxiety among historians surveying their intellectual and perhaps at times ontological conditions. Whether grounded in historiographic analysis or within a broader concern over the profession and practice of the humanities or social sciences as a whole, historians have much to be proud of and as much to be concerned about. Reflection upon the historical enterprise is not new, nor has it been wanting; to the contrary, it has been bound up in the seasoned musings of historians who, having reached the ends of their careers, deem it worthy to set their thoughts on that which has taken their lives to task.1 These thoughts and musings often offer more of the author, as either academic or in some fashion a professional historian, than anything truly historiographically concrete. There are many reasons for this. The distance and acuity required to examine one's professional vocation is a rare attribute. It demands the ability to weigh the contours and substance of one's intellectual and sociological existence as practitioner and professor of a discipline.2 Socratic admonition aside, it demands the most vigilant and concerted self-examination, at times ruthlessly honest and disquieting. Perhaps, in a strange way, philosophy of history or its more historically grounded brethren, historiography, is so terribly difficult to countenance. Those who specialize in [End Page 429] and practice historiography, especially its more pure variety (i.e., the history of history, epistemological and philosophical examination, over event-oriented historiography, e.g., the Enlightenment as historical problem), constitute a rare scholarly species. In the professional environment in which historical practice is situated, historiography and philosophy of history are indeed rarefied pursuits. Certainly, courses at the undergraduate and graduate level exist, but as necessary components of scholarly acculturation, not as means and ends unto themselves. As a specialty, historiography and the philosophy of history are tolerated intellectual baggage, necessary for becoming a historian but not to be misconstrued as doing history. With this in mind, it is never easy to examine one's own profession from within, for as practitioner such existential introspection demands an ability to step aside and peer into the mirror. Doing so opens one to the exigencies and vulnerabilities of soul-searching if not professional pulse reading. Any realignment or radical change in course can be fairly difficult and at times exceedingly open to criticism. Admittedly, such self-examination has its rewards and its possible burdens. Periodically, professions embark upon such a course in keeping with their prerogatives as stewards of their special vocation and knowledge.3 As the academy has evolved, attempts to ascertain where the disciplines are and where they are heading have become critically imperative for sustained scholarly well-being and intellectual vitality. During the last thirty to forty years scholarly disciplines have undergone pervasive influences and transformation, so much so that most of the humanities and social sciences may be professionally unrecognizable to older practitioners.4 New fields of interest, specialties, and even subdisciplines have been born.5 Critically generated theoretical analysis informs more traditionally accepted domains of knowledge and practice. Consequently, an attempt to get our bearings is paramount to understanding just where the center is within a discipline in both theory and practice. As the American historical profession has undergone the rigors of the transformation of American higher education, so too has it accommodated those changes implicit within the academy. Continued...

Refining the Map of the Counselor Development Journey: Response to Rønnestad and Skovholt

In this article, we respond to Rønnestad and Skovholt's reformulated counselor development model itself, then to some of its implications. With respect to the model: (a) although this version is more parsimonious than the original, we show that it could be more so; and (b) because the authors do not discuss determinants of psychotherapy as a career choice, we draw from existing literature to suggest some. With respect to the implications of the work, we note that: (a) trainee anxiety may not be as important as its prominence in their model suggests; (b) Rønnestad and Skovholt's finding that older practitioners turn to alternative sources (e.g., cinema; literature) to learn about human nature may be related to the consistent finding that practitioners are not research consumers; and (c) the importance Rønnestad and Skovholt attach that post-licensure supervision should be given more attention.

Dentists in general and community practice: a Scottish survey.

To identify the available workforce in general dental practice and to describe the job satisfaction, career and retirement plans of dentists in general and community practice. A postal cross-sectional survey. Primary care dentists practising in Scotland in 2000. Semi-structured questionnaires were sent to all primary care dentists identified from the Scottish Dental Practice Division as being in practice in Scotland. The response rate was 70% (1,335 GDPs and 187 CDPs). Although most dentists in both the GDS and CDS stated that they enjoyed their work, 35% of GDPs would not now choose dentistry as a career. Eighty-three per cent of the GDPs' time was spent on clinical work, of which 5% was not NHS-funded. Daily demotivation was reported by 70%, most commonly citing the job itself and the NHS 'treadmill'. Two-thirds of CDPs were women, as were half of GDPs aged less than 30. Only 35% of CDPs planned early retirement but 80% of them felt underused. Two-thirds of GDPs planned to retire in their mid-50s, and a further quarter planned to work part-time. Of the former, only a quarter agreed that nothing would induce them to work beyond this time. Conditions of work within primary care dentistry require modification to retain the current workforce and accommodate the increasing proportion of women. Part-time employment packages may encourage older practitioners to work for longer, and allow younger practitioners to fulfil family or personal commitments.

A workforce survey of dentists in Scotland

Objectives To identify the available workforce in general dental practice and to describe the job satisfaction, career and retirement plans of dentists in general and community practice. Design A postal cross-sectional survey. Setting Primary care dentists practising in Scotland in 2000. Materials and methods Semi-structured questionnaires were sent to all primary care dentists identified from the Scottish Dental Practice Division as being in practice in Scotland. Results The response rate was 70% (1,335 GDPs and 187 CDPs). Although most dentists in both the GDS and CDS stated that they enjoyed their work, 35% of GDPs would not now choose dentistry as a career. Eighty-three per cent of the GDPs' time was spent on clinical work, of which 5% was not NHS-funded. Daily demotivation was reported by 70%, most commonly citing the job itself and the NHS 'treadmill'. Two-thirds of CDPs were women, as were half of GDPs aged less than 30. Only 35% of CDPs planned early retirement but 80% of them felt underused. Two-thirds of GDPs planned to retire in their mid-50s, and a further quarter planned to work part-time. Of the former, only a quarter agreed that nothing would induce them to work beyond this time. Conclusion Conditions of work within primary care dentistry require modification to retain the current workforce and accommodate the increasing proportion of women. Part-time employment packages may encourage older practitioners to work for longer, and allow younger practitioners to fulfil family or personal commitments.

General dental practitioners' beliefs on the perceived effects of and their preferences for remuneration mechanisms

Objective To identify GDPs preferences for differing remuneration mechanisms and their beliefs on the effect of the mechanisms in care provision. Design Postal questionnaire survey of 300 GDPs holding an NHS contract with a London Health Authority. Results GDPs perceive that remuneration mechanisms are important in determining the provision of care but not overall disease levels. There were differences in the preferred remuneration mechanisms when working under the NHS compared with the non-NHS sector. When providing care under the NHS, either the current remuneration system or a salaried plus bonus would be the preferred choice, while for non-NHS care a fee-per-item mechanism is preferred. Fee-per-item arrangement was the preferred choice of younger general practitioners compared with older practitioners. Females showed a greater preference for a salaried with bonus arrangement compared with males. Conclusions If policy makers are to use remuneration mechanisms to influence the provision of care effectively, the beliefs that care providers hold about various mechanisms are important to understand how they would respond to changes in the system.

GDPs' views on alternative renumeration systems

Objective To identify GDPs preferences for differing remuneration mechanisms and their beliefs on the effect of the mechanisms in care provision. Design Postal questionnaire survey of 300 GDPs holding an NHS contract with a London Health Authority. Results GDPs perceive that remuneration mechanisms are important in determining the provision of care but not overall disease levels. There were differences in the preferred remuneration mechanisms when working under the NHS compared with the non-NHS sector. When providing care under the NHS, either the current remuneration system or a salaried plus bonus would be the preferred choice, while for non-NHS care a fee-per-item mechanism is preferred. Fee-per-item arrangement was the preferred choice of younger general practitioners compared with older practitioners. Females showed a greater preference for a salaried with bonus arrangement compared with males. Conclusions If policy makers are to use remuneration mechanisms to influence the provision of care effectively, the beliefs that care providers hold about various mechanisms are important to understand how they would respond to changes in the system.

Information technology and under-served communities.

Advances in information technology (IT) and telecommunications offer many potential benefits to Australia's under-served communities. However, there is also a risk that some of these communities will only be further disadvantaged, as IT will not contribute greatly to bringing groups such as the mentally ill and illiterate into the mainstream of the community. However, other under-served groups may experience service improvements. For people who do not have English as their first language, IT developments provide opportunities for cheaper and easier service and information delivery in their own languages. Telemedicine and IT also have the potential to make working in rural areas more attractive. On the other hand, telemedicine may be used as a means to bypass local health service providers, as has happened with other service industries. The health sector, though, is well behind these other industries in adopting IT and telecommunications. The growth of telemedicine projects is one indication that progress is being made, however. Two case studies--of telepsychiatry, and of medical education at Flinders University--provide examples of major Australian successes. The medical workforce implications will involve the overall numbers and mix of practitioners, their geographical distribution, changing professional boundaries and changing skill requirements. The only certain effect is that if IT changes the nature of medical work, large numbers of medical practitioners will need to improve their computer skills and older practitioners will find this most difficult.

Reform, but not managed care

By coincidence, the June AAP News and Wall Street Journal, June 20, 1994, arrived on the same day, and gave a contrasting picture of managed care as it is progressing in this year of reform. The WSJ headline stated Changes in Medicine Widen the Usual Gap Among Practitioners, and the AAP News headline read Physicians adopt managedcare mode. Both articles cite the differences in acceptance of managed care by the younger pediatricians and the older practitioners; the latter practiced under both modes of health care, namely fee-for-service, and now managed care.

The Care of the Patient

It is probably fortunate that systems of education are constantly under the fire of general criticism, for if education were left solely in the hands of teachers the chances are good that it would soon deteriorate. Medical education, however, is less likely to suffer from such stagnation, for whenever the lay public stops criticizing the type of modern doctor, the medical profession itself may be counted on to stir up the stagnant pool and cleanse it of its sedimentary deposit. The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or, to put it more bluntly, they are too scientific and do not know how to take care of patients. One is, of course, somewhat tempted to question how completely fitted for his life work the practitioner of

Concepts of Pregnancy, Childbirth, and Infancy in Ch'ing Dynasty China

I deas about gender organize the social relations between men and women. They gain their power because they seem to be the products of a natural order of things, deeper than any social conventions. Reproductive processes, like eating and drinking, sickness and death, appear as part of the biological substratum of human experience, operating according to universal laws that apply to all human beings and to other living creatures as well. Older practitioners of the history of science, when confronted with the bewildering variety of customs, rituals, and medical aids surrounding childbirth in remote times and places, usually recorded these as superstition or the products of naive empiricism. The consequent interpretation of the history of medicine as the gradual replacement of error by science retains its positivist appeal even today.

Determinants of requests for water fluoride assay among North Carolina dentists.

Fluoride content of drinking water is an important criterion in prescribing fluoride supplements. The majority of practicing dentists and physicians prescribe fluoride supplements, yet many apparently are unaware of the fluoride levels in their patients' drinking water. Characteristics of North Carolina (NC) dentists, their practices, and their communities were investigated to determine factors associated with whether they requested fluoride assays of their patients' drinking water. Comparisons were made between dentists sampling (assaying) and those not sampling. Licensure renewal files provided characteristics of the 79 pedodontists and 1768 general practitioners (GP's) active in NC. Eighty-eight GP's (5%) and 26 pedodontists (33%) requested water fluoride analyses between December, 1982, and May, 1983. Significant predictors of fluoride assay request by GP's were the dentist's age, the geographic region of the state, the number of dentists in the practice, and an interaction between geographic region and the number of dentists in the practice. Younger GP's and those with fewer dentists in the practice were more likely to request fluoride assays of patients' water. For pedodontists, dentist's age and geographic region were significant predictors. Additional training concerning the need for water fluoride assay appears necessary, especially among older practitioners.

The care of the patient. By Francis W. Peabody, M.D. 1927.

It is probably fortunate that systems of education are constantly under the fire of general criticism, for if education were left solely in the hands of teachers the chances are good that it would soon deteriorate. Medical education, however, is less likely to suffer from such stagnation, for whenever the lay public stops criticizing the type of modern doctor, the medical profession itself may be counted on to stir up the stagnant pool and cleanse it of its sedimentary deposit. The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or, to put it more bluntly, they are too scientific and do not know how to take care of patients. One is, of course, somewhat tempted to question how completely fitted for his life work the practitioner of

Practices, strategies, and motivations in treatment of rheumatoid arthritis

National Analysts conducted primary research with rheumatologists—specifically, two panel discussions, 25 in-depth telephone interviews, and a mail survey of conference (Auranofin Symposium and Workshop) participants—to examine current treatment practices and to probe the rationale and motivations underlying treatment strategies in rheumatoid arthritis. The research identified important areas of consensus in drug perceptions, therapeutic approaches, and disagreements. Physicians differ regarding the minimum time they wait after diagnosing rheumatoid arthritis before initiating remittive therapy, some beginning immediately and others waiting six months or longer. Younger physicians are quicker to initiate remittive treatment than their older colleagues, but both younger and older practitioners are initiating remittive therapy earlier than in the past. Some noteworthy differences between hospital-based and office-based practitioners were discerned with respect to factors that figure in their decisions to initiate remittive therapy. Differences were also found among physicians in the way they pose drug options to their patients; “authoritarian,” “libertarian,” and “guided democracy” were names given to the three styles identified. In general, however, physicians report that patients are more directly involved in treatment selection than previously, a trend that may in part be due to the use of more aggressive treatment strategies than in the past and a desire to share the psychologic burden of those decisions. Findings suggest that gold compounds will continue to be a mainstay first-line disease-modifying agent in the treatment of rheumatoid arthritis but that there may be less reluctance to use other agents as physicians become increasingly familiar and comfortable with alternative options, especially penicillamine and immunosuppressive agents.

Sexual asphyxia: A neglected area of study

Sexual asphyxia, a solitary autoerotic activity practiced almost exclusively by males, is examined in this paper. The self‐induced asphyxia may be either chemical or mechanical, and its purpose it to heighten the sexual pleasure. The practice of sexual asphyxia can result in death; however, many such deaths may erroneously be viewed as suicides or homicides as a result of the lack of knowledge of the practice. Sixteen sexual asphyxiai deaths, reported in Dade County (Miami), Florida, are examined in detail. These data confirm that practitioners are overwhelmingly young, white, middle‐class, unmarried males. When the practice is fatal among older practitioners, the data show that some complicating factor, such as the use of alcohol or other drugs, may have contributed to the accident. The most frequent method of inducing the asphyxia was simple hanging by rope and in most cases there was no indication nor suspicion of suicidal intent

Producer and Veterinarian

What I would like to do is divide my presentation into three parts: (I) where have we been in scientific agriculture? (2) where are we now? and (3) where are we going? As far as where we have been, as many of you older pract itioners know, in the last 40 years we have seen a tremendous increase in the quantity and quality of food produced in America. The two fields where America leads the world are in ( l) scientific agriculture and (2) food technology. What about the future? I think it is positive. I think there are a lot of things that we can do and it involves you and me getting involved in politics in addition to veterinary medicine.

The Care of the Patient

It is probably fortunate that systems of education are constantly under the fire of general criticism, for if education were left solely in the hands of teachers the chances are good that it would soon deteriorate. Medical education, however, is less likely to suffer from such stagnation, for whenever the lay public stops criticizing the type of modern doctor, the medical profession itself may be counted on to stir up the stagnant pool and cleanse it of its sedimentary deposit. The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or, to put it more bluntly, they are too scientific and do not know how to take care of patients. One is, of course, somewhat tempted to question how completely fitted for his life work the practitioner of

High blood pressure. detection and treatment by general practitioners.

A questionnaire was sent to a 10% random sample of general practitioners in England and Wales on their attitudes to the detection and treatment of hypertension; 62% responded and no further inquiry was made. Their view on detection and criteria for treatment and investigations performed were considered in relation to their background. More of the older practitioners always measured blood pressure and 36% of all practitioners believed that hypertensive patients usually present with symptoms. Altogether 91% thought that strokes could be prevented by treating hypertension, and only 18% reported difficulty in keeping patients on treatment. Older practitioners preferred to measure the distolic pressure using phase five, while the younger preferred phase four. Nearly all doctors were satisfied with their current sphygmomanometers.