Practice development Health Dictionary

Practice Development: From 1 Different Sources


a policy of actively and continuously improving patient care, with an emphasis on interprofessional collaboration and the integration of evidence-based practice with *person-centred care.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Consensus Development

Various forms of group judgement in which a group (or panel) of experts interacts in assessing an intervention and formulating findings by vote or other informal or formal means, involving such techniques as the nominal group and Delphi techniques.... consensus development

General Practice

A form of practice in which medical practitioners provide a wide range of primary health care services to people.... general practice

Group Practice

A formal association of three or more health practitioners or other health professionals providing health services. Income from the practice is pooled and redistributed to the members of the group according to some prearranged plan.... group practice

Developmental Delay

A term used if a baby or young child has not achieved new abilities within the normal time range. Normally, new abilities and new patterns of behaviour appear at given ages, and existing patterns of behaviour change and sometimes disappear (see child development).

Delays vary in severity and may affect the development of hand–eye coordination, walking, listening, language, speech, or social interaction. Delay may first be noticed by parents or detected during a routine developmental check.

There are many causes of developmental delay. A child who is late in most aspects of development usually has a generalized problem. This may be due to severe visual or hearing impairment, limited intellectual abilities (see learning difficulties), or damage to the brain before, during, or after birth.

Specific areas of delay may occur in movement and walking. Often there is no serious cause. However, specific causes may include muscular dystrophy and spina bifida. Delay in developing manipulative skills is often due to lack of adequate stimulation.

A lack of response to sound may be due to deafness. Autism is a rare cause of unresponsiveness to the human voice although hearing is normal. A hearing problem may cause delayed speech. Twins are often late talkers. Any generalized difficulty with muscle control can affect speech production; this may occur in children with cerebral palsy. Damage to, or structural defects of, the speech muscles, larynx (voice box), or mouth may also cause speech difficulties, as may any disorder affecting the speech area of the brain (see aphasia; dysarthria; dysphonia; speech disorders). Delay in bladder and bowel control have many possible causes (see encopresis; enuresis; soiling).

A child who shows signs of developmental delay should undergo a full assessment by a paediatrician.... developmental delay

Child Development Teams (cdts)

Screening and surveillance uncover problems which then need careful attention. Most NHS districts have a CDT to carry out this task – working from child development centres – usually separate from hospitals. Various therapists, as well as consultant paediatricians in community child health, contribute to the work of the team. They include physiotherapists, occupational therapists, speech therapists, psychologists, health visitors and, in some centres, pre-school teachers or educational advisers and social workers. Their aims are to diagnose the child’s problems, identify his or her therapy needs and make recommendations to the local health and educational authorities on how these should be met. A member of the team will usually be appointed as the family’s ‘key worker’, who liaises with other members of the team and coordinates the child’s management. Regular review meetings are held, generally with parents sharing in the decisions made. Mostly children seen by CDTs are under ?ve years old, the school health service and educational authorities assuming responsibility thereafter.

Special needs The Children Act 1989, Education Acts 1981, 1986 and 1993, and the Chronically Sick and Disabled Persons Legislation 1979 impose various statutory duties to identify and provide assistance for children with special needs. They include the chronically ill as well as those with impaired development or disabilities such as CEREBRAL PALSY, or hearing, vision or intellectual impairment. Many CDTs keep a register of such children so that services can be e?ciently planned and evaluated. Parents of disabled children often feel isolated and neglected by society in general; they are frequently frustrated by the lack of resources available to help them cope with the sheer hard work involved. The CDT, through its key workers, does its best to absorb anger and divert frustration into constructive actions.

There are other groups of children who come to the attention of child health services. Community paediatricians act as advisers to adoption and fostering agencies, vital since many children needing alternative homes have special medical or educational needs or have behavioural or psychiatric problems. Many see a role in acting as advocates, not just for those with impairments but also for socially disadvantaged children, including those ‘looked after’ in children’s homes and those of travellers, asylum seekers, refugees and the homeless.

Child protection Regrettably, some children come to the attention of child health specialists because they have been beaten, neglected, emotionally or nutritionally starved or sexually assaulted by their parents or carers. Responsibility for the investigation of these children is that of local-authority social-services departments. However, child health professionals have a vital role in diagnosis, obtaining forensic evidence, advising courts, supervising the medical aspects of follow-up and teaching doctors, therapists and other professionals in training. (See CHILD ABUSE.)

School health services Once children have reached school age, the emphasis changes. The prime need becomes identifying those with problems that may interfere with learning – including those with special needs as de?ned above, but also those with behavioural problems. Teachers and parents are advised on how to manage these problems, while health promotion and health education are directed at children. Special problems, especially as children reach secondary school (aged 11–18) include accidents, substance abuse, psychosexual adjustment, antisocial behaviour, eating disorders and physical conditions which loom large in the minds of adolescents in particular, such as ACNE, short stature and delayed puberty.

There is no longer, in the UK, a universal school health service as many of its functions have been taken over by general practitioners and hospital and community paediatricians. However, most areas still have school nurses, some have school doctors, while others do not employ speci?c individuals for these tasks but share out aspects of the work between GPs, health visitors, community nurses and consultant paediatricians in child health.

Complementing their work is the community dental service whose role is to monitor the whole child population’s dental health, provide preventive programmes for all, and dental treatment for those who have di?culty using general dental services – for example, children with complex disability. All children in state-funded schools are dentally screened at ages ?ve and 15.

Successes and failures Since the inception of the NHS, hospital services for children have had enormous success: neonatal and infant mortality rates have fallen by two-thirds; deaths from PNEUMONIA have fallen from 600 per million children to a handful; and deaths from MENINGITIS have fallen to one-?fth of the previous level. Much of this has been due to the revolution in the management of pregnancy and labour, the invention of neonatal resuscitation and neonatal intensive care, and the provision of powerful antibiotics.

At the same time, some children acquire HIV infection and AIDS from their affected mothers (see AIDS/HIV); the prevalence of atopic (see ATOPY) diseases (ASTHMA, eczema – see DERMATITIS, HAY FEVER) is rising; more children attend hospital clinics with chronic CONSTIPATION; and little can be done for most viral diseases.

Community child health services can also boast of successes. The routine immunisation programme has wiped out SMALLPOX, DIPHTHERIA and POLIOMYELITIS and almost wiped out haemophilus and meningococcal C meningitis, measles and congenital RUBELLA syndrome. WHOOPING COUGH outbreaks continue but the death and chronic disability rates have been greatly reduced. Despite these huge health gains, continuing public scepticism about the safety of immunisation means that there can be no relaxation in the educational and health-promotion programme.

Services for severely and multiply disabled children have improved beyond all recognition with the closure of long-stay institutions, many of which were distinctly child-unfriendly. Nonetheless, scarce resources mean that families still carry heavy burdens. The incidence of SUDDEN INFANT DEATH SYNDROME (SIDS) has more than halved as a result of an educational programme based on ?rm scienti?c evidence that the risk can be reduced by putting babies to sleep on their backs, avoidance of parental smoking, not overheating, breast feeding and seeking medical attention early for illness.

Children have fewer accidents and better teeth but new problems have arisen: in the 1990s children throughout the developed world became fatter. A UK survey in 2004 found that one in ?ve children are overweight and one in 20 obese. Lack of exercise, the easy availability of food at all times and in all places, together with the rise of ‘snacking’, are likely to provoke signi?cant health problems as these children grow into adult life. Adolescents are at greater risk than ever of ill-health through substance abuse and unplanned pregnancy. Child health services are facing new challenges in the 21st century.... child development teams (cdts)

Clinical Practice Guideline

A systematically developed statement to assist practitioner and patient decisions about appropriate health care for one or more specific clinical circumstances.... clinical practice guideline

Developmental Disability

A severe, chronic disability which is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains the age of 22; is likely to continue indefinitely; results in substantial functional limitations in three or more of the following areas of major life activity: self care, receptive and expressive language, learning, mobility, self direction, capacity of independent living, economic self-sufficiency; and reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care treatments or services which are of lifelong or extended duration and are individually planned and coordinated.... developmental disability

Family Practice

A form of specialty practice in which medical practitioners provide continuing comprehensive primary care within the context of the family unit.... family practice

Good Medical Practice

Guidelines for doctors on the provision of good medical care laid down by the GENERAL MEDICAL COUNCIL (GMC).... good medical practice

Health Development

The process of continuous, progressive improvement of the health status of individuals and groups in a population.... health development

Health Development Agency (hda)

Appointed by the UK government to help improve the NHS in England (Scotland, Wales and Northern Ireland have similar bodies), HDA replaced the long-established Health Education Authority in April 2000. The agency supports government priorities to improve public health and to tackle health inequalities. Among its key functions are:

Maintaining an up-to-date evidence base of ‘what works’ in public health and health improvements.

Providing useful information to health practitioners.

Commissioning research to remedy the gaps in the evidence base for medical practice.

Improving health promotion and advising on the standards for (and implementation of) public-health activities.

(See APPENDIX 7: STATUTORY ORGANISATIONS.)... health development agency (hda)

Human Development Index (hdi)

A composite index that measures the overall achievements in a country in three basic dimensions of human development— longevity, knowledge and a decent standard of living. It is measured by life expectancy, educational attainment and adjusted income per capita in purchasing power parity (PPP) US dollars. The HDI is a summary, not a comprehensive measure of human development.... human development index (hdi)

Practice Guideline

Descriptive tool or standardized specification for care of an older person in a typical situation developed through a formal process that incorporates the best scientific evidence of effectiveness with expert opinion.... practice guideline

Solo Practice

The practice of a health occupation as a self-employed individual.... solo practice

Sustainable Development

A process of development that meets the needs of the present generation without compromising the ability of future generations to meet their own needs.... sustainable development

Child Development

The acquisition of physical, mental, and social skills in children.

Although there is wide variation in individual rates of progress, most children develop certain skills within predictable age ranges.

For example, most infants start to walk at 12–18 months.

Capability for new skills is linked to the maturity of the child’s nervous system.

Individual rates of maturity are determined genetically and modified by environmental factors in the uterus and after birth.

Development is assessed in early childhood by looking at abilities in 4 main areas: locomotion; hearing and speech; vision and fine movement; and social behaviour and play.

(See also developmental delay.)... child development

Development

The process of growth and change by which an individual matures physically, mentally, emotionally, and socially. Development takes place in major phases: during the first 2 months of pregnancy (see embryo); to a lesser extent, during the rest of pregnancy

(see fetus); during the first 5 years of life (see child development); and during puberty and adolescence.... development

Hip Dysplasia, Developmental

See developmental hip dysplasia.... hip dysplasia, developmental

Developmental Disorder

any one of a group of conditions in infancy or childhood, that are characterized by delays in biologically determined psychological functions, such as language. They are more common in males than females and tend to follow a course of disability with gradual improvement. They are classified into pervasive conditions, in which many types of development are involved (e.g. *autism), and specific disorders, in which the disability is an isolated problem (such as *dyslexia).... developmental disorder

Developmental Milestones

skills gained by a developing child, which should be achieved by a given age. Examples of such milestones include smiling by six weeks and sitting unsupported by eight months. Failure to achieve a particular milestone by a given age is indicative of *developmental delay. See table.... developmental milestones

Code Of Practice

National Institute of Medical Herbalists.

1. It is illegal for anyone not a registered medical practitioner to attempt to procure an abortion: a member must not knowingly administer an abortifacient or known uterine muscle stimulant remedies to a pregnant patient, nor instruments for the purpose of procuring an abortion, nor assist in any illegal operation.

2. It is required that any intimate examinations on a patient of the opposite sex be conducted in the presence of a relative of the patient or a suitable assistant.

3. A member must not treat or prescribe any remedy for gonorrhoea, syphilis, or urinary affections of a venereal nature.

4. It is the duty of the practitioner to notify the District Medical Officer regarding any disease on the current list of notifiable diseases. In cases of industrial poisoning or accident the local district branch of the Health and Safety Executive should be notified.

5. A member must consider very carefully the implications of recommending a course of treatment contrary to the advice of the patient’s registered medical practitioner or of not recommending referral to a registered medical practitioner in the case of serious disease or uncertain diagnosis. Members must be aware of their vulnerability in law on this issue and must ensure in such a case that all available information is given to the patient and that the patient makes the final decision without coercion.

6. A parent or supervising adult must be present at any treatment or examination of a child under the age of 16, or of a mentally-retarded patient.

7. The Data Protection Act means that any practitioner keeping patient’s data on computer file must register under the terms of the Act.

8. A member must become familiar with the terms of the Medicine’s Act 1968 and subsequent statutory instruments, notably the Medicines (Retail Sale or Supply of Herbal Remedies) Order 1977. Particular care should be taken to become familiar with the statutory maximum doses of those remedies listed in Schedule III of the latter order. Detailed records of prescriptions and dispensing must also be kept.

9. The Medicines Act further states that to claim exemptions from the restrictions on the supply of certain herbal remedies, the practitioner should supply said remedies from premises occupied by the practitioner and able to be closed so as to exclude the public.

10. The Medicines Act adds that to claim the said exemptions, the person supplying the remedy “sells or supplies it for administration to a particular person after being requested by or on behalf of that person and in that person’s presence to use his own judgement as to the treatment required”. The member should avoid treatment through telephone or postal contact, although repeat prescriptions may be supplied on this basis for a limited period.

11. Dispensing and labelling of medicines should at least comply with the terms of the Medicines Act. All medicines should be labelled to clearly indicate the correct dosage or other directions for use (especially for those remedies subject to a statutory maximum dose), and with the name and address of the practitioner and the date of dispensing.

12. A member should never claim verbally or in print to be able to cure any life-threatening or serious disease.

13. The distribution or display of letter headings, business cards or practice information should be compatible with the highest professional medical standards. ... code of practice

Differences Of Sexual Development

(DSDs) see intersex.... differences of sexual development

Disorders Of Sexual Development

(DSDs) see intersex.... disorders of sexual development

Dispensing Practice

(in Britain) a general practice with a dispensary on site to issue prescribed medications to patients. See also general practitioner.... dispensing practice

Nhs Trust Development Authority

formerly, a *special health authority of the NHS established under the Health and Social Care Act 2012 to oversee NHS trusts without *foundation trust status and to support their transition to such status. The Authority closed in 2016, when its functions were transferred to the newly established *NHS Improvement.... nhs trust development authority

Practice Manager

the person responsible for running a doctor’s surgery, whose role involves managing staff, accounts, and medical records as well as developing the practice’s business strategy. Practice managers also liaise with external bodies, such as local NHS trusts and social service departments, to ensure efficient communication between the various organizations.... practice manager

Developmental Hip Dysplasia

A disorder present at birth in which the head of the femur (thigh-bone) fails to fit properly into the cup-like socket in the pelvis to form a joint. One or both of the hips may be affected.

The cause of developmental hip dysplasia is not known, although it is more common in girls, especially babies born by breech delivery or following pregnancies in which the amount of amniotic fluid was abnormally small.

If dislocation is detected in early infancy, splints are applied to the thigh to manoeuvre the ball of the joint into the socket and keep it in position. These are worn for about 3 months and usually correct the problem. Progress may be monitored by ultrasound scanning and X-rays. Corrective surgery may also be required.

If treatment is delayed, there may be lifelong problems with walking. Without treatment, the dislocation often leads to shortening of the leg, limping, and early osteoarthritis in the joint.... developmental hip dysplasia

Practice Nurse

a trained nurse caring for the patients of one or more general practitioners in the consulting room and on domiciliary consultations. In Britain, practice nurses are usually employed directly by GPs. However, they may also be employed by clinical commissioning groups as practice nurses or *district nurses.... practice nurse

Psychosexual Development

the process by which an individual becomes more mature in his or her sexual feelings and behaviour. Gender identity, sex-role behaviour, and choice of sexual partner are the three major areas of development. In Freudian psychoanalysis the phrase is sometimes used specifically for a sequence of stages, supposed by psychoanalytic psychologists to be universal, in which oral, anal, phallic, latency, and genital stages successively occur. These stages reflect the parts of the body on which sexual interest is concentrated during childhood development.... psychosexual development

Reflective Practice

the process of critically considering one’s own professional practice during or after events in order to review one’s values and to understand the emotions and reasons behind one’s actions and decisions and the effect of those actions and decisions on others. Reflection is seen as essential to developing and maintaining ethical medical practice. See autonomy.... reflective practice



Recent Searches