MedWorm: General Practices

Study Examines Misconceptions Of Who Picks Up Tab When Patients Walk Out

Health News from Medical News Today — Wed, 08 Feb 2012 08:00:00 +0100

There are ways in which patients who leave the hospital against medical advice wind up paying for that decision. Being saddled with the full cost of their hospital stay, however, is not one of them. Insurance companies know this. Patients who walk out may know this. But many physicians, according to a study published in the Journal of General Internal Medicine, do not... (Source: Health News from Medical News Today)

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Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

BMC Family Practice — Wed, 08 Feb 2012 05:00:00 +0100

Conclusions: Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings. (Source: BMC Family Practice)

The cost of diagnosing Type 2 diabetes mellitus by clinical opportunistic screening in general practice

Diabetic Medicine — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions: Almost two‐thirds of new cases of Type 2 diabetes can be detected before symptoms are reported, at reasonable cost by opportunistic screening in general practice, without the use of extra resources. As an affordable alternative to population screening, clinical opportunistic screening merits further consideration.© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK (Source: Diabetic Medicine)

Bereavement care for older people in healthcare settings: qualitative study of experiences

International Journal of Older People Nursing — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions. The study identified the interactions of healthcare staff with bereaved older people in terms of the bereavement journey. Staff demonstrated awareness of difficulties the bereaved person may encounter and showed commitment to providing support. However, lack of flexibility in services restricts meaningful interactions.Implications for Practice. (i) Healthcare staff may identify gaps in services in terms of preparing relatives and follow‐up post‐bereavement; (ii) Therapeutic relationships between staff and relatives enable ongoing support; (iii) Development of practice guidelines is a key consideration. (Source: International Journal of Older People Nursing)

Multi‐professional communication for older people in transitional care: a review of the literature

International Journal of Older People Nursing — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions. Specified discharge worker roles, multi‐professional care coordination teams, and information technology systems promote better service satisfaction and subjective quality of life for older people when compared with standard hospital discharge. Improved multi‐professional communication reduces rates of re‐admission and length of stay indicating greater cost effectiveness and efficiency for the health and social care systems. Systems of care emphasizing information exchange, education and negotiation between stakeholders facilitate communication in transitional care contexts for older adults. Conversely, lack of dialogue and lack of understanding of others’ roles are barriers to communication in transitional care.Relevance to clinical practice. Enhanced multi‐pr...

Burden of pelvis fracture: a population-based study of incidence, hospitalisation and mortality

Osteoporosis International — Mon, 06 Feb 2012 19:37:21 +0100

Conclusions Pelvic fractures are associated with high rates of hospitalisation and mortality. Given this, further work is required to identify the optimal post-fracture therapeutic strategy to improve outcomes in this elderly patient group. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s00198-012-1907-zAuthors D. Prieto-Alhambra, Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UKF. F. Avilés, Institut Català de la Salut—IDIAP Jordi Gol i Gurina, Barcelona, SpainA. Judge, Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoske...

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Health Economics of Interdisciplinary Rehabilitation for Chronic Pain: Does it Support or Invalidate the Outcomes Research of These Programs?

Current Pain and Headache Reports — Mon, 06 Feb 2012 19:34:33 +0100

Abstract Interdisciplinary rehabilitation has been shown to be effective for treatment of patients suffering from chronic nonmalignant pain with respect to activity level, pain intensity, function, or days of sick leave. However, effects in clinical outcome do not necessarily imply a superiority of the intervention from an economic point of view. Despite an increasing number of cost-utility and cost-effectiveness studies, systematic reviews outline the methodological heterogeneity of studies, which makes it impossible to perform meta-analyses and to draw conclusions from the studies. Recent publications add interesting information to the current discussion; these studies cover the long-term development of sickness absence post-intervention and the cost effectiveness of wor...

Caring for individual patients and beyond: Enhancing care through secondary use of data in a general practice setting

ICMCC: The International Council on Medical and Care Compunetics — Mon, 06 Feb 2012 16:08:07 +0100

Source: Tolar M, Balka E. International Journal of Medical Informatics, 2012 Content: It is argued that with the introduction of electronic medical record (EMR) systems into the primary care sector, data collected can be used for secondary purposes which extend beyond individual patient care (e.g., for chronic disease management, prevention and clinical performance evaluation). However, [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

GP Burnout Rates High in UK

Health News from Medical News Today — Sat, 04 Feb 2012 17:00:00 +0100

According to an investigation of GPs (general practitioners) in one region of South East England, burnout levels in UK general practice are high. The study is published in BMJ Open. The article reveals that primary care physicians (GPs, general practitioners, family doctors) who work in group practices, those who always see the same patient, and male doctors appear to be at considerably higher risk. This finding urged the researchers to reveal that "a significant group of doctors is in trouble... (Source: Health News from Medical News Today)

Most GP Complaints Resolved Locally, UK

Health News from Medical News Today — Fri, 03 Feb 2012 18:00:00 +0100

According to an analysis of complaints in the latest edition of inpractice, the Medical Defense Union's journal that appears twice a year and is aimed at GP practice manager members covering topics like complaints, RCN indemnity changes and dealing with estranged parents, over 90% of 2,410 complaints made by GP members in the year April 2009/2010 seem to have been resolved locally. According to the MDU, this quota represents a great achievement made by practice managers who frequently take a lead in managing complaints... (Source: Health News from Medical News Today)

Variation in New Zealand hospital outcomes: combining hierarchical Bayesian modeling and propensity score methods for hospital performance comparisons

Health Services and Outcomes Research Methodology — Fri, 03 Feb 2012 07:19:52 +0100

Abstract Two major statistical issues confronting comparative analyses of hospital outcomes are adequacy of case-mix adjustment and proper accounting for random variation. Hierarchical modeling has been proposed to improve precision and reduce the impact of random variation but becomes difficult to implement when there are numerous case-mix factors to control. In this paper we formulate the problem of hospital performance comparisons within the framework of potential outcomes and illustrate an approach to hospital comparisons which combines multiple category propensity score methods for the control of case-mix variations with hierarchical Bayesian modeling of case-mix adjusted summaries. The approach is similar to that proposed by Huang et al. (Health Serv Res 40:253–278...

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Excessive daytime sleepiness and narcolepsy - An approach to investigation and management.

European Journal of Internal Medicine — Fri, 03 Feb 2012 00:28:21 +0100

Authors: Morrison I, Riha RL Abstract Excessive daytime sleepiness is a common presentation to physicians both in general practice and hospital settings. In this review, we provide an update on the latest theories on the pathogenesis of the condition, and discuss the approach to investigation of the sleepy patient, with particular reference to narcolepsy. Recommended therapy is reviewed for both narcolepsy and cataplexy, to provide physicians with an important reference on the investigation and management of these troubling conditions. PMID: 22284238 [PubMed - in process] (Source: European Journal of Internal Medicine)

CCG management cap hinders push for GP quality

HealthcareRepublic Pharmacist News — Thu, 02 Feb 2012 15:07:00 +0100

Improving the quality of general practice will be difficult for clinical commissioning groups (CCGs) because the government cap on their management funding is so low, according to a CCG leader. (Source: HealthcareRepublic Pharmacist News)

Time dynamics of autoantibodies are coupled to phenotypes and add to the heterogeneity of autoimmune diabetes in adults: the HUNT study, Norway

Diabetologia — Thu, 02 Feb 2012 06:55:32 +0100

Conclusion/interpretation The pattern of antibodies, the postdiabetic loss or persistence as well as the prediabetic absence or presence of antibodies influence LADA phenotypes. Time-dependent presence or absence of antibodies adds new modalities to the heterogeneity of LADA. Content Type Journal ArticleCategory ArticlePages 1-9DOI 10.1007/s00125-012-2463-yAuthors E. P. Sørgjerd, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), HUNT Research Centre, Forskningsveien 2, 7600 Levanger, NorwayF. Skorpen, Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, NorwayK. Kvaløy, HUNT Research Centre,...

Safety Alerts Concerning NHS Direct 111 Pilots

Health News from Medical News Today — Wed, 01 Feb 2012 17:00:00 +0100

After a Pulse investigation uncovered several safety alerts within the Government's NHS 111 pilots, as well as expressing concern that GP commissioners are being excluded from the rollout - the GPC has been prompted to call for the program to be put on hold. According to information released by PCTs and NHS Direct, there have been nine serious inappropriate incidents in four of the seven 111 pilots. The pilots have been designed to offer patients a single point of content for urgent care that excludes emergencies... (Source: Health News from Medical News Today)

Mental health nurse independent prescribing: what are nurse prescribers' views of the barriers to implementation?

Journal of Psychiatric and Mental Health Nursing — Wed, 01 Feb 2012 05:00:00 +0100

This study identified many of these barriers to prescribing and these will be discussed. It is hoped that this study's findings will serve as a catalyst to prompt the removal of barriers to prescribing in mental health nursing and ultimately to enable independent nurse prescribing. Awareness about mental health nurse prescribing needs to be raised so that health care professionals, service users, carers and the general public become more familiar with the role. This should help the role to become more accepted and established in everyday practice.AbstractThis paper reports a pilot study exploring mental health nurse prescribers' perceptions of barriers to prescribing independently but also includes perceptions of barriers to supplementary prescribing. Current prescribing practice as experi...

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An exploration of the experience of mental health service users when they decide they would like to change or withdraw from prescribed medications

Journal of Psychiatric and Mental Health Nursing — Wed, 01 Feb 2012 05:00:00 +0100

This study reports on a small collaborative research project started by service users, and on a subject chosen by them, and then carried out with staff from a local NHS Trust and University.• It looks at the choices people make in changing or stopping mental health medications, and their experiences of how professional staffs were either helpful or unhelpful in advising and helping them with these choices. Some of the themes generated in the focus groups are examined in detail and recommendations made for practice including the need for better information giving to support choice.• The themes examined include ‘the two faces of service provision’ which looks at positive and less positive experiences of service provision, the general practice/mental health divide which points out...

The spontaneous resolution of heavy menstrual bleeding in the perimenopausal years

BJOG: An International Journal of Obstetrics and Gynaecology — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion There is a high prevalence, incidence and significant spontaneous rate of resolution of heavy menstrual bleeding in naturally menstruating women during the perimenopausal years. The rates have potential use for individual women, clinical decisions, devising and implementing interventions and planning the care of populations. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Federal Budget 2012-2013: Supporting quality general practice for the future

Royal Australian College of General Practitioners (RACGP) Media Releases — Mon, 30 Jan 2012 07:53:22 +0100

The Royal Australian College of General Practitioners (RACGP) is urging the Federal Government to provide more funding for general practice healthcare in the upcoming May Federal Budget to ensure communities receive the high quality care they deserve. (Source: Royal Australian College of General Practitioners (RACGP) Media Releases)

Non‐Steroidal Anti‐Inflammatory Drugs and The Risk of Clostridium Difficile‐Associated Disease

British Journal of Clinical Pharmacology — Sun, 29 Jan 2012 05:00:00 +0100

Conclusion: Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed.© 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society (Source: British Journal of Clinical Pharmacology)

Effect of screening for Type 2 diabetes on population‐level self‐rated health outcomes and measures of cardiovascular risk: 13‐year follow‐up of the Ely cohort

Diabetic Medicine — Fri, 27 Jan 2012 05:00:00 +0100

Conclusions: Screening for diabetes is not associated with long‐term harms at the population level. However, screening has limited long‐term impact on those testing negative; benefits may largely be restricted to those whose diabetes is detected early through screening.© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK (Source: Diabetic Medicine)

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Nearly 95% Of Clinical Commissioning Groups Ready To Take On Commissioning Budgets In April, UK

Health News from Medical News Today — Thu, 26 Jan 2012 10:00:00 +0100

According to BMJ Careers, In April 2012, 94.2% of the emerging clinical commissioning groups (CCGs) in England will be able to take on primary care trust commissioning budgets as they passed the strategic health authority (SHA) risk assessment of their configuration. Just 5.8% of groups were rated as "red" in a risk rating system that measures 4 areas relating to the size of the commissioning group, practice engagement, and shape, while 94.2% of groups were rated as "amber" or "green... (Source: Health News from Medical News Today)

A randomized phase-II trial comparing sequential and concurrent paclitaxel with oral or parenteral fluorinated pyrimidines for advanced or metastatic gastric cancer

Gastric Cancer — Wed, 25 Jan 2012 18:12:35 +0100

Conclusion Our study did not show sufficient prolongation of survival with the concurrent strategy to proceed to a phase-III trial; however, the sequential arms showed survival comparable to that in the concurrent arms, with less toxicity. In patients who are ineligible for cisplatin (CDDP), sequential treatment starting with S-1 and proceeding to PTX would be a good alternative strategy, considering quality of life (QOL) and the cost-benefits of an oral agent as first-line treatment. Content Type Journal ArticleCategory Original articlePages 1-7DOI 10.1007/s10120-011-0124-3Authors Kazuhiro Nishikawa, Department of Surgery, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi-ku, Osaka, 558-8558 JapanSatoshi Morita, Department of Biostatistics and Epidemi...

Increase In Physician Referrals Could Lead To Increase In Health Care Costs

Health News from Medical News Today — Wed, 25 Jan 2012 09:00:00 +0100

Physician referral rates in the United States doubled between 1999 and 2009, a new study finds, an increase that likely contributes to the rising costs of health care. The increase in referral rates coincides with an increase in chronic conditions such as Type 2 diabetes. The results are staggering: over the same time period, the estimated absolute number of visits resulting in a referral increased 159 per cent, from 40.6 million to 105 million... (Source: Health News from Medical News Today)

Going To Physician Visits With Older Loved Ones Could Improve Care

Health News from Medical News Today — Wed, 25 Jan 2012 09:00:00 +0100

Family companions who routinely accompany older adults to physician office visits could be helpful to health care quality improvement efforts, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The authors found that three-quarters of older adults who attend physician visits with a family companion are consistently accompanied over time, nearly always by the same companion. The results are featured in the January 2012 issue of the Journal of the American Geriatrics Society... (Source: Health News from Medical News Today)

GP journal highlights teaching in general practice

Royal Australian College of General Practitioners (RACGP) Media Releases — Wed, 25 Jan 2012 08:00:00 +0100

Australian Family Physician, the flagship journal of the Royal Australian College of General Practitioners (RACGP), features a range of clinical, viewpoint and research articles focusing on key issues in general practice today. (Source: Royal Australian College of General Practitioners (RACGP) Media Releases)

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[Use and acceptance of a basic geriatric assessment in primary care setting.]

Zeitschrift fur Gerontologie und Geriatrie — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSION: Hitherto BGA is not an established tool in German primary care practices. The question, which single instruments are most suitable for older general practice patients, still needs clarification. PMID: 22270893 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Gerontologie und Geriatrie)

Assuring the safety and effectiveness of new drugs: rigorous phase IV trials randomizing general practices to delayed access to new drugs

Journal of Health Services Research and Policy — Wed, 25 Jan 2012 05:00:00 +0100

Randomized trials are crucial for establishing the effectiveness of new drugs and procedures. However, they are less effective at detecting uncommon but clinically significant side effects. We propose a solution. All UK general practices could be randomized to be allowed to prescribe new licenced drugs earlier or later. This would produce a large pragmatic cluster trial which could enable rare, but harmful, effects to be demonstrated more quickly than the current usual practice of looking for harmful events in observational datasets. Given current computerization of practice records such an approach is feasible and likely to be cost-effective. (Source: Journal of Health Services Research and Policy)

Fast-Track Intubation for Accelerated Interventional Stroke Treatment

Neurocritical Care — Tue, 24 Jan 2012 07:55:42 +0100

Conclusions In acute stroke patients, intubation prior to interventional recanalization therapy can delay treatment initiation. The implementation of an I-SOP accelerates interventional treatment initiation. Content Type Journal ArticleCategory Original ArticlePages 1-7DOI 10.1007/s12028-012-9671-7Authors Oliver Herrmann, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyAndreas Hug, Spinal Cord Injury Center, University Hospital Heidelberg, Schlierbacher Landstr. 200a, 69118 Heidelberg, GermanyJulian Bösel, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyJuliana Johanna Petersen, Institute of General Practice, Goethe-University of Frankfurt/Main, Theo...

Does general practice reduce health inequalities? Analysis of quality and outcomes framework data

The European Journal of Public Health — Tue, 24 Jan 2012 05:00:00 +0100

Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement. (Source: The European Journal of Public Health)

Similar rates of relapse and time to return to normal activity with 2 or 5 days of systemic corticosteroids after asthma exacerbation but study confirmation of equivalence would require further study

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Context Asthma is common and flare-ups associated with exposure to a variety of triggers may result in emergency department (ED) visits, school and work absenteeism, hospitalisations and significant healthcare costs. The majority of adult patients presenting with acute asthma are discharged home following management in the ED. Many national and international guidelines have been developed on this topic.1 In the outpatient setting, care is focused on the use of systemic (SC) and inhaled corticosteroid (ICS) agents to regain asthma control. While prednisone is the most common SC used, there has been an interest in reducing the duration of treatment using agents with longer half life such as dexamethasone. Due to compliance and palatability concerns, this question has been most frequently add...

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Subjective memory complaints in general practice predicts future dementia: a 4‐year follow‐up study

International Journal of Geriatric Psychiatry — Fri, 20 Jan 2012 21:26:53 +0100

ConclusionsThis study indicates that the presence of SMC in an older general practice population is a significant independent predictor for subsequent hospital‐based dementia diagnosis. Thus, the GP could consider inquiring for memory complaints to identify vulnerable older patients. Copyright © 2012 John Wiley & Sons, Ltd. (Source: International Journal of Geriatric Psychiatry)

GPC rejects guidance calling for extended GP training

HealthcareRepublic Pharmacist News — Fri, 20 Jan 2012 12:24:00 +0100

The GPC has is 'very concerned' by draft guidance published by the Committee of General Practice Education Directors (COGPED) which calls for GP training to be extended by four years. (Source: HealthcareRepublic Pharmacist News)

Findings from a Delphi exercise regarding conflicts of interests, general practitioners and safeguarding children: 'Listen carefully, judge slowly'

Journal of Medical Ethics — Fri, 20 Jan 2012 05:00:00 +0100

This article details findings from a Delphi exercise that was part of a larger study exploring the conflicts of interest that arise for UK GPs in safeguarding children. The specific objectives of the Delphi exercise were to understand how these conflicts of interest are seen from the perspectives of an expert panel, and to identify best practice for GPs. The Delphi exercise involved four iterative rounds with questionnaires completed by an expert panel. Results from each round were distilled and findings sent to panel members until consensus was reached. Panel members shared insights regarding their understanding of conflicts of interest in relation to GPs and safeguarding children and responses when conflicts of interests arise. Findings suggested a broader understanding of conflicts of i...

Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: A three-arm cluster randomized trial

Drug and Alcohol Dependence — Thu, 19 Jan 2012 17:46:52 +0100

Abstract: Background: Brief advice for smoking patients has not been sufficiently integrated in routine care. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting.Method: 151 practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up.Results: Among ...

Patient satisfaction and outcome using emergency care practitioners in New Zealand

Emergency Medicine Australasia — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: The avoidance of unnecessary transfers to hospital is beneficial to patients, the ambulance service and the ED. This study demonstrates that patients are very satisfied with their assessment and treatment by ECPs, endorsing the proposal that the scheme should be extended across the Wellington Region, and perhaps New Zealand. (Source: Emergency Medicine Australasia)

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Does recognition of depression in primary care affect outcome? The PREDICT-NL study

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions. A minority of patients with MDD is recognized in primary care. Those who were unrecognized had comparable outcome after 12 and 39 months as participants with recognized depression. (Source: Family Practice)

Primary care patients with heart failure in the last year of their life

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions. A minority of patients with advanced HF have a terminal phase and died of progressive HF. In the last year of life, the GP is the main provider of care. (Source: Family Practice)

Acceptability of a guided self-help mental health intervention in general practice

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion. The intervention appeared to improve the psychological well-being of the patients and was regarded positively by both clinicians and patient participants. Further testing of the efficacy of the intervention on a larger sample with a randomized controlled trial study design is warranted. (Source: Family Practice)

Treatment of acute otitis media in general practice: quality variations across countries

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion. The majority of patients with AOM were treated with antibiotics in all six countries, but considerable variations in both prescribing rate and choice of antibiotics were identified. (Source: Family Practice)

Widespread use of pure and impure placebo interventions by GPs in Germany

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions. Placebo interventions are a widely accepted part of medical treatment in German general practices and are used primarily for their psychological effects. Impure placebos are used much more frequently than pure placebos. (Source: Family Practice)

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Personal maternal care reflections of general practice physicians

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion. This research supports the growing body of evidence that there are unique problems facing doctor–patients and clinicians treating them. However, contrary to expectations derived from anecdotal evidence, GPs indicated that care was enhanced due to their occupation. This study raises awareness of areas for consideration when female GPs approach pregnancy and health care professionals deliver maternal health care. (Source: Family Practice)

Lumbar spine and total-body dual-energy X-ray absorptiometry in children with severe neurological impairment and intellectual disability: a pilot study of artefacts and disrupting factors

Pediatric Radiology — Wed, 18 Jan 2012 06:48:44 +0100

Conclusion Factors that may negatively influence the accuracy of DXA outcome are frequently present in children with severe neurological impairment and ID. No systematic deviation of DXA outcome in coherence with the amount of disrupting factors was found, but physicians should be aware of the possible influence of disrupting factors on the accuracy of DXA. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s00247-011-2307-9Authors S. Mergler, Intellectual Disability Medicine/Department of General Practice, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The NetherlandsR. Rieken, Intellectual Disability Medicine/Department of General Practice, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherla...

Tamil-link doctor in bid to work

BBC News | Health | UK Edition — Tue, 17 Jan 2012 23:14:08 +0100

A Sri Lankan doctor jailed in the USA for aiding Tamil Tigers rebels pleads to be allowed to return to his general practice in north London. (Source: BBC News | Health | UK Edition)

High rates of depressive symptomatology among injecting drug users in Saskatoon, Canada

Evidence-Based Mental Health — Tue, 17 Jan 2012 05:00:00 +0100

QuestionQuestion What is the prevalence of depressive symptomatology among injecting drug users? Also, are there risk indicators of depressive symptomatology and is depressive symptomatology associated with HIV risk behaviours? Population 603 current injecting drug users (IDUs; defined as having injected a drug within the last 4 weeks) aged 18 years and older. IDUs were identified from a survey of 1000 people who were at risk of HIV either known current IDUs, current sex workers, men who had sex with other men or who used the services of sex workers. Participants were recruited from primary care clinics, needle exchange sites, AIDS Saskatoon, and a free meal facility. The sample comprised 76.6% of known IDUs in the Saskatoon Health Region. Setting Saskatoon Health Region, Canada; recruitme...

To Drive or Not to Drive: Assessment Dilemmas for GPs

PPAR Research — Sun, 15 Jan 2012 08:32:38 +0100

This study provides considerable information including recommendations about GP education, the assessment forms, and legal clarification. (Source: PPAR Research)

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Recognising and approving trainers: a consultation

MEDEV News — Sun, 15 Jan 2012 08:22:11 +0100

The General Medical Council (GMC) is proposing new arrangements for recognising and approving trainers and in particular: named educational supervisors named clinical supervisors lead coordinators of undergraduate training doctors responsible for overseeing students’ educational progress. They will use existing standards structured into seven areas. Local education providers such as hospitals and general practices would use the seven areas to show how they identify, train and appraise these trainers. Postgraduate deaneries and medical schools would then use that information to show the GMC what local arrangements are in place to meet our standards.Why the consultation should matter to you GMC believe that proposals provide a structure that will add value while involving minima...

Building the bypass--implications of improved access to sexual healthcare: evidence from surveys of patients attending contrasting genitourinary medicine clinics across England in 2004/2005 and 2009

Sexually Transmitted Infections — Sun, 15 Jan 2012 05:00:00 +0100

Conclusions Patient routes to GUM shortened between 2004/2005 and 2009. While GUM patients in 2009 were less likely overall to have STIs diagnosed, perhaps reflecting lower risk behaviour, there remains a substantial proportion of high-risk individuals requiring comprehensive care. Behavioural surveillance across all STI services is therefore essential to monitor and maximise their public health impact. (Source: Sexually Transmitted Infections)

Confusion regarding cervical cancer screening and chlamydia screening among sexually active young women

Sexually Transmitted Infections — Sun, 15 Jan 2012 05:00:00 +0100

Conclusion Many younger women in an urban community health centre believed that cervical cancer screening also screens for chlamydia and were confused about chlamydia screening schedules. As there is limited knowledge of the revised ACOG cervical cancer screening guidelines, there is a risk that currently low chlamydia screening rates may decrease further after these new guidelines are better known. Obstetrician gynaecologists and primary care providers should educate younger women about the differences between chlamydia and cervical cancer screening and encourage sexually active younger women to have annual chlamydia screening. (Source: Sexually Transmitted Infections)

What is so difficult about managing clinical reasoning difficulties?

Medical Education — Sat, 14 Jan 2012 22:54:51 +0100

Conclusions In order to improve the current state of affairs in the management of clinical reasoning difficulties, a collective paradigm shift is required to alter the perception of residency as an apprenticeship to one of residency as a structured educational programme. Faculty development programmes should be designed in an integrated way so that they not only develop clinical educators’ skills, but also modify their beliefs. (Source: Medical Education)

Prevalence of overweight and obesity in Danish preschool children over a 10‐year period: a study of two birth cohorts in general practice

Acta Paediatrica — Sat, 14 Jan 2012 17:15:48 +0100

Conclusion: The prevalence of overweight and obesity was observed to be stable over a decade in Danish preschool children without changes in mean BMI in the group of obese children. A strong association between overweight and obesity at 3 and at 5 years of age was detected. (Source: Acta Paediatrica)

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[Viewpoint] What are the lessons from the USA for clinical commissioning groups in the English National Health Service?

LANCET — Sat, 14 Jan 2012 05:00:00 +0100

The UK coalition Government's plans to make groups of general practices responsible for commissioning health services have attracted much attention. Investigation of the experiences of other countries in which doctors control budgets could help the UK to understand how these plans might work. We visited the USA in March 2011 to learn how medical groups manage the budgets that they negotiate with health insurers and how they work with hospitals to control costs and improve outcomes. Our report describes what we learnt and identifies several lessons for the National Health Service (NHS), as the government's plans to establish clinical commissioning groups are taken forward. (Source: LANCET)

An empirical test of short notice surveys in two accreditation programmes

International Journal for Quality in Health Care — Fri, 13 Jan 2012 05:00:00 +0100

Conclusions The study demonstrated that short notice surveys are more critical in their assessment of clinical than administrative or corporate items. Short notice surveys, while broadly comparable with existing advanced notification survey practice, produced different accreditation outcomes for a significant proportion of the study organizations. The overall value and worth of short notice surveys remains to be proved. (Source: International Journal for Quality in Health Care)

Availability Of Key Attributes Of Primary Care, Medical Home, Decrease Risk Of Death

Health News from Medical News Today — Thu, 12 Jan 2012 09:00:00 +0100

Greater access to features of high-quality primary care - comprehensiveness, patient-centeredness and extended office hours - is associated with lower mortality, according to a new national UC Davis study. Published in the January-February issue of the Annals of Family Medicine, the research is the first to link the availability of three specific attributes of primary care with reduced risk of death... (Source: Health News from Medical News Today)

Co‐administration of statins with cytochrome P450 3A4 inhibitors in a UK primary care population

Pharmacoepidemiology and Drug Safety — Thu, 12 Jan 2012 05:00:00 +0100

ConclusionsThe co‐prescription of CYP3A4‐metabolised statins and CYP3A4 inhibitors is common in UK primary care. This co‐prescription suggests the limited appreciation of potential interactions and Medicines and Healthcare products Regulatory Agency safety advice, with the potential to increase likelihood for side effects amongst patients. Strategies to reduce drug interactions with potential adverse effects should be targeted at prescribers and pharmacists. Copyright © 2012 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

Case control study: Antihypertensive drugs and risk of incident gout among patients with hypertension

NeLM - News — Thu, 12 Jan 2012 05:00:00 +0100

Source: BMJ Area: News The authors of this nested case control study aimed to determine the independent associations of antihypertensive drugs with the risk of incident gout among people with hypertension. The authors note that some particular antihypertensive drugs (such as beta blockers) have been shown to increase the levels of serum uric acid and hence may contribute to the risk of gout. However, others (such as calcium channel blockers and losartan) have been found to lower serum uric acid levels, carrying the potential to lower the risk of gout. They analysed a cohort of 24,768 people with newly diagnosed gout (incident cases) and 50,000 random matched controls from the UK general practice database. This database contains computerised medical records entered by general practitioners...

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COPD exacerbations in general practice: variability in oral prednisolone courses

BMC Family Practice — Thu, 12 Jan 2012 05:00:00 +0100

Conclusion: Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration. (Source: BMC Family Practice)

How much does screening bring forward the diagnosis of type 2 diabetes and reduce complications? Twelve year follow-up of the Ely cohort

Diabetologia — Wed, 11 Jan 2012 17:54:02 +0100

Conclusions Diabetes screening resulted in cases being identified on average 3.3 years earlier, a difference significantly shorter than previous estimates. Earlier diagnosis did not appear to impact on health outcomes. Further evidence is needed to justify the introduction of population-based screening. Content Type Journal ArticleCategory ArticlePages 1-9DOI 10.1007/s00125-011-2441-9Authors M. Rahman, General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UKR. K. Simmons, MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ UKS. H. Hennings, MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ UKN...

Health stats go online in NSW

ICMCC: The International Council on Medical and Care Compunetics — Wed, 11 Jan 2012 17:10:09 +0100

Source: Kate McDonald, Pulse+IT Content: “NSW Health has launched a new website allowing easy access to population health data for the state. Aimed at allowing local health districts and Divisions of General Practice to access population health data, the site, Health Statistics NSW, is thought to be the first of its kind in Australia.” Article Kate McDonald, Pulse+IT, [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

Primary care needs to 'up its game', says Professor Steve Field

HealthcareRepublic Pharmacist News — Wed, 11 Jan 2012 14:13:00 +0100

Primary care and general practice needs to 'up its game' and address unacceptable variation, the chairman of the NHS Future Forum has said. (Source: HealthcareRepublic Pharmacist News)

Accuracy and Precision of Desktop Spirometers in General Practices

Respiration — Tue, 10 Jan 2012 23:00:00 +0100

Respiration (DOI:10.1159/000334320) (Source: Respiration)

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CQC will struggle to regulate GPs, says FDA chair

Management in Practice — Tue, 10 Jan 2012 17:10:00 +0100

FDA Chair says CQC compliance will add no value to general practice (Source: Management in Practice)

Inflammatory arthritis: case review and primary care perspectives

Clinical Rheumatology — Tue, 10 Jan 2012 17:00:12 +0100

Abstract Inflammatory arthritis (IA) has significant physical, psychosocial and economic consequences. Delays in diagnosis and initiation of treatment significantly impact on prognosis. The infrequent, variable, non-specific and, sometimes, indolent presentation make recognition of IA by primary care physicians (PCPs) challenging. To undertake an in-depth case review assessing the diagnostic trajectory of patients diagnosed with IA to inform development of practical recommendations to facilitate timely recognition and referral of suspected IA to specialist services, a case review was undertaken in one UK general practice using a proforma to collect information on patient demographics, diagnostic activities (presentation to PCP, specialist referral and final diagnosis) and ...

News From The Annals Of Family Medicine: January/February 2012

Health News from Medical News Today — Tue, 10 Jan 2012 11:00:00 +0100

Caring for the growing number of people with multiple health conditions The January/February issue of Annals takes an up-close look at multimorbidity, the coexistence of multiple chronic health conditions in a single individual, a phenomenon that is growing at an alarming rate and bankrupting the U.S. health care system. It is estimated by the year 2020, 25 percent of the American population will be living with multiple chronic conditions, and costs for managing these conditions will reach $1.07 trillion... (Source: Health News from Medical News Today)

Team Care Improving Depression And Diabetes

Health News from Medical News Today — Tue, 10 Jan 2012 10:00:00 +0100

The growing number of people with multiple physical and mental chronic conditions are among the toughest - and costliest - to care for. The TEAMcare collaborative care program is a promising solution. In the January/February 2012 Annals of Family Medicine, Group Health Research Institute and UW Medicine researchers have found how this program works: through primary-care doctors starting and adjusting medications sooner and more often to reach goals ("treating to target"); and motivating patients to participate in their own care and monitor their illnesses... (Source: Health News from Medical News Today)

Paediatric pneumonia or empyema and prior antibiotic use in primary care: a case-control study

Journal of Antimicrobial Chemotherapy — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions Antibiotics prescribed at the first GP consultation for an RTI may protect against subsequent hospital presentation for pneumonia or empyema in some children. Given the strong rationale against unnecessary antibiotic prescribing, further research is needed to identify which children are most likely to benefit from early antibiotic treatment. (Source: Journal of Antimicrobial Chemotherapy)

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Most Doctors In Europe Concerned About How They Will Be Treated When They Are Old

Health News from Medical News Today — Mon, 09 Jan 2012 17:00:00 +0100

A new study from the Economist Intelligence Unit on healthcare provision for an aging population showed that the overwhelming majority of surveyed health professionals (81%) is concerned about the way they will be treated when they grow old, and remain skeptical whether current policies to address demographic shift caused by an aging population are realistic, comprehensive or sufficiently funded to cope with future demand... (Source: Health News from Medical News Today)

NHS Pensions, BMA Launches Final Survey Of Its Members, UK

Health News from Medical News Today — Mon, 09 Jan 2012 17:00:00 +0100

About 130,000 BMA Doctors and medical students across the UK will be questioned regarding the government's final offer in negotiations on the future of the NHS pension scheme in a major survey that has been launched by the BMA (British Medical Association). The BMA intends to learn whether the participants' views on the offer are acceptable or not. If they are not acceptable, they want to know what action the participants are prepared to take, which could potentially lead to a formal ballot on industrial action... (Source: Health News from Medical News Today)

High fidelity trainee simulation to improve trainer performance

The Clinical Teacher — Mon, 09 Jan 2012 11:25:11 +0100

SummaryBackground: Using trained actors to simulate trainee doctors in difficulty is a cost‐effective communication skills teaching tool that can be enhanced by techniques that are familiar to hi‐fidelity electronic simulation. Simulation has two broad strands: the first exchanges the patient for an actor in the clinical encounter, and the second introduces some form of technology to the encounter. The strand concerning actors is well developed, and generally focuses on ‘the consultation’. Where simulation draws on technology, the spectrum is broad: it may be relatively low‐tech, for example computer‐based scenarios to test prescribing, through to more high‐tech approaches to learning practical skills using sophisticated manikins that replicate patient signs and symptoms. ...

GMC looking to extend legal powers for medical trainers

Healthcare Republic News — Mon, 09 Jan 2012 09:25:00 +0100

The GMC is looking to extend its legal powers to formally approve medical trainers outside of general practice. (Source: Healthcare Republic News)

UK parents' decision-making about measles-mumps-rubella (MMR) vaccine 10 years after the MMR-autism controversy: A qualitative analysis.

Vaccine — Fri, 06 Jan 2012 05:00:00 +0100

CONCLUSIONS: This study corroborated some previous qualitative work but indicated that the shrinking group of parents now rejecting MMR comprises mainly those with more extreme and complex anti-immunisation views, whilst parents opting for single vaccines may use second-hand information about the controversy. In response, policymakers and practitioners should revise their expectations of today's MMR decision-makers, and their methods for supporting them. PMID: 22230590 [PubMed - as supplied by publisher] (Source: Vaccine)

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Seasonal pseudohyperkalaemia: no longer an issue?

Annals of Clinical Biochemistry — Wed, 04 Jan 2012 05:00:00 +0100

Conclusions The introduction of centrifuges into all GPs across NHS Grampian has significantly reduced the effect of seasonal variation in serum potassium results. There has also been a concurrent reduction in the number of cases of spurious hyperkalaemia. This exercise has significantly improved the overall quality of potassium results reported to Primary Care. (Source: Annals of Clinical Biochemistry)

News From The Annals Of Internal Medicine: Jan. 3, 2012

Health News from Medical News Today — Tue, 03 Jan 2012 10:00:00 +0100

1. Sixth Edition of American College of Physicians Ethics Manual Addresses New Topics and Expands on Recurrent Issues The American College of Physicians (ACP) has released the sixth edition of its Ethics Manual. New topics in the updated manual address the patient-physician relationship during health catastrophes, providing culturally sensitive care, use of human biologic materials in research, social media and online professionalism, industry sponsored research, and the challenges of taking care of so-called very important persons... (Source: Health News from Medical News Today)

Prescribing of nicotine replacement therapy to cardiovascular disease patients in England

Addiction — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: Broadening the marketing licence in the UK for nicotine replacement therapy to allow it to be prescribed to patients with CVD did not increase prescribing rates for this group of patients. (Source: Addiction)

Reimbursement restriction and moderate decrease in benzodiazepine use in general practice.

Annals of Family Medicine — Sun, 01 Jan 2012 05:00:00 +0100

CONCLUSIONS The reimbursement restriction has led to a moderate decrease in the number of incident diagnoses and initiation of benzodiazepine use in patients with newly diagnosed anxiety or sleeping disorder. This finding indicates that in settings where no such reimbursement opportunities exist, physicians have room to reduce benzodiazepine prescribing. PMID: 22230829 [PubMed - in process] (Source: Annals of Family Medicine)

100 top consultations in small animal general practice

Australian Veterinary Journal — Sun, 01 Jan 2012 05:00:00 +0100

(Source: Australian Veterinary Journal)

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StreetHealth - improving access to primary care.

Australian Family Physician — Sun, 01 Jan 2012 05:00:00 +0100

This article describes StreetHealth and reflects on strategies to improve access to primary care services in this population. Mainstream general practices may like to consider and adapt some of these strategies to better meet the needs of similar patients in their community. PMID: 22276289 [PubMed - in process] (Source: Australian Family Physician)

Microbiological contamination of spirometers - an exploratory study in general practice.

Australian Family Physician — Sun, 01 Jan 2012 05:00:00 +0100

Discussion Despite the small size of our study sample, we found potentially relevant microbiological contamination in 3 out of 16 spirometers from metropolitan general practices. The potential hazard of spirometers as reservoirs of microorganisms stresses the need for stricter attention to hygiene measures for spirometer maintenance in general practices. PMID: 22276288 [PubMed - in process] (Source: Australian Family Physician)

Are they safe in there? - Patient safety and trainees in the practice.

Australian Family Physician — Sun, 01 Jan 2012 05:00:00 +0100

This article provides practical teaching tips for supervisors in general practice. PMID: 22276280 [PubMed - in process] (Source: Australian Family Physician)

Teaching medical students - Tips from the frontline.

Australian Family Physician — Sun, 01 Jan 2012 05:00:00 +0100

Discussion Preparation and organisation before the student joins the practice can overcome initial concerns. Developing an in-house curriculum and protocol for teaching processes can improve quality of teaching and enjoyment for both teacher and student. PMID: 22276279 [PubMed - in process] (Source: Australian Family Physician)

Trainees in the practice - Practical issues.

Australian Family Physician — Sun, 01 Jan 2012 05:00:00 +0100

This article describes the key aspects of patient and financial management when trainees are present in the practice and suggests solutions to potential issues. Discussion Managing a practice where trainees are present adds additional organisational workloads and responsibilities. One aspect is the management of patients when trainees are present. This includes ensuring patients understand the requirements of a teaching practice and obtaining informed consent from patients, particularly for more junior training levels. It also requires the appropriate management of appointments to allow for teaching and supervision and a process for managing complaints and follow up. Another aspect for a teaching practice is financial management. Staff have additional roles which can impact on their servic...

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GPs in teaching practices.

Australian Family Physician — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Charles J, Valenti L, Miller G Abstract From April 2010 to March 2011, 956 general practitioners took part in BEACH (Bettering the Evaluation and Care of Health). Five hundred and ninety-four (62%) worked in a teaching practice for undergraduates, junior doctors or general practice registrars. PMID: 22276276 [PubMed - in process] (Source: Australian Family Physician)

Adherence with antiosteoporosis medications: a primary‐care study

Prescriber — Sun, 01 Jan 2012 05:00:00 +0100

AbstractThe authors describe the results of a study of adherence and persistence in all and new users of anti‐osteoporosis therapies in general practice in Ireland. Copyright © 2012 Wiley Interface Ltd (Source: Prescriber)

Delivering shiatsu in a primary care setting: Benefits and challenges.

Complementary Therapies in Clinical Practice — Fri, 30 Dec 2011 17:55:14 +0100

CONCLUSION: The study successfully integrated a shiatsu clinic into a general practice and offers a model for future research on complementary medicine in primary care. PMID: 22196572 [PubMed - in process] (Source: Complementary Therapies in Clinical Practice)

Doctors Are Cautious, Patients Enthusiastic About Sharing Medical Notes

Health News from Medical News Today — Fri, 30 Dec 2011 08:00:00 +0100

Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests. In a study published in the Dec... (Source: Health News from Medical News Today)

Assessing 5-year incidence rates and determinants of osteoporotic fractures in primary care

Bone — Wed, 28 Dec 2011 20:53:30 +0100

Abstract: Purpose: To assess the gender and age-related 5-year incidence rates of osteoporotic fractures, and their related predictors, in a primary care setting.Methods: We obtained information from the Health Search–CSD Longitudinal Patients Database (HSD). This is an Italian General Practice data repository which comprises information given by computer-based patient records of a selected group of over 900 Primary Care Physicians (PCPs).We selected all patients aged 50 to 85years, who were actively included into the PCP's list at the beginning of the enrolment period (1st January 2002–31st December 2003). We excluded individuals who were registered in the PCPs' list for less than 1year before the entry date (Index date) into the cohort, as well as those who were diagnosed with Paget ...

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Health promotion and ill-health prevention: the role of general practice.

Quality in Primary Care — Mon, 26 Dec 2011 11:06:02 +0100

CONCLUSIONS: Issues, such as GP commissioning, provide a new set of challenges for public health and ill-health prevention. The evidence base is growing but general practice, public health and academics need to work together to improve this. PMID: 22186174 [PubMed - in process] (Source: Quality in Primary Care)

Using a common cause strategy for quality improvement: improving hypnotic prescribing in general practice within a Quality Improvement Collaborative.

Quality in Primary Care — Mon, 26 Dec 2011 11:06:02 +0100

This article describes what a common cause strategy for improvement is and the steps required for this approach. We describe a practical example of how this is applied in a real-life situation. The first step in a common cause strategy is to look more deeply at this common cause variation to see whether special causes can be exposed using stratification. The second step is to seek to understand existing variation by understanding the processes and systems leading to the observed problem. Finally there is a need to redesign processes to reduce inappropriate and unintended variation in any agreed measures by agreeing and incorporating critical inputs and outputs from a provider-patient perspective in the context of systems thinking. PMID: 22186170 [PubMed - in process] (Source: Quality i...

Response to: Managing Black when in the red, challenges for general practice

Occupational Medicine — Mon, 26 Dec 2011 05:00:00 +0100

(Source: Occupational Medicine)

Connection Between Rising Obesity and 50% Increase in Acid Reflux Sufferers

About Heartburn / Acid Reflux — Thu, 22 Dec 2011 05:00:00 +0100

A new study is showing evidence that as obesity increases around the world, the number of people suffering from acid reflux is also increasing. Dr. Eivind Ness-Jensen, from the HUNT Research Center's Department of Public Health and General Practice at the Norwegian University of Science and Technology in Levanger, is leading a group of researchers who are finding that the prevalence of acid reflux (gastroesphageal reflux disease, or GERD) has increased by nearly 50% in the past 10 years. The research is showing that the increasing number of people who are obese is the "main attributable factor," Ness-Jensen said. "It's purely mechanical in one way. Added weight increases the pressure between the stomach and esophagus," forcing stomach acid back up, Ness-Jensen said. "There's an increasin...

Keep it simple? Predicting primary health care costs with measures of morbidity and multimorbidity

NHS Networks — Thu, 22 Dec 2011 05:00:00 +0100

Such information is required in order to set capitation fees or budgets for general practices to cover their expenditure on providing primary care services. It is also useful to examine whether practices’ expenditure decisions vary equitably with patient characteristics. (Source: NHS Networks)

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What Makes Patients Complex? Ask Their Primary Care Physicians

Health News from Medical News Today — Wed, 21 Dec 2011 08:00:00 +0100

As Americans live longer with multiple medical conditions, managing their care is becoming increasingly challenging. Being able to define and measure patient complexity has important implications for how care is organized, how physicians and health care systems are paid, and how resources are allocated. In an article in the Dec... (Source: Health News from Medical News Today)

Effects of an exercise programme for chronically ill and mobility-restricted elderly with structured support by the general practitioner's practice (HOMEfit) - Study protocol of a randomised controlled trial

Trials — Wed, 21 Dec 2011 05:00:00 +0100

Background: Exercise programmes can be administered successfully as therapeutic agents to patients with a number of chronic diseases and help to improve physical functioning in older adults. Usually, such programmes target either healthy and mobile community-dwelling seniors or elderly individuals living in nursing institutions or special residences. Chronically ill or mobility-restricted individuals, however, are difficult to reach when they live in their own homes.A pilot study has shown good feasibility of a home-based exercise programme that is delivered to this target group through cooperation between general practitioners and exercise therapists. A logical next step involves evaluation of the effects of the programme.Methods/designThe study is designed as a randomised controlled tria...

"Obs Stable" Is Vague And Should Not Exist In Hospital Notes

Health News from Medical News Today — Wed, 21 Dec 2011 00:00:00 +0100

According to an article published in the Christmas issue published on bmj.com today, the phrase "obs stable" in hospital notes is vague and doesn't accurately reveal the health status of the patient. The phrase can possibly mislead hospital staff and should not be used, instead observations should be written in full, argue Dr Gregory Scott and his team. The phrase is written in hospital notes to let staff know there were no alarming problems with a patient during observation. When examining patients, abnormalities in these observations act as an alarm for doctors... (Source: Health News from Medical News Today)

Characteristics and job satisfaction of general practitioners using Complementary and Alternative Medicine in Germany - is there a pattern?

BMC Complementary and Alternative Medicine — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions: The identified differences suggest that those GPs using and believing in CAM have a different medical orientation and approach which in turn may influence their job satisfaction. With this finding CAM use turns out to be a relevant factor regarding job satisfaction and, with this, may be a possible lever to counteract the growing dissatisfaction of GPs in Germany. This finding could also be important for designing strategies to promote the recruitment of young doctors to general practice. (Source: BMC Complementary and Alternative Medicine)

Diabetes management can be safely transferred to practice nurses

Evidence-Based Nursing — Mon, 19 Dec 2011 05:00:00 +0100

Implications for nursing practice Practice nurses (PNs) following protocols provide as effective care for patients with type 2 diabetes as general practitioners (GPs). Patients are more satisfied with PNs helping them with diabetes management compared with GPs. Implications for nursing research Further large-scale studies need to be conducted to trial models of care delivered by PNs in this context as well as more generally. Economic analyses need to be performed to ascertain the comparative cost-effectiveness of the two models of care. Qualitative and observational studies would provide further explanation of the different models of care. Context People with chronic diseases such as type 2 diabetes need a team approach to their care, and many models have been trialled to deliver cost-e...

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Nurse case management with a therapeutic algorithm for people living with diabetes, hypertension and raised LDL cholesterol: after 1 year 22% of those receiving the intervention have all three parameters under control versus 10% of those receiving usual care

Evidence-Based Nursing — Mon, 19 Dec 2011 05:00:00 +0100

Implications for practice and research Nurse case managers can improve simultaneous control of hypertension, hyperglycaemia and hyperlipidaemia among patients living with Type 2 diabetes with the use of an algorithm guiding changes in medications versus usual care. Frequent patient contact with nurse case managers can lead to improved lifestyle modifications and intensified medication regimes which reduce cardiometabolic risk. Clinical inertia by primary care providers is an issue when managing diabetes as well as other chronic illnesses. The use of algorithms and/or protocols by nurse case managers who have more frequent patient contact can assist in reducing the deleterious health outcomes of not treating to target. Context Type 2 diabetes mellitus is a disease that serves to accelera...

Relationships between patients, informal caregivers and health professionals in care homes

Evidence-Based Nursing — Mon, 19 Dec 2011 05:00:00 +0100

Implications for nursing practice Care delivery in the home creates a unique and potentially challenging set of relational issues for the nurse, client and informal carer. The communication skills, values, attitudes and behaviours of the nurse are influential in determining the dynamic of the nurse-client-informal carer relationship in the home. Implications for nursing research Further research is needed to examine the views of stakeholders on the factors that influence nurse-client-informal carer relationships in the home-care setting. Further research is needed to examine the success of interventions to promote positive relationships among stakeholders in the home-care setting. Context Care provision in the home is becoming increasingly common. To date, there is little available resea...

MRI Improves Understanding Of How Doctors Make Diagnoses

Health News from Medical News Today — Sat, 17 Dec 2011 08:00:00 +0100

Doctors use similar brain mechanisms to make diagnoses and to name objects, according to a study published in the online journal PLoS ONE and led by Marcio Melo of the University of Sao Paulo in Brazil. Doctors often make diagnoses within their first moments of interaction with a patient. To investigate the neural processes involved in this quick diagnostic process, the researchers used functional MRI scanning to assess the cerebral activity in doctors while they diagnosed lesions in chest X-rays... (Source: Health News from Medical News Today)

Treatment pathways for patients with atrial fibrillation

International Journal of Clinical Practice — Sat, 17 Dec 2011 02:27:16 +0100

Conclusions: Although there is more evidence of treatment maintenance than treatment change, especially in the first year after diagnosis, the amount of therapeutic change remains noteworthy and appears higher than in some previous studies. Prescription patterns for AF therapy suggest that too few high‐risk patients are receiving best practice treatment, and particularly of concern is that some of these patients are being transferred away from best practice treatment over time. (Source: International Journal of Clinical Practice)

Lymphocytic Colitis and Collagenous Colitis: A Review of Clinicopathologic Features and Immunologic Abnormalities

Advances in Anatomic Pathology — Fri, 16 Dec 2011 17:50:17 +0100

Lymphocytic colitis (LC) and collagenous colitis (CC), 2 histologic forms of microscopic colitis, were recognized as rare disease entities 4 decades ago. An increasing body of evidence accumulated in the past 40 years reveals increasing incidence and prevalence rates, a wide spectrum of clinical presentations, and several histologic variants. Although several recent randomized clinical trials confirmed the efficacy of oral budesonide in treating LC and CC, disease relapse after a short-duration treatment is common. Despite their common clinical presentations and well-defined histologic diagnostic criteria, there are only few studies on the immunologic abnormalities in colonic tissue. The aim of this review is to (1) familiarize the pathologists in general practice with histomorphology of L...

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Under NHS Reforms GPs Who Have Taken Over Budgets From PCTs Sliding Millions Into The Red, UK

Health News from Medical News Today — Fri, 16 Dec 2011 10:00:00 +0100

Financial evaluations demonstrate that GPs who have taken over budgets from PCTs under the Government's NHS reforms are sliding millions into the red. According to a Pulse analysis of financial data reported by CCGs across 55 primary care trusts, two-thirds of shadow clinical commissioning groups (CCGs) reporting figures are currently missing their financial targets. The analysis raises questions over the GPs capacity to save costs and deliver planned savings... (Source: Health News from Medical News Today)

Potential application of item-response theory to interpretation of medical codes in electronic patient records

BMC Medical Research Methodology - Latest articles — Fri, 16 Dec 2011 05:00:00 +0100

Conclusion: The application of item response theory models to coded electronic patient records might potentially contribute to identifying medical codes that offer poor discrimination or low calibration. This might indicate the need for improved coding sets or a requirement for improved clinical coding practice. However, in this study estimates were only obtained for a small proportion of participants and there was some evidence of poor model fit. There was also evidence of variation in the utilisation of codes between family practices raising the possibility that, in practice, properties of codes may vary for different coders. (Source: BMC Medical Research Methodology - Latest articles)

Risk of Herpes Zoster in Patients Prescribed Inhaled Corticosteroids: a cohort study.

BMC Pulmonary Medicine - Latest articles — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions: The use of inhaled corticosteroids, even at high doses and in conjunction with inhibitors of their metabolism, was not a significant risk factor for the occurrence of herpes zoster in adults. (Source: BMC Pulmonary Medicine - Latest articles)

Doctors recognized by the British honours systems: A retrospective analysis of the last decade

JRSM — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions The most honoured specialty was General Practice. However, when corrected for total subspecialty population, the number one ranking specialty was Public Health Medicine. Academic clinicians are well represented. The findings may be of interest to the medical community. (Source: JRSM)

A healthy diet can cost less than junk food, says new research

University of Bristol news — Thu, 15 Dec 2011 19:40:00 +0100

Parents of some obese children could save up to £6.58 each week by changing their shopping habits and opting for a healthier diet, according to University of Bristol research published in the latest issue of the British Journal of General Practice. (Source: University of Bristol news)

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GP survey: revalidation, commissioning and workload

HealthcareRepublic Pharmacist News — Thu, 15 Dec 2011 11:04:00 +0100

Take part in our online poll to have your say on issues affecting general practice, including revalidation, commissioning and workload. (Source: HealthcareRepublic Pharmacist News)

Release of GP practice prescribing data for England - September 2011

NeLM - News — Thu, 15 Dec 2011 05:00:00 +0100

Source: NHS Information Centre Area: News In a letter to cabinet ministers on 7 July 2011, the Prime Minister restated the commitment to make available "prescribing data by GP practice by December 2011". These data have been released and provide information relating to September 2011. Data for subsequent months will be released monthly thereafter. The data cover all general practices in England and include figures on the number of prescription items that are dispensed each month and information relating to costs. All prescribed and dispensed medicines (by chemical name), dressings and appliances (at section level) are listed for each GP practice, as well as the total number of items that were prescribed and then dispensed. (Source: NeLM - News)

Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English General Practice Patient Survey

Quality and Safety in Health Care — Thu, 15 Dec 2011 05:00:00 +0100

Conclusion Substantial ethnic differences in patient experience exist in a national healthcare system providing universal coverage. Improving the experience of patients in low-scoring practices would not only improve the quality of care provided to their White patients but it would also substantially reduce ethnic group differences in patient experience. There were large variations in the experiences reported by ethnic minority patients in different practices: practices with high patient experience scores from ethnic minority patients could be studied as models for quality improvement. (Source: Quality and Safety in Health Care)

Diagnostic misconceptions? A closer look at clinical research on Alzheimer's disease

Journal of Medical Ethics — Wed, 14 Dec 2011 05:00:00 +0100

The current focus on early intervention trials in Alzheimer's disease research raises particular ethical issues. These arise out of problems of validating study results and translating them into general practice for one thing and out of unwanted effects of an uncertain diagnosis for diagnosed people for another. The first addresses the demands of scientific research compared to those of medical practice, questioning how the medical value of clinical trials is evaluated. The second relates the scientific and medical value of early intervention trials to the normative value of an uncertain diagnosis. Are people who are diagnosed with a potential early form of AD in clinical studies patients proper—although they would not have been diagnosed with the given "disease" in non-research-orie...

Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

BMC Family Practice — Tue, 13 Dec 2011 05:00:00 +0100

Conclusions: Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings. (Source: BMC Family Practice)

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Tuberculosis Diagnosis Rate Higher Among New Mothers After Childbirth

Health News from Medical News Today — Mon, 12 Dec 2011 17:00:00 +0100

According to a new UK-wide cohort study published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, the incidence of TB (tuberculosis) diagnosis is substantially higher in new mothers after childbirth, indicating that this group of women represents a potentially new target group selected for screening. In a collaborated study, researchers from the Health Protection Agency and the University of East Anglia, evaluated data obtained from the General Practice Research Database on all pregnant women between 1996 and 2008... (Source: Health News from Medical News Today)

Cancer survival rates 'threatened by rising cost'

NHS News Feed — Mon, 12 Dec 2011 16:45:00 +0100

“Cancer survival rates could fall because of a rise in the cost of diagnosis and treatment over the next 10 years,” the Daily Express warns today. Other papers, including the Daily Mail claim that treating patients at home instead of in hospital could stop cancer treatments from “bankrupting” the UK’s healthcare system. The papers have each chosen to make stark warnings based on different aspects of the same report. The report, which projects the UK’s cancer treatment costs in 2021, was published by the private healthcare insurance company, Bupa. The report calculates that last year 318,000 people in the UK were diagnosed with cancer, with an overall cost for cancer care of £9.4 billion across NHS, private and voluntary sectors. By 2021 the number of new cancer cases is predic...

HPA: New study finds risk of TB diagnosis increased in women after pregnancy

NeLM - News — Mon, 12 Dec 2011 05:00:00 +0100

Source: Health Protection Agency Area: News The Health Protection Agency (HPA) has issued a press release noting the results of a UK study published in the American Journal of Respiratory and Critical Care Medicine, which found that the risk of tuberculosis (TB) diagnosis is significantly increased in women during the first six months after pregnancy. The researchers analysed data from the General Practice Research Database on all women who were pregnant between 1996 and 2008 (192,801 women and 264,136 pregnancies). There were 177 cases of TB among this group - they calculated that this was equivalent to a rate of 15.4 per 100,000, which is higher than that seen in those who are not pregnant (9.1 per 100,000). After adjusting for age, region and socio-economic stat...

Saliva secretion rate and acidity in a group of physically disabled older care home residents

Odontology — Sat, 10 Dec 2011 16:55:52 +0100

Abstract A growing number of older people have teeth, which are vulnerable to oral diseases. To maintain good oral health, an adequate amount of saliva should be secreted and the saliva should possess adequate buffer capacity. The study aim was to investigate the associations of saliva secretion rate and acidity with gender, age, and some medical characteristics in a convenience sample of physically disabled older care home residents. In 20 male and 30 female physically disabled older care home residents with a mean age of 78.1 ± 9.7 years, the resting, chewing-stimulated, and acid-stimulated whole saliva secretion rate and acidity, as well as the main medical diagnosis and the number of medications used, were registered. Resting, chewing-stimulated and aci...

Diagnosis Of Tuberculosis Is Increased In Postpartum Women

Health News from Medical News Today — Sat, 10 Dec 2011 09:00:00 +0100

The incidence of tuberculosis (TB) diagnosis is significantly increased in mothers postpartum, suggesting a potential new population to target for screening, according to a new UK-wide cohort study. In the joint study between the Health Protection Agency and the University of East Anglia, researchers analyzed data on all women with pregnancies between 1996 and 2008 from the General Practice Research Database, which contains records from 460 practices across the UK, representing 5.5 percent of the UK population... (Source: Health News from Medical News Today)

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GPC warns NHS shakeup could destabilise general practice in Northern Ireland

HealthcareRepublic Pharmacist News — Fri, 09 Dec 2011 16:00:00 +0100

General practice in Northern Ireland risks becoming 'destabilised' if shifting workload from secondary to primary care is not properly funded, the Northern Ireland GPC has warned. (Source: HealthcareRepublic Pharmacist News)

Mental Health Network briefing: Preventing suicide through community and emergency healthcare

NeLM - Mental Health — Thu, 08 Dec 2011 05:00:00 +0100

Source: NHS Confederation Area: News This briefing introduces the NPSA's new suicide prevention toolkits for community, emergency and general practice staff, launched in December 2011, and outlines their benefits for providers, illustrated by the experience of some pilot sites. (Source: NeLM - Mental Health)

Exposure to oral bisphosphonates and risk of cancer

International Journal of Cancer — Thu, 08 Dec 2011 05:00:00 +0100

In this study we examined the risk of all cancer and site specific cancers in individuals taking bisphosphonates. Data were extracted from the UK General Practice Research Database to compare site‐specific cancer incidence in a cohort of oral bisphosphonate users and a control cohort. Hazard ratios were calculated using Cox regression modelling. The bisphosphonate and control cohort contained 41,826 participants (mean age 70, 81% female). Overall, the bisphosphonate cohort compared with the control cohort had a reduced risk of all cancer after any bisphosphonate usage (HR=0.87, 95% CI 0.82, 0.92). In the bisphosphonate cohort, compared with the control cohort, there was no evidence of a difference in the risk of lung (HR=1.03, 95% CI 0.88, 1.20) or prostate cancer (HR=0.86, 95%CI 0.67, 1...

‘Perverse incentives’ undermine tariffs

BMA daily feed — Wed, 07 Dec 2011 16:49:00 +0100

Concern that payment by results leads to foundation trusts pulling in work from general practice (Source: BMA daily feed)

How Will Patients, Families & Doctors Handle A Flood Of Personal Gene Data?

Health News from Medical News Today — Wed, 07 Dec 2011 09:00:00 +0100

Sequencing the entire human genome took more than a decade before leaders of the Human Genome Project announced their completion of a rough draft in a 2000 White House ceremony. Finished in 2003, sequencing that first genome cost nearly $3 billion. Today, with advances in technology, an individual's whole genome can be sequenced in a few months for about $4,000. But knowing just what to do with this knowledge has not kept pace with the gusher of genetic data... (Source: Health News from Medical News Today)

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GP journal highlights neurology

Royal Australian College of General Practitioners (RACGP) Media Releases — Wed, 07 Dec 2011 08:00:00 +0100

New drive to improve NHS accountability to patients

OnMedica Latest News — Wed, 07 Dec 2011 05:00:00 +0100

Information updated for patients to spot best GP practices Related items from OnMedicaGPs deride appointments call centre ideaDoH sets out plans for NHS 111UK general practice ranks highly in world surveyIntegration of care belongs at heart of NHS reformPerformance data may not guide patients’ choice (Source: OnMedica Latest News)

Patient Reported Outcomes and Their Importance in the Development of Novel Surgical Techniques.

Surgical Innovation — Wed, 07 Dec 2011 05:00:00 +0100

Discussion. The patient perspective on health care is an important aspect of health care quality assessment. This is especially important with regard to the development of novel surgical techniques such as SILS and NOTES. With these techniques, the potential benefits are most likely to be found in the realms of reduced scarring and improved patient satisfaction. The findings from this study demonstrate the public's interest in these new techniques and thus give further support to continued research and development in this area. PMID: 22158844 [PubMed - as supplied by publisher] (Source: Surgical Innovation)

Practice sexual health confidentiality questioned

Management in Practice — Tue, 06 Dec 2011 14:13:00 +0100

General practice “may not be the best place to go” for sexual health services if you don’t want your mum to find out (Source: Management in Practice)

GP 'not the best place for sexual health advice'

Nursing in Practice — Tue, 06 Dec 2011 13:03:00 +0100

General practice “may not be the best place to go” for sexual health services if you don’t want your mum to find out (Source: Nursing in Practice)

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Practice sexual health confidentiality questioned

Nursing in Practice — Tue, 06 Dec 2011 13:03:00 +0100

General practice “may not be the best place to go” for sexual health services if you don’t want your mum to find out (Source: Nursing in Practice)

Preventive Care Delivery And Funding

Health News from Medical News Today — Tue, 06 Dec 2011 10:00:00 +0100

Female physicians, smaller patient loads and electronic reminders are associated with better delivery of preventive health care to patients, rather than the way in which primary care practices are funded, states an article in CMAJ (Canadian Medical Association Journal).. Although there is significant interest around the world in improving primary care delivery -- that is, first-line general health care -- and disease prevention, there is a lack of evidence about which payment model is associated with superior delivery of primary care... (Source: Health News from Medical News Today)

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece

BMC Family Practice — Tue, 06 Dec 2011 05:00:00 +0100

Conclusions: The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete. (Source: BMC Family Practice)

Organisational determinants of production and efficiency in general practice: a population-based study

The European Journal of Health Economics — Mon, 05 Dec 2011 17:34:09 +0100

Conclusions Nurses are currently undertaking other tasks than GPs, and larger practices do not lead to increased production per GP. However, a relative increase in list size increased the efficiency. This indicates that organisational changes aiming to increase capacity in general practice should be carefully designed and tested. Content Type Journal ArticleCategory Original PaperPages 1-10DOI 10.1007/s10198-011-0368-1Authors Kim Rose Olsen, Danish Institute for Health Services Research, Copenhagen, DenmarkDorte Gyrd-Hansen, Danish Institute for Health Services Research, Copenhagen, DenmarkTorben Højmark Sørensen, Danish Institute for Health Services Research, Copenhagen, DenmarkTroels Kristensen, Research Unit of Health Economics, University of Southern Denmark, ...

Pulse checks 'could prevent 12,000 strokes'

NHS News Feed — Mon, 05 Dec 2011 17:00:00 +0100

The Daily Mail reports that, if doctors checked the pulse of every patient they see, this measure could “prevent 12,000 strokes a year”. The aim of the pulse checks would be to pick up cases of atrial fibrillation, a common heart rhythm disorder that increases the risk of a stroke. The figure comes from a report released by the Atrial Fibrillation Association (AFA) and Anticoagulation Europe (ACE), which warn that there is a “silent epidemic” of atrial fibrillation and that this will worsen in the UK as the population ages. The report also sets out a number of ways that might improve the diagnosis and treatment of atrial fibrillation, including campaigns to raise awareness, further training for GPs and improved access to heart monitoring when a case is suspected. What is atrial...

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Mistaken Identity: New Report Highlights The Global Impact Of Medical Misdiagnosis

Health News from Medical News Today — Mon, 05 Dec 2011 08:00:00 +0100

Researchers have discovered that over a million people worldwide diagnosed with TB go on to develop an incurable but manageable fungal infection which is usually left untreated because it is mistaken for a recurrence of the disease. In a new report published in the Bulletin of the World Health Organization, the researchers from University of Manchester and University of Toronto say because the X-ray features and symptoms are so similar doctors often misdiagnose and prescribe the wrong treatment which can lead to tens of thousands of unnecessary deaths... (Source: Health News from Medical News Today)

The predictive value of single nucleotide polymorphisms in the VEGF system to the efficacy of first-line treatment with bevacizumab plus chemotherapy in patients with metastatic colorectal cancer

International Journal of Colorectal Disease — Mon, 05 Dec 2011 06:32:46 +0100

Conclusions The VEGFR-1 319 C/A SNP is a potential predictive marker for bevacizumab plus chemotherapy in patients with mCRC. Patients with the A allele appeared to have increased response rates. The results call for validation. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00384-011-1382-6Authors Torben Frøstrup Hansen, Danish Colorectal Cancer Group South, Vejle Hospital, University of Southern Denmark, Vejle, DenmarkRené dePont Christensen, Research Unit of General Practice Odense, Institute of Public Health, University of Southern Denmark, Odense, DenmarkRikke Fredslund Andersen, Danish Colorectal Cancer Group South, Vejle Hospital, University of Southern Denmark, Vejle, DenmarkKaren-Lise Garm Spindler, Danish Colorectal Cancer...

Does a diabetes annual review make a difference?

Diabetic Medicine — Mon, 05 Dec 2011 05:00:00 +0100

Conclusions: Metabolic control improved over time but this was largely independently of the diabetes annual review, which appears to add little clinical value to existing New Zealand general practice care processes. Currently, general practitioners are paid to undertake a diabetes annual review and report the measurements collected. We would argue that payment needs to be directed to demonstrating appropriate changes in clinical management or achieving meaningful clinical goals, and that the annual review results should be part of systematic feedback to general practitioners, particularly directed at clinical inertia.© 2011 The Authors. Diabetic Medicine© 2011 Diabetes UK (Source: Diabetic Medicine)

Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children [Article]

Archives of Pediatrics — Mon, 05 Dec 2011 05:00:00 +0100

Conclusion While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs, such agents are associated with a dose-dependent increased risk, concordant with findings in adults. (Source: Archives of Pediatrics)

Perthes' disease in the UK: Geographic and temporal trends in incidence reflecting deprivation inequalities in childhood

Arthritis and Rheumatism — Mon, 05 Dec 2011 05:00:00 +0100

Conclusion:The incidence of Perthes' disease has a strong North‐South divide, with a greater disease incidence within the Northern regions of the UK. There is a marked decline in incidence over the study period, which is more marked in Northern areas. The declining incidence, along with the geographic variation, suggests that a major aetiological determinant in Perthes' disease is environmental, which is closely linked to childhood deprivation. (Source: Arthritis and Rheumatism)

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Ethicality and confidentiality: is there an inverse-care issue in general practice ethics?

Clinical Ethics — Mon, 05 Dec 2011 05:00:00 +0100

This paper discusses confidentiality as a routine issue of concern to British general practitioners participating in a qualitative study as well as in contemporaneous practice literature. While keen to reflect on routine issues, such as confidentiality, participants who professed a lack of expertise in medical ethics also perceived reluctance or inability to access educational resources or ethics support. Such lack of ability might include a perception of non-entitlement to access advice and support, a fear of criticism, or simply that resources fail to be advertised. Participants' insights are set alongside a concurrent debate in the professional literature over whether problems with maintaining confidentiality should be rigorously discussed in a public forum. A preliminary suggestion is ...

Patient perspective on herpes zoster and its complications: An observational prospective study in patients aged over 50years in general practice

Pain — Mon, 05 Dec 2011 05:00:00 +0100

Summary: Despite early diagnosis and treatment with antiviral agents, many herpes zoster patients report persistent pain and marked long-term reduction in health-related quality of life.Abstract: Understanding the effect of herpes zoster and zoster-related pain should inform care to improve health-related quality of life in elderly patients. A 12-month, longitudinal, prospective, multicenter observational study conducted in primary care in France enrolled patients aged ⩾50years with acute eruptive herpes zoster. Patient-reported zoster-related pain was assessed by validated questionnaires (Douleur Neuropathique en 4 Questions [DN4], Zoster Brief Pain Inventory [ZBPI], and Neuropathic Pain Symptom Inventory [NPSI]) on days 0 and 15, and at months 1, 3, 6, 9, and 12. Health-related quality...

Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care.

BMC Family Practice — Fri, 02 Dec 2011 05:00:00 +0100

Conclusions: The present study shows considerable variation in the quality of guidelines on AGE in children, as well as inconsistencies between the recommendations. It remains unclear how to asses the extent of dehydration and determine the preferred treatment or referral of a young child with AGE presenting in general practice. (Source: BMC Family Practice)

The Teaching Files: Head and Neck Imaging

Academic Radiology — Fri, 02 Dec 2011 05:00:00 +0100

This first edition collection of 225 head and neck cases offers a well-organized, comprehensive overview of both the common and uncommon entities most likely to be encountered in either clinical practice or board examinations. The target audience includes medical students, residents in radiology or otolaryngology, neuroradiology fellows, subspecialist neuroradiologists, and general practice radiologists who read head and neck cases. (Source: Academic Radiology)

Alliance Of Community Health Plans Report Demonstrates That Enhanced Services And Higher Quality Benefits Lead To Improved Health

Health News from Medical News Today — Thu, 01 Dec 2011 08:00:00 +0100

Community health plans are partnering with physician practices to initiate a range of care management programs for people living with chronic diseases; these programs have resulted in decreased emergency room (ER) use, improved health and lower costs. The findings, released by the Alliance of Community Health Plans (ACHP), are part of a report that is a comprehensive look at the way community health plans partner with providers to improve care... (Source: Health News from Medical News Today)

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Attitude, knowledge and behaviour towards evidence‐based medicine of physical therapists, students, teachers and supervisors in the Netherlands: a survey

Journal of Evaluation in Clinical Practice — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions There is a weak positive attitude of physical therapists, teachers, supervisors and students towards participating in research in general practice, but there is a lack of knowledge and active behaviour regarding EBM, especially among physical therapy students. (Source: Journal of Evaluation in Clinical Practice)

Prevalence of overweight and obesity in Danish preschool children over a 10‐year period. A study of two birth cohorts in general practice

Acta Paediatrica — Thu, 01 Dec 2011 05:00:00 +0100

Child and adolescent mental health care in Dutch general practice: Time trend analyses

BMC Family Practice — Thu, 01 Dec 2011 05:00:00 +0100

This study aims to investigate the identification and treatment of child and adolescent mental health problems in general practice over a five-year period (2004-2008). Methods: Data of patients aged 0-18 years (N ranging from 37716 to 73432) were derived from electronic medical records of 42-82 Dutch general practices. Time trends in the prevalence of recorded mental health problems, prescriptions for psychotropic medication, and referrals to primary and secondary mental health care were analysed. Results: In 2008, 6.6% of children and 7.5% of adolescents were recorded as having mental health problems; 15.2% of these children and 29.4% of these adolescents were prescribed psychotropic medication; 18.9% of these children and 22.9% of these adolescents were referred, mainly to secondary ment...

Accuracy of oscillometric determination of the ankle-brachial index as screening method for peripheral artery disease

Artery Research — Thu, 01 Dec 2011 05:00:00 +0100

In this study we assessed the accuracy and reliability of oscillometric ABI determination compared with Doppler. (Source: Artery Research)

Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice

Gut — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions IID poses a substantial community and healthcare burden in the UK. Control efforts must focus particularly on reducing the burden due to Campylobacter and enteric viruses. (Source: Gut)

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Role of acute diverticulitis in the development of complicated colonic diverticular disease and 1-year mortality after diagnosis in the UK: population-based cohort study

Gut — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions Although most patients have experienced no prior episodes of acute diverticulitis, fistula formation is preceded by bouts of inflammation. Excess 1-year mortality across the spectrum of CCDD compared with the general population is substantial. (Source: Gut)

A study of the effects of central ray vertical (y-axis) positioning, pelvis (y-axis) rotation and pelvis (x-axis) translation on measurement of the anatomical short leg from the anteroposterior (AP) Ferguson radiograph

Clinical Chiropractic — Thu, 01 Dec 2011 05:00:00 +0100

Introduction: Anatomical leg length inequality (LLI) is very common in general practice. In fact, a leg length difference of greater than 5–10mm results in a predictable, full postural compensation pattern. Even small discrepancies are implicated in the pathogenesis of many spinal disorders including back pain. (Source: Clinical Chiropractic)

Risk of cancer in patients exposed to gabapentin in two electronic medical record systems

Pharmacoepidemiology and Drug Safety — Thu, 01 Dec 2011 05:00:00 +0100

ConclusionsThe epidemiological data in a US cohort with up to 12 years of follow‐up and a UK cohort with up to 15 years of follow‐up do not support a carcinogenic effect of gabapentin use. However, the confidence intervals for some analyses were wide, and an important effect cannot be confidently excluded. Copyright © 2011 John Wiley & Sons, Ltd. (Source: Pharmacoepidemiology and Drug Safety)

Factors influencing Dutch practice nurses’ intention to adopt a new smoking cessation intervention

Journal of Advanced Nursing — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion. Important associations were found between profession, attitude, social norms and satisfaction, and the intention to adopt the new smoking cessation intervention. Practice nurses who do not intend to adopt need to be persuaded of the advantages of adopting. Perceived social norms need to be restructured and before presenting the intervention to a general practice current smoking cessation activities should be determined to increase the intervention’s compatibility with these current practices. (Source: Journal of Advanced Nursing)