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General Medical Practice

Géraldine Bloy, Laetitia Moussard Philippon, Laurent Rigal
INTRODUCTION: Healthy behaviours become less common when descending the social ladder, which contributes to social inequalities in health. General practitioners (GPs) could have an impact on this general trend by providing preventive care counselling. We wanted to describe the social inequalities related to physical activity (PA) and the counselling given to patients, in order to improve our understanding of how inequalities can be produced at the doctor-patient relationship level. METHODS: Prev Quanti simultaneously examined social differences in the patients' level of PA and in the PA counselling provided by their GPs...
September 6, 2018: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Melanie Handley, Frances Bunn, Claire Goodman
BACKGROUND: There are an increasing number of interventions to improve hospital care for patients with dementia. Evidence for their impact on staff actions and patient outcomes is, however, limited and context dependent. OBJECTIVE: To explain the factors that support hospital staff to provide dementia sensitive care and with what outcomes for patients with dementia. DESIGN: A realist evaluation using a two-site case study approach. SETTING: Two hospital trusts in the East of England...
November 30, 2018: International Journal of Nursing Studies
Peipei Zhao, Bolin Cao, Cedric H Bien-Gund, Weiming Tang, Jason J Ong, Yi Ding, Weiying Chen, Joseph D Tucker, Zhenzhou Luo
BACKGROUND: Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) infection and sexually transmitted infection (STI) in China. Inadequate clinical services and poor clinical competency among physicians are major barriers to improving the sexual health of MSM. This study aims to understand physician clinical competency in providing MSM health services in China. METHODS: We conducted an online cross-sectional survey among Chinese physicians who have seen male patients for STI complaints in the past year...
December 13, 2018: BMC Health Services Research
Charlotte F Davies, Joanna M Kesten, Mark Gompels, Jeremy Horwood, Megan Crofts, Annette Billing, Charlotte Chick, Margaret T May
BACKGROUND: HIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed. METHOD: We implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol...
December 13, 2018: BMC Family Practice
Susana Carregal-Romero, Sandra Plaza-García, Rafael Piñol, José L Murillo, Jesús Ruiz-Cabello, Daniel Padro, Angel Millán, Pedro Ramos-Cabrer
Medical imaging is an active field of research that fosters the necessity for novel multimodal imaging probes. In this line, nanoparticle-based contrast agents are of special interest, since those can host functional entities either within their interior, reducing potential toxic effects of the imaging tracers, or on their surface, providing high payloads of probes, due to their large surface-to-volume ratio. The long-term stability of the particles in solution is an aspect usually under-tackled during probe design in research laboratories, since their performance is generally tested briefly after synthesis...
December 12, 2018: Biosensors
Tom Thomas, Joht S Chandan, Philip R Harvey, Neeraj Bhala, Subrata Ghosh, Krishnarajah Nirantharakumar, Nigel J Trudgill
Background: Perianal abscess (PA) is associated with inflammatory bowel disease (IBD). The incidence of IBD after a diagnosis of PA and potential predictors of a future diagnosis of IBD are unknown. Methods: The Health Improvement Network (THIN) is a primary care database representative of the UK population. Incident cases of PA were identified between 1995 and 2017. Subjects with PA were matched to controls within the same general practice. Primary outcome was subsequent diagnosis of Crohn's Disease (CD) or ulcerative colitis (UC)...
December 13, 2018: Journal of Crohn's & Colitis
Elisabeth Bendstrup, Wim Wuyts, Tiago Alfaro, Nazia Chaudhuri, Robin Cornelissen, Michael Kreuter, Kirsten Melgaard Nielsen, Anna-Marie B Münster, Marjukka Myllärniemi, Claudia Ravaglia, Tim Vanuytsel, Marlies Wijsenbeek
Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with a dismal survival rate of only 3 years and no curative pharmacological therapy. The recent approval of 2 anti-fibrotic drugs (nintedanib and pirfenidone) that slow disease progression has provided some hope for patients. However, effectively managing anti-fibrotic treatment can be a challenge due to tolerability issues, the presence of pulmonary and extra-pulmonary comorbidities, and the need for concomitant medications in many patients. In general, making clear evidence-based decisions can be difficult for physicians because patients with comorbidities are often excluded from clinical trials...
December 13, 2018: Respiration; International Review of Thoracic Diseases
Iain Strickland, Mkaya Mwamburi, Steven Davis, James C R Ward, Janet Day, Andrew T Tenaglia, Eric J Leibler, Peter S Staats
A patient audit was conducted in the UK to evaluate the impact of gammaCore use in multimorbidity patients on quality of life and healthcare resources utilization measures. A total of 233 patients were enrolled and their data was examined over a 1-year period after their gammaCore prescription. Of these patients, 132 (56%) had primary headache disorders while 101 (44%) were patients without a headache disorder (nonheadache patients). The mean age was 49 years, 169 (72%) were female, the mean number of comorbid conditions was 3...
December 2018: American Journal of Managed Care
Danique R M Vlaskamp, Benjamin J Shaw, Rosemary Burgess, Davide Mei, Martino Montomoli, Han Xie, Candace T Myers, Mark F Bennett, Wenshu XiangWei, Danielle Williams, Saskia M Maas, Alice S Brooks, Grazia M S Mancini, Ingrid M B H van de Laar, Johanna M van Hagen, Tyson L Ware, Richard I Webster, Stephen Malone, Samuel F Berkovic, Renate M Kalnins, Federico Sicca, G Christoph Korenke, Conny M A van Ravenswaaij-Arts, Michael S Hildebrand, Heather C Mefford, Yuwu Jiang, Renzo Guerrini, Ingrid E Scheffer
OBJECTIVE: To delineate the epileptology, a key part of the SYNGAP1 phenotypic spectrum, in a large patient cohort. METHODS: Patients were recruited via investigators' practices or social media. We included patients with (likely) pathogenic SYNGAP1 variants or chromosome 6p21.32 microdeletions incorporating SYNGAP1 . We analyzed patients' phenotypes using a standardized epilepsy questionnaire, medical records, EEG, MRI, and seizure videos. RESULTS: We included 57 patients (53% male, median age 8 years) with SYNGAP1 mutations (n = 53) or microdeletions (n = 4)...
December 12, 2018: Neurology
Kathrin Ludwig, Corina Machnitzke, Thomas Kühlein, Marco Roos
Objective: At the end of the Practical Year (PY), medical students decide on a specialization. Individual motivational factors and barriers play a central role in the choice of the subsequent subject area and the place of establishment (city/country). The aim of this study was to document the barriers of PY students within the General Practice (GP) tertiary elective over time. Methodology: Two guided interviews were conducted with each participant (N=19) as part of qualitative process monitoring - a pre-interview at the start and a post-interview after completion of the PY...
2018: GMS Journal for Medical Education
Stephanie L Harrison, Monica Cations, Tiffany Jessop, Sarah N Hilmer, Mouna Sawan, Henry Brodaty
Psychotropic medications have a high risk of serious adverse events and small effect size for changed behaviours for people with dementia. Non-pharmacological approaches are recommended as first-line treatment for changed behaviours, yet psychotropic medications remain highly prevalent in long-term aged care settings. This narrative review describes the current evidence regarding deprescribing psychotropic medications for people with dementia in long-term care. Deprescribing psychotropic medications can be achieved without harm to the person with dementia, and most people experience no withdrawal symptoms...
December 11, 2018: Drugs & Aging
Nader Najafi, Russ Cucina, Bruce Pierre, Raman Khanna
Importance: Physicians frequently use cardiac monitoring, or telemetry, beyond the duration recommended by published practice standards, resulting in "alarm fatigue" and excess cost. Prior studies have demonstrated an association between multicomponent quality improvement interventions and safe reduction of telemetry duration. Objective: To determine if a single-component intervention, a targeted electronic health record (EHR) alert, could achieve similar gains to multicomponent interventions and safely reduce unnecessary monitoring...
December 10, 2018: JAMA Internal Medicine
Daisy J M Ermers, Karin J H van Bussel, Marieke Perry, Yvonne Engels, Henk J Schers
Background: Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice. Methods: We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed...
December 10, 2018: Family Practice
Costin Teodor Streba, Sorin Popescu, Daniel Pirici, Ioana Andreea Gheonea, Mihai Vlădaia, Bogdan Silviu Ungureanu, Dan Ionuţ Gheonea, Tiberiu Ştefăniţă Ţenea-Cojan
INTRODUCTION: Hepatocellular carcinoma (HCC) currently represents a major health concern, mainly for its shifting pre-existing conditions that in turn lead to late diagnosis, thus increasing the mortality rate. An improved training of medical personnel involved in diagnosis, staging and the management of treatment is required. AIM: We thus aimed to transition tumor view from two-dimensional, on-screen, methods to real, palpatory three-dimensional (3D) representations that can be printed using generally available tools, thus approachable in virtually any medical setting worldwide...
2018: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Aglae Sousa, Andrea A Cardoso, Monia Kayo, Guilherme Gregorio, Jair de Jesus Mari, Denise Razzouk
BACKGROUND: There is a scarcity of tested instruments for measuring mental health services and costs. The Client Sociodemographic Service Receipt Inventory (CSSRI) is the most used tool in economic evaluation in mental health in Europe; it was translated into five languages, and it was mainly used to evaluate deinstitutionalisation process in mental health system reform. AIMS OF THE STUDY: To translate and adapt to the Brazilian healthcare system, and to test its inter-rater reliability, validity and its feasibility in a deinstitutionalized sample of psychiatric hospital living in residential facilities...
September 1, 2018: Journal of Mental Health Policy and Economics
Gino Roberto Corazza, Pietro Formagnana, Marco Vincenzo Lenti
Modern medicine, still largely focused on single diseases, is unprepared for managing clinical complexity (CC), which is an emerging issue. Ageing of the general population has favoured the occurrence of chronic diseases, which generate multimorbidity that has been considered for many years the main feature of CC. However, more recent studies have shown that CC is something more and different and originates from the dynamic interaction among the patient's intrinsic factors (age, gender, multimorbidity, frailty) as well as contextual factors (socioeconomic, behavioural, cultural, and environmental)...
December 5, 2018: European Journal of Internal Medicine
Ahmed M Alshehri, Jamie C Barner, Sharon Rush
BACKGROUND AND PURPOSE: To examine the impact of a Medication Therapy Management (MTM) course on third-year pharmacy students' (P3s) perceived abilities and intentions to provide MTM services before and after the course. EDUCATIONAL ACTIVITY AND SETTING: An anonymous 48-item self-administered survey was administered to P3s before and after the MTM course. Forty-six items using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) measured abilities in MTM provision using the following seven subdomains: general MTM ability (GA), medication therapy review (MTR), medication-related problems identification/recommendations (MRPIR), disease measurement/monitoring (DM), communication (CO), follow-up/referral (FR), and billing/documentation (BD)...
January 2019: Currents in Pharmacy Teaching & Learning
Kelly M Conn, Anthony Corigliano, Alexander J DeLucenay, Kobi Nathan, Guillermo Montes
INTRODUCTION: Pharmacists' beliefs about medications have been identified as a potential factor in how patients are counseled. However, no studies have assessed this relationship. METHODS: Third year pharmacy students were surveyed using previously validated questionnaires about medication beliefs, including the BMQ-General (General-Overuse and General-Harm subscales), Benefit, and Perceived Sensitivity to Medications (Sensitive Soma) scales; each is rated on a five-point Likert scale (higher scores represent stronger feelings)...
January 2019: Currents in Pharmacy Teaching & Learning
Linda Helena Anna Bonnie, Mechteld Renee Maria Visser, Jettie Bont, Anna Wilhelmina Maria Kramer, Nynke van Dijk
Introducing Entrustable Professional Activities (EPAs) into primary care postgraduate medical education (PGME) programmes may be challenging, due to the general nature of primary care medicine, but trainers and trainees both stand to benefit from their use. We investigated the expectations of trainers and trainees in a primary care PGME programme regarding the use of EPAs. We held two focus group discussions with trainers and four with trainees from the Dutch General Practice training programme, to explore their views on the use of EPAs in their training programme...
December 10, 2018: Education for Primary Care
Cristian Sager
The general objective is to adapt recommendations on monosymptomatic primary enuresis (ME) to the regional context. The instruments used were “Guide for the Adaptation of Clinical Practice Guidelines” and “Guidelines for creation of Consensus” (Sociedad Argentina de Pediatría). ME is called intermittent urinary incontinence during the sleep of children > 5 years of age, with no other symptoms of the urinary tract. It is differentiated from non-monosymptomatic enuresis, defined by the presence of other symptoms of the lower urinary tract, mainly during the day...
December 1, 2018: Archivos Argentinos de Pediatría
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