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General Medical Practice

Nathaniel W Taggart, Brent M Gordon, Gareth J Morgan, Bryan H Goldstein
The complex nature of congenital heart disease (CHD) has hindered the establishment of management standards for peri-catheterization anticoagulation. We sought to describe anticoagulation practice variability among providers performing cardiac catheterization in children and adults with CHD. A web-based survey ( ) was distributed to pediatric and congenital interventional cardiologists. Respondents were queried on their training, practice setting, years in practice, and case volume...
August 18, 2018: Pediatric Cardiology
Dimity Pond, Karen Mate, Nigel Stocks, Jane Gunn, Peter Disler, Parker Magin, John Marley, Nerida Paterson, Graeme Horton, Susan Goode, Natasha Weaver, Henry Brodaty
OBJECTIVE: Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients. DESIGN: Double-blind, cluster randomised controlled trial. SETTING: General practices in Australia between 2007 and 2010. PARTICIPANTS: General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention; 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention; 55 waitlist)...
August 17, 2018: BMJ Open
M B K C Dayasiri, S F Jayamanne, C Y Jayasinghe
BACKGROUND: The burden of poisoning among children is largely underexplored in rural Sri Lanka. This study describes the patterns of demographic characteristics, poison related factors, clinical management and outcome following acute poisoning among children (9 months- 12 years) in rural Sri Lanka. METHOD: This hospital based multi-center study included Anuradhapura Teaching hospital, Polonnaruwa District General hospital, and 34 regional hospitals within Regional Director of Health Services in North Central province of Sri Lanka...
August 18, 2018: BMC Pediatrics
Ambrose H Wong, R Andrew Taylor, Jessica M Ray, Steven L Bernstein
STUDY OBJECTIVE: The prevalence of agitation among emergency department (ED) patients is increasing. Physical restraints are routinely used to prevent self-harm and to protect staff, but are associated with serious safety risks. To date, characterization of physical restraint use in the emergency setting has been limited. We thus aim to describe restraint patterns in the general ED to guide future investigation in the management of behavioral disorders. METHODS: We conducted a cross-sectional study of adult patients presenting to 5 adult EDs within a large regional health system for 2013 to 2015, and with a physical restraint order during their visit...
August 14, 2018: Annals of Emergency Medicine
Guo-Zhang Zhu, Wei-Rui Zhao, Cheng-En Luo, Bing Cai, Xiang-Xue Kong, Wen-Feng Zhan, Zhong-Sheng Sun, Sheng-Kang Luo
BACKGROUND: Vascular complications resulting from intravascular filler injection and embolism are major safety concerns for facial filler injection. It is essential to systematically screen full face arterial variations and help design evidence-based safe filler injection protocols. METHODS: The carotid arteries of 22 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 12 cadaveric heads were injected with the contrast in a sequential order...
August 14, 2018: Plastic and Reconstructive Surgery
A F Santoro, S M Shear, A Haber
BACKGROUND: Associations between childhood adversity and negative health outcomes are well documented within the general population; however, this relationship has yet to be confirmed in adults with intellectual and developmental disabilities (I/DD). Bridging the gap between public health and I/DD research is critical in order to better understand the ways in which the health of people with I/DD are compromised by adversity and social disadvantage and to develop preventative care frameworks and health-promoting practices specifically for adults with I/DD...
August 17, 2018: Journal of Intellectual Disability Research: JIDR
Emma Louise Healey, Ebenezer K Afolabi, Martyn Lewis, John J Edwards, Kelvin P Jordan, Andrew Finney, Clare Jinks, Elaine M Hay, Krysia S Dziedzic
BACKGROUND: Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake...
August 17, 2018: BMC Musculoskeletal Disorders
Bram Tilburgs, Myrra Vernooij-Dassen, Raymond Koopmans, Marije Weidema, Marieke Perry, Yvonne Engels
BACKGROUND: ACP enables individuals to define and discuss goals and preferences for future medical treatment and care with family and healthcare providers, and to record these goals and preferences if appropriate. Because general practitioners (GPs) often have long-lasting relationships with people with dementia, GPs seem most suited to initiate ACP. However, ACP with people with dementia in primary care is uncommon. Although several barriers and facilitators to ACP with people with dementia have already been identified in earlier research, evidence gaps still exist...
August 16, 2018: BMC Geriatrics
Louise S Deeks, Mark Naunton, Guan Han Tay, Gregory M Peterson, Gregory Kyle, Rachel Davey, Paresh Dawda, John Goss, Gabrielle M Cooper, Julie Porritt, Sam Kosari
BACKGROUND AND OBJECTIVES: Non-dispensing pharmacists are being suggested as a useful addition to the workforce in general practice. The aim of this study was to describe the activities of three general practice pharmacists over six months in a pilot trial. METHOD: Three general practices integrated a part-time (15.2-16 hours per week) non-dispensing pharmacist to be employed according to their individual skillset and local workplace needs. Each general practice pharmacist maintained a daily activity diary, which was subsequently analysed...
August 2018: Australian journal of general practice
Tarun Sen Gupta, Carole Reeve, Sarah Larkins, Richard Hays
BACKGROUND: Medical workforce problems still dominate headlines despite considerable investment in education, training and other initiatives. There is little consensus about what Australia's general practice workforce should look like or what training outcomes should be reported. OBJECTIVE: The aim of this paper was to explore a number of issues relevant to outcomes of workforce programs and offer suggestions for identifying and overcoming these issues. DISCUSSION: Social accountability literature highlights the importance of outcomes focusing on community needs...
August 2018: Australian journal of general practice
Richard Hays, Tarun Sen Gupta
BACKGROUND: Australia continues to develop as a multicultural nation, with a population that is ageing and developing complex health needs. The world around us is changing, and the pace of change is increasing. These contextual changes pose challenges for general practice training. OBJECTIVE: This paper explores the potential impact of these changes on the general practice workforce. DISCUSSION: General practitioners (GPs) will continue to have a central role in coordinating continuous, comprehensive care but are more likely to act as managers of multi-source, continuous monitoring data that facilitate personalised medical care...
August 2018: Australian journal of general practice
Manasi Jiwrajka, William Yaxley, Marlon Perera, Matt Roberts, Nigel Dunglison, John Yaxley, Rachel Esler
BACKGROUND: Benign prostatic hyperplasia (BPH) is the most common benign tumour in men. Although men with BPH often need medical or surgical management from a urologist at some point throughout the timeline of their disease, most men are initially assessed and managed by a general practitioner (GP) in the primary healthcare setting. OBJECTIVE: The aim of this article is to highlight the principles of the pathogenesis, presentation, assessment and management of BPH in a primary care setting...
July 2018: Australian journal of general practice
Tim Braun, Leamor Kahanov
PURPOSE: Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015 to 2016 and 2016 to 2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics. METHODS: This study targeted high school and intercollegiate athletic programs across the United States...
September 2018: Medicine and Science in Sports and Exercise
Luke A Devine, Shiphra Ginsburg, Terese Stenfors, Tulin D Cil, Heather McDonald-Blumer, Catharine M Walsh, Lynfa Stroud
PURPOSE: Although the field of medical education research is growing and residents are increasingly recruited to participate as subjects in research studies, little is known about their experiences. The goal of this study was to explore the experiences and perceptions of residents who are study participants in medical education research. METHOD: A phenomenographic approach was chosen to examine the range of residents' experiences as research participants. A maximum variation sampling strategy was used to identify residents with diverse experiences...
August 14, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Caoimhe Madden, Sinéad Lydon, Ciara Curran, Andrew W Murphy, Paul O'Connor
BACKGROUND: There is limited research, and guidance, on how to address safety in general practice proactively. OBJECTIVES: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined. METHODS: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened...
December 2018: European Journal of General Practice
Pier Mannuccio Mannucci, Alessandro Nobili, Emanuela Marchesini, Emily Oliovecchio, Laura Cortesi, Antonio Coppola, Elena Santagostino, Paolo Radossi, Giancarlo Castaman, Lelia Valdrè, Cristina Santoro, Annarita Tagliaferri, Cosimo Ettorre, Ezio Zanon, Giovanni Barillari, Isabella Cantori, Teresa Maria Caimi, Gianluca Sottilotta, Flora Peyvandi, Alfonso Iorio
BACKGROUND: In older people, multiple chronic ailments lead to the intake of multiple medications (polypharmacy) that carry a number of negative consequences (adverse events, prescription and intake errors, poor adherence, higher mortality). Because ageing patients with haemophilia (PWHs) may be particularly at risk due to their pre-existing multiple comorbidities (arthropathy, liver disease), we chose to analyse the pattern of chronic drug intake in a cohort of PWHs aged 60 years or more...
August 16, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
T F Weigel, E Hanisch, A Hanisch, A Buia, L P Müller, J Messias, C Hessler
The ways of thinking in the manufacturing sciences are increasingly determining the rationality within medicine as a practical or action-based science. This "technological paradigm" infiltrates the field of medicine with the promise of increasing efficiency while simultaneously improving quality at various points in the system. Simple linear causal relationships generally need to be taken into account when manufacturing products. Even complex manufacturing processes can be broken down into the smallest units and, therefore, also be automated...
August 12, 2018: Journal of Surgical Education
William V Padula, Joyce M Black, Patricia M Davidson, So Yeon Kang, Peter J Pronovost
OBJECTIVE: Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a composite rate of hospital-acquired conditions (HACs), to adjust payments and score hospitals on quality since 2015. However, PSI90 may be associated with adverse prioritization for preventing some conditions over others...
July 17, 2018: Journal of Patient Safety
R G Pebody, N L Boddington, H K Green, S Bolotin, A Charlett, J M Watson
During the 2009 influenza pandemic, a rapid assessment of disease severity was a challenge as a significant proportion of cases did not seek medical care; care-seeking behaviour changed and the proportion asymptomatic was unknown. A random-digit-dialling telephone survey was undertaken during the 2011/12 winter season in England and Wales to address the feasibility of answering these questions. A proportional quota sampling strategy was employed based on gender, age group, geographical location, employment status and level of education...
August 15, 2018: Epidemiology and Infection
Thierry Almont, Fadila Farsi, Ivan Krakowski, Rabih El Osta, Pierre Bondil, Éric Huyghe
PURPOSE: To assess, focusing on population of healthcare professionals providing oncosexology care to men with cancer, clinical practice, attitudes, knowledge, communication, and professional interaction. METHODS: We performed a descriptive cross-sectional study with an online self-administered e-questionnaire addressed to all medical, paramedical, or administrative professionals attending the 4th "Cancer, Sexuality and Fertility" Meeting in Toulouse, France...
August 14, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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