[Top]
Computer Systems
Title: Using computers to work smarter: a guide
for GPs
Authors: Schattner P
Source: Australian Family Physician 2006;
35(1/2): 28-31(Jan/Feb)
Summary: Computers have many uses in general practice, but
to get the most out of them requires commitment of time and money.
This article describes some of the most important benefits of
computers, but also indicates some of the difficulties in their use
which can be overcome with simple strategies. Realising the
benefits of computers requires a positive mindset which welcomes
their role in improving the quality of patient care and the
efficiency of general practice.
URL: http://www.racgp.org.au/afp
URLNotes: Full text access available to all
Depression
Title: Antidepressants unlimited: are
antidepressants the best option for treating depression in general
practice?
Authors: Van Marwijk H, Tylee A,
Dowrick C, Kendrick T
Source: European Journal of General Practice 2005: 11(3,4):
119-121 (Sept-Dec)
Summary: Antidepressants are among the world's most
prescribed drugs. However, there are several controversies around
their extensive use in primary care, and doubts about their
effects, especially in children and older people. Psychological
interventions are probably at least as effective as
antidepressants, and are preferred by many patients. These issues
were discussed at the debating sessions at WONCA 2004 in
Amsterdam.
URL: http://www.ejgp.com/
URLNotes: Abstracts only
Title: St John's Wort
Authors: Lawvere S, Mahoney MC
Source: American Family Physician 2005;
72: 2249-54
Summary: St John’s Wort has been used to treat a variety
of conditions. Several brands are standardized for content of
hypericin and hyperforin, which are among the most researched
active components of St. John’s Wort. St. John’s Wort has been
found to be superior to placebo and equivalent to standard
antidepressants for the treatment of mild to moderate depression.
Studies of St. John’s Wort for the treatment of major depression
have had conflicting results. St. John’s Wort is generally well
tolerated, although it may potentially reduce the effectiveness of
several pharmaceutical drugs.
URL:
http://www.aafp.org/online/en/home/publications/journals/afp.html
URLNotes: Full text access available to all
Deprivation
Title: Underfunding of primary care in deprived
areas affects everyone
Author: Hardy JN
Source: British Medical Journal 2006; 332(7535): 236 (28
Jan) [letter]
URL: http://ejournals.ebsco.com/login.asp?bCookiesEnabled=TRUE
URLNotes: Full-text access available via the RCGP
e-journals portal
[Top]
Diseases
[Top]
Title: Asthma: top 10 tips
for diagnosis and management
Author: Newson LR
Source: The New Generalist 2005; 3(4): 22-24 (Winter)
Summary: Asthma remains underdiagnosed and poorly treated
despite an increased awareness of the condition. Almost one in five
of 12 to 14-year-old UK schoolchildren have used asthma medication
in the past year. There are currently 51 million people in the UK
diagnosed with asthma, which has been estimated to cost the NHS
£850 million a year. More than 18 million working days are lost to
asthma each year.
URLNotes: No electronic access
Title: Association of population and practice
factors with potentially avoidable admission rates for chronic
diseases in London: cross sectional analysis.
Author: Saxena S, George J, Barber J, Fitzpatrick
J, Majeed A.
Source: Journal of the Royal Society of Medicine 2006;
81-89
(Feb)
Summary: The purpose of this study was to examine the
association between underlying ill health, material deprivation and
primary care supply factors and hospital admission rates for
potentially avoidable admissions in primary care trusts in London.
The study looked at 31 primary care trusts in London with a total
resident population of 7 million patients. The study found
that although hospital admission for some chronic diseases are
potentially avoidable and rates of hospital admission for these
conditions are possible indicators of the quality of care, they
should be interpreted in conjunction with measures of population
composition and deprivation. Failure to do this may result in
primary care trusts and general practitioners being criticized for
aspects of health care utilization that are not under their direct
control.
URL: http://www.jrsm.org/
URLNotes: Original research available to all
Title: Pathways to the diagnosis of colorectal
cancer: an observational study in three UK cities.
Authors: Barrett J, Jiwa M, Rose P, Hamilton
W.
Source: Family Practice 2006; 23(1): 15-19 (Feb)
Summary: Colorectal cancer can present in a variety of
ways, and with any of several symptoms. Different referral routes
from primary to secondary care cater for these different
presentations. The route that has received most investment in the
UK National Health Service is the 2-week clinic, but the
proportions of patients taking this and other routes to diagnosis
are largely unknown. This study looked at incidences of
colorectal cancer in Exeter, Oxford and Sheffield, UK and found
that the pathway with the most resources, the 2-week clinic,
was used by only a minority of patients.
URL: http://ejournals.ebsco.com/login.asp?bCookiesEnabled=TRUE
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Title: Research into prostate cancer
Author: Jiwa M
Source: Australian Family Physician 2006; 35(1/2): 7
(Jan/Feb) [letter]URL:
http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/
URLNotes: Full text access available to
all
Title: Combating
vascular disease in Scotland [editorial]
Author: Begg A
Source: British Journal of Cardiology 2005; 12(6): 409-10
(Nov/Dec)
URL: http://www.bjcardio.co.uk/pdf/2281.pdf
URLNotes: Full text access available to all
Title: Primary care epidemiology: its scope and
purpose
Authors: Hannaford PC, Smith BH, Elliott AM
Source: Family Practice 2006; 23(1): 1-7
(Feb)
Summary: Primary care epidemiology can contribute to wider
improvements in health and health care services, through better
understanding of disease aetiology, use of health care services and
the role of different health care interventions. Primary care is
delivered by a wide range of health professionals, including
nurses, doctors, care assistants, social workers, mental health
specialists, dieticians, pharmacists, dentists, optometrists and
other health care professionals, administrators and clerical staff.
The practice of each of these professional groups can contribute
to, and needs to be informed by, primary care epidemiology.
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URLNotes: Full-text access available via the RCGP
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General Practice Nurses
Title: Practice nurses: working smarter in
general practice
Author: Walker L
Source: Australian Family Physician 2006;
35(1/2): 20-22 (Jan/Feb)
Summary: Recent government funding initiatives have
increased the number of nurses in general practice and the range of
tasks undertaken by them. These nurses are trained, professionally
regulated health care professionals who can make a significant
contribution to the work of the practice. Approaches are
described that enhance available general practice services, allow
for the nurse to substitute for the general practitioner in some
tasks, and leads to a delegation of roles that can improve patient
health outcomes. A well educated, well supported practice
nurse can enhance both the services provided by a general practice
and the income derived from such services.
URL: http://www.racgp.org.au/afp/200601/3466
URLNotes: Full text access available to all
Title: The WiPP general practice nursing
project
Author: Robinson F
Source: Practice Nurse 2006; 16 February:
12-14
Summary: A career pathway and
educational framework is being developed for nurses in primary
care
URLNotes: No electronic access
General Practitioners
Title: Characteristics of career advisors for
general practice: a qualitative study of UK GPs
Authors: Thorley J, Chambers R
Source: Australian Family Physician 2006; 35(1/2): 75-76
(Jan/Feb)
Summary: Career support needs of general practitioners are
poorly described in the literature. This study looked at 26
practising GPs from two United Kingdom counties. General
practitioners believed they would benefit from the provision of
career advice and guidance provided by trained peers. They were
looking for advisors to whom they could relate and who understood
their professional and personal needs, in particular: listening
skills, life experience, credibility, protected time, ability to
challenge, give careful consideration, trustworthiness, knowledge
about GP careers, facilitation skills, and empathy. A
strategy put in place in Australia might enable GPs to implement
career plans.
URL: http://www.racgp.org.au/afp/200601/3548
URLNotes: Full text access available to all
[Top]
Medical Education
Title: Assessment of professional attitude and
conduct in medical undergraduates
Authors: Korszun A, Winterburn PJ, Sweetland H,
Tapper-Jones L, Houston H.
Source: Medical Teacher 2005; 27(8): 704-8
(Dec)
Summary: One year after implementation of a new
schedule of summative assessment of professional attitude and
conduct (AC) for medical undergraduates at the University of Wales
College of Medicine (UWCM), we evaluated its effectiveness and
obtained feedback of the perceptions of participating teachers and
students. The majority of students and teachers agreed that AC
should be an integral part of their assessment. However, several
problems were highlighted, in particular, students' perception that
marks were sometimes based on assessment of knowledge rather than
attitude and conduct and teachers' reluctance to identify
unprofessional behaviour in students. The use of longitudinal
assessment of professional AC was found to be effective at
identifying students with persistent AC problems and also provided
an opportunity for formative experience. The reluctance of teachers
to identify negative behaviours, compared to deficiencies in skill
and knowledge, is an important aspect of developing a reliable
method of evaluating professional attitudes.
URL: http://ejournals.ebsco.com/login.asp?bCookiesEnabled=TRUE
URLNotes: Full-text access available via the RCGP
e-journals portal
Title: Australian evidence for
interprofessional education contributing to effective teamwork
preparation and interest in rural practice
Authors: McNair R, Stone N, Sims J, Curtis C
Source: Journal of Interprofessional Care 2005; 19(6):
579-94 (Dec)
Summary: A pilot interprofessional education (IPE)
placement for undergraduate health care professional students was
undertaken in rural Victoria, Australia from 2001 to 2003. Medical,
nursing, physiotherapy and pharmacy students were involved, and the
project is ongoing. This paper briefly outlines the educational
model, then focuses on the evaluation methods and results obtained
from student evaluations. The placement experience improved
self-reported teamwork skills and knowledge, and supported
participating students' belief in the value of interprofessional
practice. Placements strengthened nursing and allied health
students' intention to work in rural health settings after
graduation. The rural interprofessional educational experience
improved interprofessional abilities in a group of students who
have the potential to influence change towards collaborative
practices in their future workplaces. The results obtained provide
sufficiently strong evidence to justify the continuation and
expansion of this educational model in the Australian setting.
Pedagogical and evaluation modifications are discussed that may
benefit future IPE programs.
URL:
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URLNotes: Full-text access available via the RCGP
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Title: Effective teaching through active
learning
Authors: Gibbs T, Brigden D, Hellenberg D.
Source: South African Family Practice 2005; 47(9): 5-7
(Oct)
Summary: There can be few
practitioners whose daily working life is not involved someway in
teaching or learning. Used in its broadest sense, we engage
teaching everyday in our advice to patients, and conversely we
learn from each of our patients. As we move inexorably towards
compulsory reaccreditation for all practitioners, purposeful and
effective continuing professional development takes over from the
previously passive continuing medical education model. As
Universities and Medical Schools recognise where most healthcare
occurs and sees the benefits of community-based education,
increasing numbers of undergraduate and postgraduate students pass
daily through our surgery doors. No doubt, the majority of busy
practitioners see these activities as an increased workload rather
than an opportunity, a stress factor rather than a possibility to
develop in their personal lives.
URL: http://www.ajol.info/journal_index.php?jid=75
URLNotes: Abstracts only
Title: Interprofessional postgraduate education
in primary health care: is it making a difference?
Author: Pullon S, Fry B
Source: Journal of Interprofessional Care
2005; 19(6): 569-78 (Dec)
Summary: This paper explores attitudes to, and
perceptions of, the impact of interprofessional postgraduate
education for primary health care professionals, based on a postal
survey of 153 primary health care professionals undertaking
postgraduate qualifications in New Zealand. The study found that
interprofessional postgraduate qualification study for primary
health care professionals in New Zealand resulted in personal and
professional benefit for individuals and their clinical practice,
and increased understanding about their own and other health
professionals' roles. The interprofessional nature of the education
was seen as positive, contributing to a modest increase in
collaboration between health professional groups. Barriers to
furthering participation in interprofessional learning and
increasing intersectorial collaboration in the workplace are
identified and discussed.
URL:
http://ejournals.ebsco.com/login.asp?bCookiesEnabled=TRUE
URLNotes: Full-text access available via the RCGP
e-journals portal
Title: The multiple-choice paper of the MRCGP
examination: a study of candidates' views of its content and effect
on learning
Author: Dixon H
Source: Education for Primary Care 2005;
16(6): 655-62 (Nov)
Summary: Candidates views of postgraduate medical
examinations are seldom sought in a systematic way. There is little
published evidence of candidates views of the MRCGP examination,
and its consequential validity, i.e. the effect of the assessment
on learning or care for patients. A random sample of 100 registrars
sitting the October 2003 multiple-choice paper (MCP) of the MRCGP
exam were sent a questionnaire to seek their views about the
validity of the paper. Most respondents found the questions
difficult, in particular general medicine and medical specialties,
but believed the paper assessed the application of their knowledge
about common or important topics, relevant to general practice.
However, more than half the candidates believed the paper contained
inappropriate questions and were critical of some of the question
formats. Pressure of time was a problem for many candidates, most
of whom believed they needed a further 30 minutes to complete the
paper. Preparation strategies were almost exclusively strategic,
most often through help from fellow registrars rather than the
trainer or vocational training scheme. Practising past papers was
the most frequent desirable additional help. There are
opportunities afforded by candidate feedback for the assessment
governance system and the development of the paper, and qualitative
feedback is of benefit in the evaluation of the quantitative data
from the results of the assessment.
URL:
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URLNotes: Full-text access available via the RCGP
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[Top]
Medical Treatment
Title: The use of medication for chronic pain
in primary care, and the potential for intervention by a
practice-based pharmacist.
Authors: McDermott ME, Smith BH, Elliott AM, Bond
CM, Hannaford PC, Chambers WA
Source: Family Practice 2006; 23(1): 46-52 (Feb)
Summary: The majority of people with chronic pain use
analgesics regularly. Ensuring their safe and appropriate use is
important. This study aimed to describe patterns of analgesic
prescribing in one general practice, devise a method of identifying
chronic pain patients from prescribing records, and assess
prescribing recommendations made after a pharmacist-led review of
analgesic prescribing and identify the proportion of these acted on
by GPs. The study found that there was little or no
relationship with changes in chronic pain severity or general or
psychological health.
URL:
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URLNotes: Full-text access available via the RCGP
e-journals portal
Title: What effects do patients feel from their
antihypertensive tablets and how do they react to them? Qualitative
analysis of interviews with patients
Authors: Benson J, Britten N
Source: Family Practice 2006; 23(1): 80-87
(Feb)
Summary: Patients
commonly experience palpable effects from antihypertensives. Few
studies have examined patients' experiences of these effects and
how they influence patients' behaviour and medicine-taking. The
objective of this study was to describe the palpable effects that
patients attribute to their antihypertensive tablets and the ways
that they react to them. The study involved in depth interviews
with a maximum variety sample of 38 patients taking
antihypertensive medication in 2 mainly urban UK general practices.
The study found that the term ‘side effect’ fails to distinguish
between palpable effects that are welcome or unwelcome, or to
recognise that some unwelcome effects may nevertheless be
acceptable. The study recommended that clinicians explore the range
of palpable effects that patients attribute to antihypertensives
and patients' possible preparedness to tolerate unwelcome effects,
in order to better identify patients' preferences in this
area.
URL:
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URLNotes: Full-text access available via the RCGP
e-journals portal
Title: Do ASCOT results signal a change for
hypertension management?
Authors: Morrell, J.
Source: The New Generalist 2005; 3(4): 13-16 (Winter)
Summary: ASCOT, the largest-ever European trial in
hypertension, recruited more than 19,000 men and women with
hypertension and at least three other cardiovascualr risk factors.
The trial was conceived amidst growing appreciation of the need to
control high blood pressure with more than one agent and to
identify the best therapeutic combination. Earlier trials generated
controversy by not reducing CHD events by as much as theoretical
predictions would estimate, and one of several explanations was
that the metabolic side-effects of the older drugs were to blame.
Accordingly, the ASCOT investigators chose a head-to-head design
between newer and older drugs as well the rather unusual primary
endpoint of fatal and nonfatal CHD.
URLNotes: No electronic access
Title: Making sense of aches and pains
Authors: Calnan M, Wainwright D, O'Neill C,
Winterbottom A, Watkins C
Source: Family Practice 2006; 23(1): 91-105 (Feb)
Summary: The uncertainty about the status of upper
limb disorders (ULDs), particularly the non-specific conditions, is
believed to have consequences for clinical management and patient
care. This paper presents evidence about how sufferers with
ULDs respond to their pain, how their pain is managed, when and who
they go to for formal help and how sufferers evaluate the care they
receive. This study found the common strategy was to wait and see
what happens as the pain was believed to be a natural part of the
ageing process. Self-management was the preferred strategy but
orthodox practitioners were usually the first choice for formal
care. Complementary and alternative medicines (CAM) were popular
but were used to complement orthodox care. Practitioners were
evaluated mainly in terms of their ability to alleviate pain. The
study recommended that GPs should not depend on orthodox
medications alone when caring for patients with upper limb
pain.
URL:
http://ejournals.ebsco.com/login.asp?bCookiesEnabled=TRUE
URLNotes: Full-text access available via the RCGP
e-journals portal
Title: GPs' opinions of their role in prenatal
genetic services: a cross-sectional survey
Authors: Qureshi N, Armstrong S, Modell B
Source: Family Practice 2006; 23(1): 131-6 (Feb)
Summary: In the UK about 4.5% of the population carry
cystic fibrosis, whilst in the inner city areas an even higher
proportion carry one of the haemoglobin disorders such as
thalassaemia. Couples who both carry the same recessive disorder
have a 1 in 4 risk of an affected child in every pregnancy. The
objective of this study was to assess GPs' confidence in their
ability to provide initial prenatal advice for couples carrying
common autosomal recessive disorders (either the cystic fibrosis or
thalassaemia gene), and their opinions of different approaches for
referral to prenatal diagnostic services for such at-risk
couples. The study used a cross-sectional postal survey of all
644 GPs in 388 general practices in Nottinghamshire and found that
GPs perceive that they lack the confidence to provide basic
prenatal genetic advice to women at risk of the commonest recessive
disorders, with particularly low confidence where the couple both
carry thalassaemia. A significant knowledge gap was demonstrated by
the poor awareness of the importance of rapid referral to prenatal
diagnostic services.
URL:
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URLNotes: Full-text access available via the RCGP
e-journals portal
Title: What do stroke patients and their carers
want from community services?
Authors: Hare R, Rogers H, Lester H, McManus RJ,
Mant J
Source: Family Practice 2006; 23(1): 131-6
(Feb)
Summary: Previous research has
focused on the longer term needs of new stroke patients at fixed
time intervals after the event, but neglected those of stroke
patients who may have had the event many years earlier. The aim of
this study was to identify the long-term support needs of patients
with prevalent stroke, and their carers identified from practice
stroke registers. The study involved seven practices in South
Birmingham. And three major themes emerged: emotional and
psychological problems; lack of information available for patients
and their families; the importance of Primary Care as the first
point of contact for information or problems, even if these were
non medical. The study suggested that better methods of providing
information for long-term survivors of stroke, and for addressing
their emotional and psychological needs are required. Primary care
could be a key setting for helping to provide more inclusive
services for both patient and carer.
URL:
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URLNotes: Full-text access available via the RCGP
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Mental Health
Title: The treatment of common mental health
problems in general practice
Authors: MAGPIE Research Group
Source: Family Practice 2006; 23(1): 53-9
(Feb)
Summary: Previous studies
report GPs under-treat mental health disorders, particularly
depression, and treatments are non-specific and lack an evidence
base. They conclude further training and education of GP's is
required. The objective of this study was to describe the
treatment of common mental health disorders in relation to the
level and severity of psychological problems as defined by the GP
and external assessment. The study involved a cross sectional
survey of General Practice attenders in New Zealand. Fifty
consecutive adult patients were recruited from each practice of 70
randomly selected GP's. The psychological status of 773 respondents
selected via the General Health Questionnaire (GHQ) was assessed,
and details of management provided. The study found that
there is a clear association between the level of
psychological problem identified and treatment. In contrast to
previous views that treatment often appears to be given regardless
of diagnosis, these results provide a picture of general practice
management of common mental disorders more in line with
evidence-based practice than previously described.
URL:
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URLNotes: Full-text access available via the RCGP
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[Top]
Practice Management
[Top]
Title: Testing a European set of indicators for
the evaluation of the management of primary care practices
Authors: Engels Y,
Dautzenberg M, Campbell S, Broge B, Boffin N, Marshall M et
al
Source: Family Practice 2006; 23(1): 137-47
(Feb)
Summary: Effective practice management is an
important prerequisite for offering good clinical care.
Internationally valid, reliable and feasible indicators and
instruments are needed to describe and compare the management of
primary care practices in Europe. This paper describes
development and evaluation of the European Practice Assessment
instrument and indicators (Engels Y, Campbell S, Dautzenberg M et
al. Developing a framework of, and quality indicators for, general
practice management in Europe. Fam Pract 2005; 22(2): 215–22). The
study design was a validation and feasibility study set in 273
general practices in Austria, Belgium, France, Germany, Israel, The
Netherlands, Slovenia, Switzerland and the UK. The study found
that the EPA instrument provides feedback to practices that
facilitates quality improvement and can compare primary care
practices on a national and an international level.
URL:
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URLNotes: Full-text access available via the RCGP
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[Top]
Research
Title: Research governance: ethical
issues
Authors: Slowther A, Boynton P, Shaw S
Source: Journal of the Royal Society of Medicine 2006; 99:
65-72
Summary: Healthcare
research is haunted by a history of unethical studies in which
profound harm was caused to vulnerable individuals. Official
systems for gaining ethical approval for research, designed to
prevent a repetition of these shameful examples, can prove
bureaucratic and inflexible in practice. The core ethical
principles of respect for autonomy, prevention of harm, promotion
of benefit, and justice (which form the basis of professional codes
of research conduct) must be applied flexibly to take account of
contextual, methodological, personal and practical considerations.
Ensuring that the design and conduct of all research is ethically
sound is the responsibility of all involved - including
researchers, research institutions, ethics review committees and
regulatory bodies.
URL: http://www.jrsm.org/
URLNotes: Original research available to all
Suicide
Title: Suicide in mental health in-patients and
within 3 months of discharge
Authors: Meehan J, Kapur N, Hunt IM, Turnbull P,
Robinson J, Bickley H, Parsons R, Flynn S, Burns J, Amos T, Shaw J,
Appleby L
Source: British Journal of Psychiatry 2006; 188: 129-134
(February)
Summary: Suicide prevention is a health
service priority. Suicide risk may be greatest during psychiatric
in-patient admission and following discharge. The aim of this study
was to describe the social and clinical characteristics of a
comprehensive sample of in-patient and post-discharge cases of
suicide. The study took a national clinical survey based on a
4-year (1996-2000) sample of cases of suicide in England and Wales
who had been in recent contact with mental health services
(n=4859). The study found that post-discharge suicide was most
frequent in the first 2 weeks after leaving hospital; the highest
number occurred on the first day. The study suggested that suicide
might be prevented among in-patients by improving ward design and
removing fixtures that can be used in hanging. Prevention of
suicide after discharge requires early community follow-up and
closer supervision of high-risk patients.
URL: http://bjp.rcpsych.org/
URLNotes: Abstracts only
Title: Suicide within 12
months of mental health service contact in different age and
diagnostic groups
Authors: Hunt IM, Kapur N, Robinson J, Shaw J,
Flynn S, Bailey H, Meehan J, Bickley H, Parsons R, Burns J, Amos T,
Appleby L
Source: British Journal of Psychiatry 2006; 188: 135-142
(February)
Summary: Suicide prevention is a health service
priority but the most effective approaches to prevention may differ
between different patient groups. The aim of this study was to
describe social and clinical characteristics in cases of suicide
from different age and diagnostic groups. The study took a national
clinical survey of a 4-year (1996-2000) sample of cases of suicide
in England and Wales where there had been recent (<1 year)
contact with mental health services (n=4859). The study found that
deaths of young patients were characterised by jumping from a
height or in front of a vehicle, schizophrenia, personality
disorder, unemployment and substance misuse. In older patients,
drowning, depression, living alone, physical illness, recent
bereavement and suicide pacts were more common. People with
schizophrenia were often in-patients and died by violent means.
About a third of people with depressive disorder died within a year
of illness onset. Those with substance dependence or personality
disorder had high rates of disengagement from services. The study
suggested that prevention measures likely to benefit young people
include targeting schizophrenia, dual diagnosis and loss of service
contact; those aimed at depression, isolation and physical
ill-health should have more effect on elderly people.
URL: http://bjp.rcpsych.org/
URLNotes: Abstracts
only
[Top]
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