Primary Care

Primary Care

  • Arthur Leibovitz added an answer:
    Who should treat elderly patients in a community? Their primary care physician or a specialist in geriatrics?
    Geriatric medicine is a distinct medical specialty with vast specific knowledge accumulated over the last 30 years. On the other side most present primary care community physicians have not been exposed to systematic geriatric education. How could this gap be bridged?
    Arthur Leibovitz · Tel Aviv University
    Hi Samuel Very detailed point of view. How does the healthy system in Singapur function ? Alike the NHS in the UK ?
  • Tim Noonan added an answer:
    Are you familiar with the notion of complementary and alternative medicine more than conventional primary care?
    Conventional medicine prides itself on being science-based, and shuns alternative medicine for being "unproven," however, many of the non-communicable diseases have been taken care of successfully by alternative medicine. Conventional medicine is still behind and it will send your health into a downward spiral.
    Tim Noonan · STAT Medical Transport
    I do not see a benefit from the "alternative" medicine treatment for low back pain. There was a statistically significant difference in satisfaction favoring the enhanced placebo group, which suggests that the benefit is related to how well the idea is sold to the patients. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain "Participant Satisfaction Significant group-related differences were observed in response to the question “Would you have the same intervention you received in this study again for low back pain?” χ2(3, n = 106) = 8.15, P = .04 ( Table 5). Significantly more participants receiving the enhanced placebo SMT indicated “probably to definitely yes” than the other groups individually (P < .05). Significant group-related differences were observed in response to the question “How would you rate the overall results of the intervention you received in this study for low back pain?” Significantly more participants receiving the enhanced placebo SMT indicated “good to excellent” than participants receiving the standard placebo SMT or no treatment (P < .05). A significant difference was not observed between participants receiving the SMT and the enhanced placebo SMT (P = .07)." - The other paper looks at reducing stress to help ulcerative colitis. This is not news or "alternative" medicine. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Levenstein S, Prantera C, Varvo V, Scribano ML, Andreoli A, Luzi C, Arcà M, Berto E, Milite G, Marcheggiano A. Am J Gastroenterol. 2000 May;95(5):1213-20. PMID: 10811330 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/10811330 Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study. Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Andreoli A, Luzi C. Am J Gastroenterol. 1994 Aug;89(8):1219-25. PMID: 8053438 [PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/8053438 Why is stress reduction for ulcerative colitis being presented as "alternative" medicine? .
  • David Palacios Martínez added an answer:
    Somebody knows anything about BIT´s annual world congress of endobolism (http://www.bitlifesciences.com/wce2014/)?
    I have been invited as a speaker. I have previously participated as a speaker at Spanish and international conferences, but never before in a conference in Asia or paying for being a speaker. Has anybody had any experience about this conference or this organizer? Thanks you all.
    David Palacios Martínez · Servicio Madrileño de Salud, Madrid, Spain.
    Hi Mrs Gade, I have not found any significant aditional information about BIT´s annual world congress of endobolism 2014. It seems to be a new conference. Sincerely, David.
  • Marsha Green added an answer:
    Does anyone know of good papers regarding implementation of clinical decision support systems in primary care?
    Looking at good (and bad!) examples of successful CDSS implementation in primary care/general practice
    Marsha Green · College of St. Scholastica
    Take a look at the Institute for Clinical Systems Improvement (ICSI) website - this is a collaborative program which conducts process improvement/standardization/protocols focused on delivering guidelines for multiple clinical topics that are related to primary care.
  • Rodney P Jones added an answer:
    Does a long time series of deaths in Scotland shed light on what is happening in urgent care?
    Analysis of a time series of monthly deaths in Scotland from 1990 to 2012 shows evidence for a series of infectious like events which also appear to be linked to increases in ED attendance, medical admissions and a wobble in the gender ratio. http://www.bmijournal.org/index.php/bmi/article/viewFile/167/117 Is this the missing piece of information explaining what is happening in urgent health care? Your comments and thoughts would be welcome.
    Rodney Jones · Healthcare Analysis & Forecasting, Camberley, UK
    Have submitted some more work which suggests that the transmission of the agent reaches a minimum in the summer suggesting Vitamin D is of vital importance. This is somewhat timely given the explosion of studies demonstrating the beneficial effects of vitamin D against mortality and morbidity. So until we can all come up with a better solution (immunization or low cost anti-viral) vitamin D for the elderly seems a sensible first step.
  • Fernando A. Alonso López added an answer:
    Can someone tell me how or if they are incorporating Spirometry in their primary care offices?
    HEDIS guidelines require us to do Spirometry to gauge the severity of COPD, preferably when the patient is not suffering an acute exacerbation. Would someone share with me how they are addressing that guideline?
    Fernando Alonso López · Servicio Cántabro de Salud
    We have 2 nurses with skills about spirometry to make all our health center need. Using an spirometer and calibration bubble all the weeks
  • Imran Shuja Khawaja added an answer:
    Are there any review articles on integration of sleep medicine in a primary care setting?
    There are several studies on integrating mental health services in primary care. I am interested in integrating sleep medicine services in a primary care setting.
    Imran Khawaja · University of Minnesota Twin Cities
    Thanks a lot. I will look up this site.
  • Aziz Sheikh added an answer:
    How can we improve patient's safety in the Middle East Region?
    The incidence of preventable adverse events, errors and near misses is relatively high in developing countries. Can you share some successful programs to improve patient's safety by improving systems?
    Aziz Sheikh · The University of Edinburgh
    You may find it useful to take a look at this recent paper on global safety priorities for primary care: http://www.ncbi.nlm.nih.gov/pubmed/24260028
  • Joanne Pike added an answer:
    Are you aware of exemplar models of community based primary health care and/or integrated models of care for older adults with multimorbidities?
    I'm particularly interested in models that span multiple health and/or social care sectors.
    Joanne Pike · Glyndwr University
    Here in Wales we have a case management approach, whereby District Nurses and Case managers (nurses with an advanced practice qualification - at Masters level) work within an intergrated team. But there are many variations of this still, and it is an evolving service. The services are targeted at those living at home with multiple morbidities. The model is a development of the 'Evercare' or Kaiser Permenante model. Try this address for the strategic approach being taken. I know it's dated, but there have been progress reports published on the net. http://www.wales.nhs.uk/documents/serviceplane.pdf
  • James Harris added an answer:
    Can someone send me the the beck anxiety inventory for primary care 7 item self report instrument?
    Typically a 7 item self-report instrument
    James Harris · University of Phoenix
    David, Many Thanks! Have a good weekend; best, James
  • George Dowswell added an answer:
    Sexual dysfunction following cancer and cancer treatment: European perspectives on primary care service provision?
    I suspect that there's lots of good practice across Europe but that it is not being translated between settings and healthcare systems. Is anyone working on improving primary care diagnosis and treatment of sexual dysfunction? There are networks for primary care, cancer, sexual dysfunction but what about a network for primary care identification and treatment of sexual dysfunction following cancer? Such a network could engage clinicians from primary, secondary and tertiary care, not only with an interest in cancer, academics from a range of disciplines, patients and patient groups, policy makers.
    George Dowswell · University of Birmingham
    Thank you - Yesterday someone mentioned to me that HTA had funded a study at UCL so I really appreciate your helpful message - I was going to chase this up when I had found out a little more. You've made it easy now. George
  • Rahul Alam added an answer:
    How can I obtain GP/PALS/PCT/CCG complaints data?
    Has anyone had any experience in trying to obtain patient level complaints data from any of the above organisations?
    Rahul Alam · The University of Manchester
    Hi, That's really helpful - thank you. I'll pursue both these avenues. Many thanks again. Rahul Alam
  • Ezequiel R. Rodriguez Rey added an answer:
    How widespread is the trend to higher emergency department attendances?
    There has been recent alarm in the UK regarding a rapid increase in ED attendances which I suspect is far wider than just the UK. Any observations from elsewhere in the world?
  • Helena Britt added an answer:
    What are your thoughts on using computer aided diagnosis/differential diagnosis generators (DDx) - Patient net or SkyNet?
    Do clinicians routinely use differential diagnosis generators in primary/secondary care? We are undertaking a systematic literature review of their utility and trying to ascertain their feasability in UK General practice. Are they likely to be helpful or be a hindrance?
    Helena Britt · University of Sydney
    Dobn;t use them in Aus. Select a term from an interface terminology, whihc may be differential. Proivding a list of terms used by GPs is more frutiful thatn generating differential diagnoses in my view.
  • Urica Parris added an answer:
    Do you have any information on successful implementations of fall-prevention strategies in your country?
    We will be looking at the implementation of the fall-prevention strategies in the acute sector, primary care and nursing homes.
    Urica Parris · D'Youville College
    Multidisciplinary team medication reviews, on admission and quarterly, as well as, if there is a change in the status of residents who has a history of falls; Evaluate and monitor residents for 72 hrs after a fall
  • Juan M Mendive asked a question:
    Primary prevention of depression - can anyone help?
    Primary care environment to prevent depression from opportunistic approach. What is the quality of life implication of that?
  • Aoife Lawton added an answer:
    What are the visual, clinical and verbal barriers and facilitators to disclosure of domestic violence in a primary care setting?
    I'm looking for research around patient engagement in primary care - GP setting. Specifically around domestic violence discovery and disclosure.
    Aoife Lawton · Health Service Executive
    Hi both, thank-you for the insights. I was just assisting a Nurse Practitioner with a piece of research she is doing in this area. I have put together a bibliography for it. She is doing a PhD on this topic. When it becomes available I will send a link. In the meantime, this is the bibliography: 1999. Domestic violence in patients visiting general practitioners--prevalence, phenomenology, and association with psychopathology. S Afr Med J, 89, 635-40. 2004. Pilot educational outreach project on partner violence. Prev Med, 39, 536-42. 2007. What do abused women expect from their family physicians? A qualitative study among women in shelter homes. Women Health, 45, 105-19. 2011. Intimate partner violence. Am Fam Physician, 83, 1165-72. AHMAD, F., HOGG-JOHNSON, S., STEWART, D. E., SKINNER, H. A., GLAZIER, R. H. & LEVINSON, W. 2009. Computer-assisted screening for intimate partner violence and control: a randomized trial. Annals of Internal Medicine, 151, 93-102. BRADBURY-JONES, C., DUNCAN, F., KROLL, T., MOY, M. & TAYLOR, J. 2011. Improving the health care of women living with domestic abuse. Nursing Standard, 25, 35-40. CORBALLY, M. A. 2001. Factors affecting nurses' attitudes towards the screening and care of battered women in Dublin A&E departments: a literature review. Accident & Emergency Nursing, 9, 27-37. FLURY, M., NYBERG, E. & RIECHER-RÖSSLER, A. 2010. Domestic violence against women: Definitions, epidemiology, risk factors and consequences. Swiss Medical Weekly, 140, w13099-w13099. GRUNFELD, A. F., RITMILLER, S., MACKAY, K., COWAN, L. & HOTCH, D. 1994. Detecting domestic violence against women in the emergency department: a nursing triage model. Journal Of Emergency Nursing: JEN: Official Publication Of The Emergency Department Nurses Association, 20, 271-274. GUTMANIS, I., BEYNON, C., TUTTY, L., WATHEN, C. N. & MACMILLAN, H. L. 2007. Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health, 7, 12-12. HEGARTY, K. & O'DOHERTY, L. 2011. Intimate partner violence - identification and response in general practice. Australian Family Physician, 40, 852-856. HEWITT, L. N., BHAVSAR, P. & PHELAN, H. A. 2011. The secrets women keep: intimate partner violence screening in the female trauma patient. Journal of Trauma, 70, 320-323. LIEBSCHUTZ, J., BATTAGLIA, T., FINLEY, E. & AVERBUCH, T. 2008a. Disclosing intimate partner violence to health care clinicians - what a difference the setting makes: a qualitative study. BMC Public Health, 8, 229-229. LIEBSCHUTZ, J., BATTAGLIA, T., FINLEY, E. & AVERBUCH, T. 2008b. Disclosing intimate partner violence to health care clinicians - what a difference the setting makes: a qualitative study. BMC Public Health, 8, 229-229. MORSE, D. S., LAFLEUR, R., FOGARTY, C. T., MITTAL, M. & CERULLI, C. 2012. "They told me to leave": how health care providers address intimate partner violence. Journal of the American Board of Family Medicine, 25, 333-342. RAMSAY, J., RUTTERFORD, C., GREGORY, A., DUNNE, D., ELDRIDGE, S., SHARP, D. & FEDER, G. 2012. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. British Journal of General Practice, 62, 647-655. RICKERT, V. I., DAVISON, L. L., BREITBART, V., JONES, K., PALMETTO, N. P., ROTTENBERG, L., TANENHAUS, J. & STEVENS, L. 2009. A randomized trial of screening for relationship violence in young women. Journal of Adolescent Health, 45, 163-170. SOGLIN, L. F., BAUCHAT, J., SOGLIN, D. F. & MARTIN, G. J. 2009. Detection of intimate partner violence in a general medicine practice. Journal of Interpersonal Violence, 24, 338-348. SPRAGUE, S., MADDEN, K., SIMUNOVIC, N., GODIN, K., PHAM, N. K., BHANDARI, M. & GOSLINGS, J. C. 2012. Barriers to Screening for Intimate Partner Violence. Women & Health, 52, 587-605. SVAVARSDOTTIR, E. K. & ORLYGSDOTTIR, B. 2009. Identifying abuse among women: use of clinical guidelines by nurses and midwives. Journal Of Advanced Nursing, 65, 779-788. TAN, E., O'DOHERTY, L. & HEGARTY, K. 2012. GPs' communication skills - a study into women's comfort to disclose intimate partner violence. Australian Family Physician, 41, 513-517. TREVILLION, K. 2011. Domestic violence: responding to the needs of patients. Nursing Standard, 25, 48-56.
  • Heinz Spranger added an answer:
    Can someone tell me how it is globally sought to make people sensitive to problem-oriented knowledge about health and disease?
    Do we really only need Google knowledge, or transformation of science into all areas of life?
    Heinz Spranger · Interuniversitäres Kolleg für Gesundheit und Entwicklung
    I want to extend my question now. GOOGLE knowledge is finite. In fact the capacity of the www will soon be much larger than the wikipedia topics include. But digital media are fast. They are more comprehensive than our explanations asking for compliance. So – we have a need of them. On the other side I fear that global education, realization of health care and acceptance by our clients now goes in the wrong direction. We should not only accumulate knowledge of health and disease. Therefore we currently have to transform knowledge to primarily the realm of experience, the skills, cognition and perception. As science literature speaks of tacit knowledge, this means for both, health practitioners and patients, knowing more than we know to say and could realize. Implicit knowledge is gaining an increasing importance as human resource. It should be subsequently outlined that these problems affect the four process categories of knowledge management (knowledge generation, representation, communication, and use). Who has an idea of how we awake clients or patients knowledge in the field of information on primary care?
  • Mark Laslett added an answer:
    In your opinon: Is healthcare a right or privilege? (Thank you for your replys)
    Health Care
    Mark Laslett · Auckland University of Technology
    @Marika. We are now getting to refined usage of words, and the issue of free will is entirely a separate discussion. However I will say this: when someone says "I must do this.." or "I have to.." does not mean that choice is excluded. Quite the opposite usually, since the individual has chosen one path from among others available. This is choice. The evidence that choices are free, however hard sometimes, is that people make them all the time. Sometimes people freely choose disastrous paths, sometimes beneficial ones. Often we don't know how we will respond to difficult choices until we are faced with the options or are in circumstances where choices must be made. While the unique circumstances of everyone's background (culture, geography etc) certainly shape many aspects of our behaviour, the freedom to act exists, and the proof is that people do, all the time, often entirely in contrast to what their culture, society and background would encourage or demand. None of these accidents of birth imply determinism. The issue of free will / determinism is an epistemological discussion, not a political one such as the question of rights i.e. freedom to act in a social context. The concept of voluntarism however is difficult to argue against, whether or not you are a determinist or advocate of free will. I don't, but one could argue that our genes, society or God determines our behaviour, but advocating voluntary interaction with others simply means not forcing others to your will. It is polite, it gives dissenters the opportunity to withdraw, and ensures that the concerted action of groups of individuals are not held together by anger and fear. It also requires groups with different viewpoints to acknowledge that other individuals and groups may differ in opinion, and that interactions with them should be polite, respectful and non-violent. Again there are mountains of evidence that such respect and politeness can exist among individuals and groups of diametrically opposed views. Most multicultural societies on Earth actually are rather peaceful, or at least relatively non-violent - and there are many. I live in one, and so do you I think. It is easy to be distracted by the criminals and small proportion of sociopaths who rape, murder and pillage innocent people, but most live their lives, interact with different folk of widely disparate beliefs and opinions. You might be surprised how many of your own friends disagree with you on very fundamental issues. I know I have many such friends. Friendships, social and business relationships are based on values held in common, and mostly we set aside the differences in favour of the benefits and pleasures and interactions resulting from the common values. Many long lasting and loving marriages are between individuals with vastly different philosophies and world views. Of course it is easier to support voluntarism if you accept the principle that individuals have free will and the individual rights to their own life, liberty and pursuit of happiness. This places others, regardless of their different or opposing views as one's equals with regards to the freedom to act - or not. If we differ on the the issue of free will, perhaps we can agree that the principle of voluntarism is a sound principle with which to interact with others? If so, then my points about the right to seek healthcare is a right, but the right to the services of healthcare providers needs to be questioned. As stated in earlier posts my belief is that the involuntary coercion of health care workers to provide service, or the involuntary support of taxpayers of healthcare workers and patients is unacceptable, still holds and follows directly from the principle of voluntarism.
  • Singh Shivakumar added an answer:
    Who knows a good definition of acute kidney injury (based on biochemistry data) to be implemented in observational primary care datasets?
    Most observational studies on community-acquired acute kidney injury use hospital admission and relevant ICD codes as their study outcome. However, we have access to a primary care data base that can be linked to laboratory data and this may allow us to additionally study renal outcomes that did not require hospital admission and those that were not primarily attributed to AKI.
    Singh Shivakumar · Stanley Medical College
    Dr Tobias Dreischulte has stated that this study was done to evaluate AKI in a cohort group of hypertensive patients to quantify the risk of a certain drug exposure in the community . I shall briefly share my experience on AKI in elderly hypertensive patients . Elderly patients admitted for fractures are assessed by me for fitness for surgery .If a female patient has a serum creatinine of 1.3 mgs% or more & a male patient with serum creatinine of 1.5 mgs% , the surgery is postponed by 48-72 hrs . Most of these patients are hypertensives on ACEI / ARB , who are also taking NSAIDS for osteoarthritis & also pain of fractures . I have to immediately assess whether the rise in creatinine is due AKI or CKD . Since these patients are hypertensives , they would have some record of baseline creatinine done as a routine about 1-2 years ago . The ACEI / ARB are withdrawn & replaced with Calcium Channel Blockers . The NSAIDS are also withdrawn & replaced with Paracetamol . They are adequately hydrated with IV fluids ( 0.9% Saline ) . The serum creatinine is checked daily & a drop of serum creatinine is misleading as John Pickering highlighted , but reassuring ! If there are no complications of AKI , they would undergo surgery & at discharge , the creatinine done would be considered as baseline . The patients are very anxious & it is my duty to explain to them whether it is AKI or CKD . The delay in surgery improves renal function & prevents AKI from progressing stage 1 & 2 to stage 3 .
  • Charon Blaney added an answer:
    Why is face to face interaction between nurse and patient so important to their hospital stay satisfaction?
    My research is based on connecting the insurer with the hospital, with the provider for a transparent effort in care. Having an insurer-sponsored health coach embedded into the hospital to assist in making the patients transition home easier, as well as connecting them, immediately post discharge with the resources they may need and want.
    Charon Blaney · University of Phoenix; Blaney Investments; Ustawi Research Institute
    This interaction builds relationships and makes the patient feel that the nurse cares. In addition face to face aids in physical and mental assessment of the patient
  • Surya Dila asked a question:
    How to manage a patient with diabetic neuropathy in primary care?
    Neuropathy is one of the major complication in diabetes mellitus type 2. What can be done for a patient with this condition in a primary care setting besides management for blood glucose control? How effective can it be in affecting the prognosis of complication process?
  • Fernando A. Alonso López added an answer:
    Measuring Intermediate results in Primary Health Care
    Measuring Intermediate results in Primary Health Care
    Fernando Alonso López · Servicio Cántabro de Salud
    2nd. If you need more information please say me but is in spanish language
  • Nathan Hill added an answer:
    Who is the care giver at primary health care centres in uk for patients with non communicable diseases (like diabetes and hypertension) ?
    What is the speciality of the heath care giver at the health centers in uk?are they general practioners or family physcianes?
  • Nathan Hill added an answer:
    Is anyone planning a study of primary care patients?
    The Scottish Primary Care Research Network (SPCRN ) facilitates eligibly funded research in primary care. We work with researchers to ensure that their study protocols are suitable for the primary care setting, and that the project aims are achievable. We also recruit primary care professionals to research projects, and facilitate the invitation of suitable patients.
  • Robert Bowman asked a question:
    Accelerating Cycles of Primary Care Decline in the US
    Accelerating Cycles of Primary Care Decline in the US

About Primary Care

The primary research focus is on the prevention, early diagnosis and management of common illness in general practice - particularly childhood infection, cancer, cardiovascular disease and stroke. Primary care has recently developed a new stream of clinical research which seeks to improve the conceptual understanding and effectiveness of early and more reliable diagnosis and monitoring in a number of chronic diseases. The primary aim is that Primary care has an international reputation for developing innovative methods of research synthesis and research use to ensure that research findings change clinical practice.

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