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Family Medicine - Science topic

Explore the latest questions and answers in Family Medicine, and find Family Medicine experts.
Questions related to Family Medicine
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Is there anyone interested in reviewing an article of mine in Cureus ? its about family medicine .If so, please send me your Cureus email
thank you
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It is normal practice that people unrelated to the journal may be invited to review manuscripts. Are you sure the reviewer must have a Cureus email? I myself deal with maxillofacial surgery, so I'm afraid that most topics in family medicine are unfamiliar to me and will not be suitable for a reviewer.
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Family medicine[note 1] is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body.[1][2] The specialist, who is usually a primary care physician, is named a family physician.[note 2] It is often referred to as general practice and a practitioner as a general practitioner
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During the first few years of the 21st century, right after the completion of the human genome sequence, there was a lot of talk (and hype) about "personalized medicine" -- the tailoring of the medical treatment and clinical management of disease to the particular individual suffering the disease. How far have we gone from that point and how close are we from a full-fledged "personalized medicine"?
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This Ayurvedic concept of Predictive, Preventive and Personalized Medicine may be informative:
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world health organization and USDA 
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If you are eating the correct amount of calories and eating your macro-nutrients and micro-nutrients then you will have a healthy diet. But we can always stay away from certain foods, like processed foods, to make our diets even healthier.
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I am seeing so many different titles for nurses in primary care practices who are doing care coordination - which is also defined in a number of different ways. I would love to get some feedback around what people think may be the differences.
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In my PhD, I identified 9 different professions delivering case management. The specific training of each brought an eclectic range of expertise and challenges to the role. However, in nursing poor role definitions and inconsistent use of titles have complicated understanding for the practitioner and the patient. In addition, there may be intra and inter-professional differences in explaining how case management should be delivered and by whom.
The academic and grey literature terms interchangeably including care management, case management, activity, approach and interventions - sometimes, this variation arises within the same article, adding more confusion. Sue Lukersmith’s work has been very helpful but the terminology used still differs within and across various professions adding further misunderstanding between different professional disciplines. EG social workers refer to "care " rather than case management.
Therefore, a sensible approach in defining a case management service should first clarify its purpose and the needs of the people it aims to serve. This will point toward the knowledge and skills needed for the conduct of the role. Have a look at my thesis on : https://eprints.soton.ac.uk/421176/1/Saltrese_A_Final_Thesis_2018_April.pdf
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All tapes that have been used to address the UH have in common that they compress and cover the umbilicus. We suggest that activating skin around the hernia and not covering the hernia at all might be a cost effective and safe alternative. Please check out this Clinical note on the subject. We are looking forward to hearing your questions and comments. Esther and Martyna
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Dear Roy, we are not speaking of devices, we are speaking of using a small piece of elastic tape applied to the skin, no more. It is not inconvienent at all, it is very cost effective and parents learn how to apply themselves. In most cases tape is needed for only 2 -4 weeks and it complements the therapy already being given. Difficult to prove and virtually impossible to research as obtaining permission is not easy especially when treating yojng children. As a clinician not using every possibility to help a child, and doing no harm in the process, is my first priority. So that leaves us in a stale mate position. Am I not suppossed to use a treatment tool until it has been proven effective? Or could I say as a clinicians that hey... this works. It will be up to researchers to look into it further. That is why I have posted this here in the first place. Hope to find someone interested enough to do a pilot.
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In the early years of the development of medical specialization, in 1923, Francis Weld Peabody said that patients got confused and did not know to apply to which branch as a result of specialization in medical disciplines; he emphasized that there should be a specialization branch that would take patients as a whole, but this warning did not attract much attention at that time. Studies on this view have only begun after the Second World War, and the beginning of specialization training of medicine has been in following years. On this issue, "General Health Specialization" had been placed in legal regulation of medicine at 1947 in Turkey and education of assistants began, but this educational process did not succeed. Then, training of specialization in medicine had been added to agenda with the stream of Alma-Ata Conference in 1978 and it took part in legal regulation under the name of “Family Medicine Specialization” with firstly its education and then its practise in Turkey in 1983.
The year 1947 can be considered as a starting year of training of specialization in Primary Health Care for Turkey. When did training of specialization in Primary Health Care start in other countries and especially in your own country?
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Ünlüoğlu İ., Ayrancı Ü., Turkey in Need of Family Medicine, Primary Care, 3: 988-994, 2003.
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Hi. Do we need to ask permission from the related publishers if we want to use tables and figures from journal article or a citation is enough ?
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Since the copyright of an article has to be transferred to the publisher by the author(s) before publication, permission to use a table or a figure has to be requested from the publisher. It must be cited in the legend of the table or figure with reference and "with permission of ...". There is an exception only with public sources, whereby the source must be specified however also exactly.
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I need a good doctor to be a mentor for my graduation research.
My topic is about vitamin D, so I want orthopedic, family medicine or internal medicine physician.
How can I find?
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What is your research about Zahra?
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Is the duration of Residency training of Nigerian doctors adequate, prolonged or inadequate?
Any studies to prove that long duration of training correlate with a higher quality of the resultant specialists ?
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Duration of residency is specialty dependent and varies by the scope of the competencies expected from the specialist after the training. I think the shortest residency duration may be 4 years.
I am not aware of any study that had tested the effect of duration of training on the quality of the trainee; such study promises to be very revealing, if well designed.
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Hello dear researchers!
I congratulate you on this magnificent research project and I confess that I am very interested.
I would like to know if you have had any cases of DHA-PIP failures during this project?
Thank you!
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following
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S-1 seems to be seriously useful against a variety of tumors, & my remote research at Yale, on 5-azaorotic acid (pyrimidine antimetabolite, which he calls "Oxo") was cited in Shirakawa's original paper (misspelling my name  "Grant" in the text, but correctly as "Granat" in the reference).
We had given it IV; he incorporated it as PO, leading to significant diminution of the side-effects of 5-FU.
I think we need that oral drug here in the US, for gastric & pancreatic cancer; & probably for colon, although it's fairly equivalent to Xeloda.
I did not continue in research or oncology, but became a practicing Family Physician, still in Private Practice, but very interested in what has become of my humble research years ago. And I have patients who I believe could benefit from the advantages of S-1.
I would especially like to hear from any of the Japanese original researchers.
Pepi Granat, MD 
Pepi Granat, MD
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Did you mean "non-inferior" above re: S-1 & capecitabine? (your first statement).
PG
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Publicacion en revistas estudiantiles
Publicaciones de estudiantes de medicina en revistas de impacto
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Estimada Angela Dominguez
Muchas gracias, coincido totalmente con lo referido, en la actualidad el fomento a la investigación desde pregrado en Latinoamérica es centro de importancia sin duda alguna y como no eje clave del desarrollo academico científico de un pais. Sin duda alguna importantisimo.
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The effects of Daith ear piercings on migraines was first noticed by chance.
After Dr Thomas Cohn a respected pain physician in the USA noted on his blog in March 2015 that people were reporting improvements in their migraines, increasing numbers of migraine sufferers are having Daith Piercings.
Is anybody studying this effect?
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 I read your discussion with great interest as it touches the underlying mechanisms of the potential effect that Daith piercing may have on migraines. My background is from biomaterials and I confess immediately that I'm a complete novice in migraine and it's treatment. However, I realised that since the interest in using the piercing as a potential treatment or placebo treatment is high among the patients and apparently some doctors now, there is an opportunity to offer my knowhow for use. Daith piercings have a relatively high complication rate due to the difficult area, type of tissue, piercing models used and lack of standardisation of the actual procedure. No one seems to even know in which exact spot should the piercing be placed to be effective.
Our technology has been developed to alleviate the problems soft tissues have around titanium implants. Basically our material is able to achieve a strong bonding between the cell's and tissues and the implant surface. It is already in use in dental implants and there it's function is to speed up the healing and closure of the gingival tissue wound around the implant, thus reducing the risk of bacteria being able to enter the wound. Other effects observed are that no fibrous encapsulation forms around the implant, inflammatory response is reduced and general healing is improved.
I'm interested in starting a project on the daith piercing, because I read from Dr. Blatchley's internet survey results that exactly these type of complications are common also around the piercings. The goals of the project should be such that the potential treatment would be as safe and effective as the current knowhow already allows. Now, I understand that such project would be foolish to run without the expertise of people like yourselves, because without the understanding of the underlying mechanisms, it would have a high potential going wrong. I wish to therefore ask you all what you think of the potential of Daith piercing as a treatment option. In my mind from an implantology point of view it's a fairly straight forward project. But what are your thoughts on the neurological evidence? what are the main objectives and biggest failure pits?
best regards
Ilkka
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this is used in BAC calculations
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We have been doing field research that recruits real-world drinkers from a bar at different BrAc levels (highest thus far was .29). We do administer a drinking questionnaire at the end of the study where we ask participants about drinking habits and other illegal drugs they have been consuming. The biggest problem of course is the social desirability of these answers and the extent to which this episodic recall is accurate at these high levels. 
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My question was derived from the thought of examining levels of metabolization of opioids among chronic pain patients.
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Most welcome!
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Some answers come in a recent webinar where my close colleagues from VRCM* cover this question based on their own experience and that from other groups in the field. This recorded talk is available on-demand at: www.stagowebinars.com
*) F. Dignat-George & R. Lacroix from Vascular Research Center of Marseille (F), see corresponding ResearchGate pages 
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And for those who are not aware of ISEV initiatives::
Spread the Word! 
Let your colleagues know about the Annual ISEV2017 Meeting in Toronto! Reach out to those who are and those who might be interested in exosomes, ectosomes and other extracellular vesicles. ISEV2017 is the only global and comprehensive meeting covering the entire field of extracellular vesicle studies.  With each new member, attendee and presenter the ideas become richer, data more exciting, field more mature and the Society stronger. 
Share on your networks!
 
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is there evidence that using lavender oil via diffusion (personal or ambient) can be contra-indicated in patients medicated with benzodiazepines?
There is a clear effect reported from lavender oil in capsules (ingestion) on GAD. However, can't find literature on lavender used in diffusion - can it increase sedation on patients using benzodiazepines?
Anyone can point me in the right direction?
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Hello Leslie,
I found this:
In the animal studies section they state:
"Lavender inhibited the onset, shortened the duration, and reduced the intensity of seizure attacks [30]. Anticonvulsant effects of lavender together with diminution in spontaneous activity, when combined with other narcotics, have been reported [31, 32]. Inhalation of lavender was also noted to inhibit convulsion induced by pentylenetetrazol, nicotine, or electroshock in mice [33]. Linalool, one of the major components of lavender oil, has been shown to inhibit the convulsion induced by pentylenetetrazol and transcorneal electroshock in different animal models [34, 35], an effect that may induce via a direct interaction with the glutamatergic NMDA subreceptor as well as GABAA receptors [36]. "
Citation 36 (see above) is L. F. Silva Brum, E. Elisabetsky, and D. Souza, “Effects of linalool on [3H] MK801 and [3H] muscimol binding in mouse cortical membranes,” Phytotherapy Research, vol. 15, no. 5, pp. 422–425, 2001
which I found here:
In their abstract, they report "To further clarify the anticonvulsive mechanisms of linalool, we studied the effects of linalool on binding of [3
H]MK801 (NMDA antagonist) and [3H]muscimol (GABAA agonist) to mouse cortical membranes. Linalool showed a dose dependent non-competitive inhibition of [3
H]MK801 binding (IC50 = 2.97 mM) but no effect on [3H]muscimol binding."
So one source notes that lavender has no effect on the GABA A receptor, which is where benzodiazapines work.  Inhibition of the excitatory NMDA receptor, in the presence of high doses of benzodiazapines may show a synergistic effect, but I believe this would be a very long reach.
Were I to study the effects of Lavender and sedation I'd begin by excluding patients chronically using benzodiazapines.  
Hope this helps
Rich
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Gillespie,S.and Pearson,R.(2001).Giardia lamblia in principles and practice of clinical parasitology 10th ed.Engeland.
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I work on haemophilia and thrombosis so the acronyms of another subspeciality can be mysterious or worse - misleading. I am interested in Thalassaemia as well as haemophilia because in many LDCs (Less Developed Countries) the doctors and centres that care for haemophiliacs also treat thalassaemia. Ideally I would like to meet with a member of your team and find out what you are doing and whether you are open to collaboration with a centre in an LDC.
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Robert is right. In the pharmacokinetics/pharmacodynamics context of drug metabolism, ADME refers to Absorption, Distribution, Metabolism and Excretion/Elimination.
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I don´t undertand why they create campaigns, protocols, investigations and resources for battered women when the battered man, nowadays, is a minor problematics but continues being a problematics in our society.
¿Por qué se tiene más en cuenta la violencia de género hacia la mujer que hacia el hombre¿
No entiendo por qué solo se crean campañas, protocolos, investigaciones y recursos para mujeres maltratadas cuando el hombre maltratado, actualmente, es una problemática menor pero sigue siendo una problemática en nuestra sociedad.
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Social expectation is that men will react violently to violence or threats against them, and there exists to a degree social shame or humiliation when men reach out for help instead of solving their own problems of this nature. Previous generations' expectations are the standards to which the current generation of men are being held to, and not every man today is comfortable or able due to social conditioning and shaming of historical male tendencies. Raising a generation of men to standards which do not match the standards by which they are being judged is understandably going to lead to some cognitive dissonance when instead of fighting back men of this generation reach out for help. Monica is absolutely correct that the majority of social violence today is against women, and for that I intend to make sure my daughter knows how to fight back,  use pepper spray when she is old enough, and a pistol when she is old enough to carry concealed. For my part, I refuse to raise a damsel in distress, just as I would refuse to raise a son who was a victim. I don't see this as an identity politics issue, I see this as a generational issue; the World War II generation would kick or shoot an attacker where the sun doesn't shine, but today's young men in the United States and possibly elsewhere are taught to wait for someone else to rescue them from their victimhood so they can gain access to recovery tools/social services. Suppression of male tendencies it the name of political correctness disables self-defense as well. Education should focus on the proper use of abilities for self defense and the defense of others, instead of training any combat abilities at all out of men. Isshin-Ryu karate has as one of it's core principles that the skills taught are to be used for self defense, never for attack; when I was six years old, my single mother put me into classes at the local dojo to learn how to stick up for myself because my father was not around, and I remain grateful for that to this day. If the United States would adopt the principle of mandatory self-defense training such as Japan does, perhaps the domestic violence rates would look like Japan's. An example of an outstanding effort by an organization working to provide self-defense training among marginalized men and women to give them the tools to free themselves from victimization in a way that does not make them dependent on anyone is the Pink Pistols. True freedom is fundamentally incompatible with any kind of dependence, be that economic, safety, or social, and that organization is doing amazing work to free a minority group from fear of violence, especially in the wake of the Orlando shooting. Domestic violence is not something anyone should ever have to deal with, and it is time people rediscover how to fight back before it is too late and someone else becomes a victim.
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I ask for  Arabic Version of Roe Anginal questionnaire
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We are in our country Saudi Arabia translate the English Questionnaire to Arabic, then 2 or 3 consultants in the same specialty review it, then the Arabic version translated again to English by neutral person ( prefer official translation office ) to ensure exact translation.       
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As pharmacist, are your patients actively participating in designing their own drug therapy? 
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It is a good question.
This relationship was well discussed in a report "Concordance, adherence and compliance in medicine taking" done for the National Co-ordinating
Centre for NHS Service Delivery and Organisation R & D (NCCSDO). According to this report:
Compliance is defined as: ‘The extent to which the patient’s behaviour matches the prescriber’s recommendations.’ However, its use is declining as it implies lack of patient involvement.
Adherence is defined as: "The extent to which the patient’s behaviour matches agreed recommendations from the prescriber.’ It has been adopted by many as an alternative to compliance, in an attempt to emphasise that the patient is free to decide whether to adhere to the doctor’s recommendations and that failure to do so should not be a reason to blame the patient. Adherence develops the definition of compliance by emphasising the need for agreement.
Concordance is a relatively recent term, predominantly used in the United Kingdom (UK). Its definition has changed over time from one which focused on the consultation process, in which doctor and patient agree therapeutic decisions that incorporate their respective views, to a wider concept which stretches from prescribing communication to patient support in medicine taking. Concordance is sometimes used, incorrectly, as a synonym for adherence.
This was more clarified in following article: 
Which says: 
Concordance is fundamentally different from either compliance or adherence in two important areas: it focuses on the consultation process rather than on a specific patient behaviour, and it has an underlying ethos of a shared approach to decision-making rather than paternalism. Concordance refers to a consultation process between a health care professional and a patient.
Compliance refers to a specific patient behaviour: did the patient take the medicine in accordance with the wishes of the health care professional? For this reason it is possible to have a non-compliant (or non-adherent) patient. It is not possible to have a non-concordant patient. Only a consultation or a discussion between the two parties concerned can be non-concordant.
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Nailfold videocapillaroscopy is a useful tool to distinguish primary vs secondary Raynaud's phaenomenon. Please share your experience.
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Dear Colleague,
In our department we routinely perform NVC in every patient with Raynaud’s phenomenon. However, differentiation between primary and secondary Raynaud’s is only the most basic indication.
 NVC is essential in both initial diagnosis and follow-up of systemic sclerosis patients. The extent of observed microangiopathy (defined as early, active or late scleroderma patterns) reflects overall severity of the disease and internal organ involvement. For example capillary loss and presence of avascular areas is associated with interstitial lung disease and poor prognosis. There are also several methods of calculating risk of new digital ulcerations, e.g. CSURI (capillaroscopic skin ulcer risk index), which takes into consideration number and size of giant capillaries.
NVC is also included in current classification criteria of systemic sclerosis (EULAR/ACR 2013).
In dermatomyositis and anitsynthetase syndrome NVC is useful in monitoring treatment response, since normalization of capillary pattern can be observed as early as 3 months after initial therapy.
 In mixed connective tissue disease and undifferentiated connective tissue disease capillaroscopic scleroderma pattern is associated with symptoms of systemic sclerosis.
Patients with connective tissue diseases overlapping with systemic sclerosis  also have typical capillary pathologies.
 For more than a decade prof. Maurizio Cutolo performed extensive, evidence-based research on microvascular damage in systemic sclerosis. You can easily find his numerous publications, for example:
Finally, while it is possible to observe capillaries even with simple magnifying glass, state-of-the-art NVC should be performed using specialist equipment, with software designed to perform quantitative analysis. In Europe such capillaroscopes are available for about 800-900 euros.
Best regards
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He has hypothyroidism, diabetes, and hypertension. Last summer he was admitted to the ICU for severe hyponatremia (after a 4 day period of febrile illness). Several investigations we done, no specific cause was found (no infection, no malignancies and no adrenal insufficiency). It was decided it was caused by malnutrition and colonic irrigation that was done 4 days in a row.
This summer he has been complaining of fatigue for 4 days associated with worsened back pain. Routine investigations were done, including electrolytes. His Na is 132 mEq/L. 
The patient complains frequently that he feels cold. He is always overdressed. The past few days have been extremely hot, temperatures ranged between (33-36C). According to his family he has been overdressed, and covers himself with heavy blankets. The bed and blankets are wet with sweat. He almost drinks 2.5L of water daily.
*40 days ago his Na level was 134 mEq/L, his water intake was restricted and his Na levels became within normal range within a few days.
*His antihypertensive medication has no diuretic. He has a sessile colonic polyp discovered almost a year ago.
Could his hyponatremia possibly be caused by excessive sweating and high water intake? (Mimicking Exercise-Associated hyponatremia in athletes).
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Urine sodium in this patient is ~ 50 mMol/L. In presence of hyponatremia a urine Na of > 20 mMol/L is suggestive of relative excess of volume due to Inappropriate secretion of Antidiuretic hormone or Hypothyroidism, or Glucolorticoid deficiency or Stress.
In this patient hypothyroidism is already present. Stress also may be a factor. SIADH can't be ruled out at the moment.
If it is purely due of sweating (extrarenal losses) Urine Na should be < 20 mMol/L.
Water restriction to < 1 liter per day should correct hyponatremia in this patient. Also, correction of hypothyroidism will be needed.
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I am preparing a review of the subject and need information.
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I think, in England, the role of the nurse midwife in the community in conjunction with community  nursing  was/is one of the first primary care including family nursing programs and practice which, in my view, preceded any contemporary primary care.today.  Ontario, Canada had an active family/primary care nursing program at McMaster University in the 1970s. The role is resurrecting again. with a focus on multidisciplinary health care team approaches.   
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Our department, Family Medicine at the College of Human Medicine, at Michigan State University is wondering if you provide any kind of a global ranking information and if there's a way for us to collect that data and be able to compare across other departments of Family Medicine?
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Dear Thomas,
Thank you so much for taking the time to share this.  I have shared it with the powers to be at my institution to see if they would be interested in pursuing this process.  I really appreciate you input!.
Deb
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I am most interested in the intersections between family medicine doctors-in-training and aging patients living with dementia.
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Francine, thanks so much for your response.  I am very familiar with Peter's work -- and in fact just had the pleasure of bringing him to the Philadelphia area to give the keynote address at a symposium on dementia and the arts that I organized in early November.  His work at The Intergenerational School is of great interest to us, though a bit removed from the notion of med students learning from elders with dementia.
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I would like to analize which is the answers rate of GP\FM on web-based survey that they received.
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@leonardoFerreiraFontenelle I runned a web-based survey in a GP population and I would like to compare my experience with others like that. Of course the survey that I used it is different then others but I would like to looking for some data about this issues. Thank you for your suggestion
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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?
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There is some evidence from clinical trials for Gingko biloba as well as for Oenethera biennis (Evening primrose oil)
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I am conducting a systematic review of intervention studies and am interested in finding all relevant publications. If you would like more information, the review protocol is registered on Prospero:
I can be contacted via this ResearchGate portal 
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Dear Ibrahim,
Thank you for spending the time to respond to my question - it adds to the completeness of the review.
Kind regards,
Liza
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A local health service has recently introduced a, add on service to assist GPs in offering better service to people with chronic mental illness, after four years, there is need to determine whether that service is having desired outcomes.
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And thank you Sheila, I will look at Alastair's paper. Much appreciated.
Interesting take on this, Ariel's suggestion above was to consider an objective measure, my initial take was Clinician's self-report (not so objective) and your suggestion adds in the consumer preference.
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Looking for a model/theory/framework/ classic paper or systematic review that provides an overview on what factors influence a patient's decisions, in general and specific to treatment decisions?
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Chris, we are writing up a proposal and we were looking at different factors that influence patient's decisions as one factor: it seems as if most people keep directing to 'shared decision making' ideas however there must be other factors that influence a patient's decision. I am surprised that there is no overarching model or review on different factors ranging from socio-economic to shared-decision making to motivation....
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We are looking at predicting adherence to medical and behavioral health care recommendations among individuals with metabolic syndrome. I'm curious if anyone might be able to provide personal insight into specific indicators (behavioral or otherwise) that have been effective/reliable in quantifying the construct of treatment adherence?
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Successful management requires identification and addressing both root cause, barrier. Patient vary considerably in their readiness and capacity. Success can be defied as better quality of life. greater self esteem. higher energy level etc. There is an approach for obesity management from Canadian obesity network: www.obesitynetwork.ca
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n-3 fatty acids have a well known effect on hypertriglyceridemia in humans.  The effect is a dramatic decrease in plasma triglycerides in hypertriglyceridemic patients treated with a weekly dose of 3,6g of n-3 fatty acids. I would like to know the mechanism of this  effect on VLDL, as a precursor of the Intermediate density lipoproteins structure. And the oxidability  of both lipoproteins,the  post treatment - VLDL depleted of triglycerides, and  its remnant Intermediate density lipoproteins.
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Many European studies differ completely with outcomes compared to USA studies. In essence, the difference of source creates the issue.
Most USA studies are more often survey or supplement studies, while most EU studies are whole food studies.
are slanted towards pharmaceutical agenda rather than actual human cell biology.
VLDL and like triglycerides, are more often utilized as conversion compounds in hormonal synthesis pathways along the ergocalciferal path.
So without knowing what your end target of the research; it is hard to just finalize "a" oxidation or reduction pathway when there are a few.
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Borderline Personality Disorder is not a diagnostic label usually used by primary care physicians in Spain. I'm not sure if this is a shortcoming or appropriate. Will more knowledge and use of the label BPD lead to better clinical management of BPD patients in primary care?
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I think Jose Nunes makes very good point.
I find it hard to believe that doctors/psychiatrists make this diagnosis (of course with care) to insult the patient (as some colleagues have suggested) and cause them harm)
I can share with colleagues the relief numerous patients of mine have expressed when this diagnostic possibility is carefully and sensitively discussed (making sure the patient does not feel guilty and having positive approach).
Indeed, we need to have some understanding of what we are communicating about (the patient and the doctor) and using a diagnostic label usually helps.
As for the prejudice and stigma, to conquer this, we need to work on our own minds and on the minds of fellow members of society.
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Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. When health providers disagree with their patients, colleagues, or regulatory professional bodies about the suitability of specific types of care, there are conflicting views on whether such health providers should be forced to violate their conscience, or punished if they refuse to do so.
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The general ethical and legal consensus in the U.S.A. is that it depends on two things. First, it depends on the seriousness of the action that a practitioner believes immoral. More serious actions, such as physician assisted suicide, are ones where we tend to allows practitioners to refuse to participate. Second, it depends on the broader costs of allowing practitioners to refuse to participate. For example, in cases such as pharmacists refusing to fill prescriptions for birth control or the morning after pill, there are more significant concerns about the costs of allowing such refusals (particularly in rural areas). So we tend to not allow refusals to participate when broader costs become higher.
It's hard to be much more specific, and certainly the laws in the U.S.A. have significant variation amongst states and vary based on the particular issue.
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The epistemological and irrefutable change of the paradigm in Medicine and medical science and the new interactionist and teleonomic concept of health, changed the scenario of medical education, clinical practice and health governance. In our University formally from 1998, but not formally before, we introduced rigorous quality procedures for educating physicians and clinical teachers to Person Centered medicine which changes clinical method integrating the old one, which is, in a wrong way, problem centered on only biological variables: to date a great epistemological error. We launched also a PCM International Academy, and a program for spreading our procedures which resulted reliable and valid and for preparing PhD and clinical teachers.
At the same time researchers in medical education, are in trouble because they are linked to obsolete clinical assessment methods If they are not physicians make a great difficulty to understand new methodological languages. To date Medicine is risking developing its teaching and practice methods on obsolete physiological concepts, thanks to a spread epistemological ignorance of basic science teachers - eg they don't know the Allostasis revolution in physiology which is not known by almost all physicians and clinical teachers or the Relativity theory of biological reaction, fundament of PCM- confirming to date a wrong deterministic and mechanic approach to medical science and human nature that make far humans by their true nature, reinforcing a wrong and amoral dominant only bio-technological paradigm-well seen by the stock market- and the imperialist ingenuous empirical, superficial, pseudo epistemological approach called "evidence based medicine".
Like is happened in physics at beginning of the last century, with the birth of quantum physics, our experience depicts the necessity of a power operation, because physicians, who could receive from the adoption of Person centered clinical method, great benefits, as we showed, In difficult way accept innovations and the drug stock market has no interest to promote a change, which gives to persons more autonomy and less necessity of medicines. But the transition to Person centered Medicine is an obliged way if we want build medicine on the truth and not on pragmatic or amatorial trials of beginners in Person centered Medicine, or , its new plagiaristic superficial surrogates like " Personalized medicine", or " Skil person medicine" and on folk and ignorant people who want reduce Person Centered Medicine to a “non Conventional medicine”, like acupuncture, with approaches plagiarized from Internet !
We need people, for orienting to PCM Health Governance" and Medical Education, research and teaching PCM all over the world-,to date pioneers yet- humble for learning, brave for research, with a psycho-affective maturity and linked to the Hippocratic oath, for teaching basic sciences , clinics and research oriented to this epochal change of the human nature epistemology and to intoduce in their work and life the new concepts of Person Centered Medicine and Health not pseudo-health merchants and/or promoters of pseudo-truth adaptative conceptions of human nature , sold to the best power which has money and roles, surrogates of humanity.
Is it ignorance,"ignavia" or will of evil ?
Essential References
Brera G:R The Manifesto of Person Centered Medicine Medicine, Mind and Adolescence. 1999.XIV,1-2 :7-11 on line www.unambro.it
Brera G.R. Brera G.R. La medicina centrata sulla persona e la formazione dei medici nel terzo millennio. Con l’introduzione di Iosef Seifert : I sette scopi della medicina
"Person Centered Medicine and Medical Education in third Millennium with the introduction of Iosef Seifert . The seven aims of Medicine it.) Pisa:IEPI-Università Ambrosiana; 2001
Brera G.R. Epistemology and medical science: change of the paradigm. in G.R. Brera-Claudio Violato Ed . Proceedings from the Conference:”Return to Hippocrates: Quality and Quantity in Medical Education:Milano : Università Ambrosiana : 2005
Brera.G.R. Person Centered Medicine:theory, teaching research. International Journal of Person Centered. Medicine. ;1:69-79
History of Person Centered Medicine http://www.unambro.it/html/pdf/PCM_History.pdf
Brera GR Perspectives of Person Centered Medicine teaching in Italy -“Person Centered Medicine and Medical Education.” May 4 2011 (invited presentation in WHO)
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Answer to Dr. Mergen's letter
Limits of the Engesl's bio-psychosocial model
The Hengel's bio-psychosocial model is an interactionist model, based on an adaptative conception od health as " The organism ability to adapt or dominate a stress finalized to mantain a balance" (1) inspired to the system theory. It differs from Person Centered Medicine because it is deterministic . it is oriented to Cannon's overcame physiology paradigm :" Stability to constancy" ., but human beings are not adaptative "systems","organisms" but they are persons builders of a true or false reality about the inner and the outer world, giving to experience a meaning to which they are naturally called. It means that any knowledge, feeling or act have a meaning independently from the subject's awareness. Persons change their adaptation models. depending on the meaning interpretation quality and this is linked the biological variables behavior through neuromediators nad hormones whiche sends signals for the genes expressions, The right concept is the "Stability to change". (Peter Sterling, Allostasis paradigm that you show to don't know as many. teachers of basic science teachers or physicians. The quest for a meaning means that our life is trascendent and that there is a natural teleonomy, that Kairology assessed toward truth,love and beauty. The quality of the existential choices, also to be a physician, determine the being's quality and the person's existence and profession, acting as a risk or protective factor for physician and patient's health. Existence and science are related,
This fact allows to give a meaning to disease and suffering not only in reserching the true causes of a clinical picture, but as an existential event that can open to existence unforeseeable possibilities.
This interpretation allows to physicians and patients to become protagonists of an event, their meeting, that can not be reduced to a bio-psychosocial system but is more higher than their same existence., which calls for a sense and is meaningful. The interpretation quality of the event allows to both to become "Human beings", real persons or surrogates that adapt themseleves only to abstract theories, shared habits, or biotech protocols or suggestions.
Person Centered Medicine is interactionist and teleonomic, and put at first place spirituality, (the quest for a meaning) not as an option but as a necessity for a right interpretation of person's quality of life, determinant for health.
It means tge necessity to ask to ourselves: who is this person, how this person interprets his event ? It corresponds to the same question that a physician must pose to himself, in order to avoid to become only a bio-technician of life or death. To date a spread fashion.
Physicians must be trained to this interpretation work and to live their profession as an existential mission, an answer given to the fundamental question of existence. This intention works for their fulfillement and health,
Please read with more attention the Manifesto of Person Centered Medicine.
Prof. Giuseppe R.Brera
Published on Research Gate
Milan, 20 January 2014
International Program in PCM
(1) J.Romano in J.Am.Med Ass. ,143 1950 This definition has been adopted by Hengel
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We are planning to conduct a psycho-oncology trial including the topics end-of-life care and beraevement care.
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Dear Volker Beierlein,
Thank you for your quick response. You are completely rigth with your speculation about my screening intention and your note about sensitivity. I am looking forward to read you paper.
Best regards (also from Jochen Ernst)
Gregor
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Dear Rodrigo
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Overdiagnosis is a side effect of testing for early forms of disease which may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. A typical example is a back pain.
Back pain is the largest cause of disability in the United States for working-age consumers and the second largest cause of physician office visits. The general category of low back pain is a complex mishmash of various conditions that produce pain in the back and/or radiating into the legs. When a patient presents at a primary care office with a new complaint of pure back pain, the prognosis for a quick recovery is good. The primary indicators of potential chronicity causing extended disability are psychosocial rather than physical signs. These low-risk patients are easily identified in a brief physician visit.
Clinicians who consult with these patients have an obligation to educate and support patients without increasing their concerns. Although additional diagnostic tests such as MRI appear to be harmless, in fact the discussion of normal aging signs often raises concerns rather than reassures patients. Any discussion of back injury with these patients is inappropriate because in most cases, back pain cannot be attributed to a specific event, but is more likely a hereditary factor.
If the patient prognosis can be modified by the physician for better or worse, what should they say to alleviate concerns without appearing to minimize the patient’s complaint?
Its necessary present to the patient the scientific evidence that back pain often has a favorable prognosis without diagnostic tests or therapy. Discuss with back pain patients that they can maximize their chances of quick, recovery. With these measures the cost decreases in attendance this pathology overdiagnosed.
Our biggest problem is that we don't have enough time to explain all this to patient
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Australia is introducing a purpose built screening tool for former members of the Australian Defence Force from July 2014, with a focus on mental health as well as health risks related to specific deployments. My question is about the most successful approach to health screening for younger veterans in primary care/family medicine, e.g. self-report versus face-to-face interview; gender and profession of the interviewer. Insights from research and practice would be appreciated. Thanks in advance.
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Veterans are a system savvy group, and understand the structure of healthcare that can start from a questionnaire. As a result we have found that in person questioning, with directed questions based on the veterans age and experiences, was the best way to go. Here is a link to a recent journal I edited on the topic of military health issues: http://issuu.com/medchi/docs/mmvol13issue3 hope it is helpful.
Tyler
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I have found the FDA guidelines for labeling supplements. There are many supplements that are metabolized along the CYP450 pathway and, thus, interact with medications. I believe that a warning should be added to the label indicating the potential for drug interactions.
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Thank you. The article is very helpful. It helped clarify for me the function of each regulatory body.
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I am very eager to know the exact meaning of the medical practice and its limitations. These days many of the new therapeutic interventions and branches has been evolved with the same name of medical practice. But the lacunae in the clinical practitioners are providing plenty of opportunities to the evolution of many new fields and these all say the same word of practice which are not relevant to the work they do. Does the medical practitioners had any limitations and what can be the ideal qualities of a medical practitioner.
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This is an interesting topic and has regulatory inplications. I would take the simple view that anything that can promote health can be considered within the scope of medical practice, directly or indirectly.
As to the limits, any thing relevant that is evidence based or falls within an ethical trial whould be valid medical practice.
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