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General Practice - Science topic

Acute and chronic illnesses, preventive care and health education for all ages and all sexes
Questions related to General Practice
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During this time of intense pressure on general practices and local hospitals, could practitioner assistants (equivalent to F1 doctor qualification) and/or practice nurses be employed to contribute to the pharmacy environment with personal, social and therapeutic health management, including being qualified to prescribe some medications and thus be able to support pharmacists and to relieve some of the footfall in General Practices and Emergency Departments of their heavy workload?
The main hurdle to overcome would involve providing financial support to the chemist shops to enable this kind of employment. Also to consider would be the change in culture within the medical professions would be a paradigm shift in the inter professional roles that professionals play in the healthcare environment.
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Interesting question. Before I retired, I was a nurse practitioner (actually, advanced practitioner, but that was not a title that informed people very much about what I did) for bladder and bowel health.: (https://www.nhsemployers.org/articles/advanced-practice-and-enhanced-practice)
I used to carry out assessment and treatment, often after general practitioner (GP) referral, and would be involved in assessment and treatments that GPs felt that I would be more able to carry out than they (as generalists) could.
At the moment - probably owing to the legacy of COVID-19 - the local practices where I live seem to be very busy and use locums quite a lot.
So, I feel that to increase the clinical care available from pharmacies would be a very positive step. At the moment, practice nurses and pharmacists within the GP practices take on a lot more responsibility than they used to be given, including prescribing. And in the chemist shops, pharmacists now carry out vaccination.
I am not sure about the monetary perspective; would the NHS be able to employ these practitioners? I really don't know how this would work out or be allowed. There would also be the aspect of who were the nurses - for example - be managed. There would be the need for clinical supervision and support in the way that we had a (marvellous) manager, who was at one grade higher than we were, who we looked up to (in more ways than one). And she, likewise, had a manager and so it went up.
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As our general practice in the rice field show increase in yield, and more vegetative growth, what are the constraints and prospects for its wide application and adaptation in rice, horticultural crops, and many more?
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Yes, integrated application of manures and chemical fertilizers is a must for improving soil nutrient status and nutrient use efficiency and ultimately enhances nutritional security under a rice-wheat system.
Also check,
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During COVID_19 Why antibiotic prescriptive rates are higher in remote consultations than during in person appointments .
Antibiotics ,Prescription,Remote consultations, COVID_19,
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The use of antibiotics during consultation in the remote area is higher during the pandemic because many appointment visits to the hospital for minor ailments are canceled by both patients and the Physician for two main reasons:
The patients are afraid of engaging themselves in high risk zone for covid -19, so they choose online consultation above the physical, which of course will not provide enough means for proper examination and investigation to arrive at a more appropriate diagnosis or discover associated illnesses. For the Clinician to provide a seemingly satisfactory service, he prescribes antibiotics a lot among other drugs.
Also, on the Physician's part, they advise that patients with chronic diseases which are however stable, should reduce their hospital visits especially if the main aim is for drug refill and medical checkups. This is to enhance the provision of more attention to emergencies, which the pandemic constitutes significantly. Virtual consultation is however encourage for common infections with the prescription of medications , e.g., antibiotics , which often time might not be needed if proper examination is carried out. Needless to say, this misuse is one of the main reasons why antibiotics resistance is growing day by day in our clinical practice.
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Dentistry being the one of the high risk profession for the COVID 19 outbreak transmission. For now we are in the lockdown period and only providing the Emergency dental treatment services with proper PPE. I would like to know the opinion regarding the Dental Practice after lockdown. Can we start our practice in normal way ? Do we need to modify the way how we do our routine dental practice?
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1. Have patience
2. Conduct emergency treatment till countries have some control over pandemic
3. Follow WHO guidelines for infection control and community spread
4. For all patients to undergo an aerosol related procedure, conduct Covid test one week before procedure.
5. PPE , hand hygiene and other infection control - should be efficient
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I'm looking for a recommendation of a journal with a high word count (above 6,000 words) related to any of the following topics: public health, general practice, primary care, older adults, medications.
Thanks for your advice!
Kristie
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If I understand correctly you are looking for a Journal that deals with public health or in any case with similar topics and general medicine and health management for the elderly. If you are interested I am on the editorial board of the Journal of Public Health International (JPHI) of which I send you the link: https://openaccesspub.org/journal/jphi
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Dear Research Gate community,
I am currently attempting to install a formyl group using the Vilsmer-Haak reaction on a 2,4- substituted thiophene.
The reaction was adapted from a reference, using dry DMF and glassware. I followed the reaction by TLC and LCMS, but did not see any change after 6 h. I am currently working up the reaction. However, I am not confident in the reaction.
I did not notice any fuming of the phosphorous oxychloride upon opening the bottle. Is it general practice to distill POCl3 before use?
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Like Grant Simpson pointed out, if substituents (or one of them) is electron withdrawing the reaction will be difficult to achieve.
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Are there any fields known for having an only narrow (and hence not significant) science-practice gap? Management, for instance, has been identified as a field with a rather significant gap (Banks et al, 2016) and I would be interested in counterexamples. My first guess is that in medicine, finance, marketing, or engineering, practitioners at least sometimes enthusiastically implement academic findings. I would grateful to hear about any studies in these regards.
Thanks and cheers
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Geochemistry
Best Regards Valentin Ade
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I expect that the question of discharge and recovery may be a contentious issue. Hopefully, the description and supplementary questions below will promote a good debate. Thank You. We all know and accept that mental health is an important part of everyone's life. We can be affected by mental health as individuals or the experience of close family and friends, peers and neighbours. At times the mental health services are involved. It appears that the medical model’s dominance and socio-political discourse, legislation and national policy [in the UK] means that once a patient always a patient is the common school of thought. Once in services it seems that discharge is ubiquitous and quixotic. It is rarely discussed or researched especially from a service user’s perspective. Once you are in the grip of services there is no way out. This may include general practice. You see your family doctor for psoriasis and the questions are focused to your mental state. Recovery is not discharge nor discharge recovery! Recovery orientation has been a part of policy [in the UK] over the past 10 years since the publication of Making Recovery a Reality. Recovery, arguably, isn’t a new model or approach, challenges the dominance of the medical model, and, the paternalistic state, and, Recovery suggests a life beyond the walls of the asylum, and life outside community services. Recovery, arguably, while debated as to a definition [personal, clinical, social, and more recently service defined recovery] personal recovery is accepted as the foundation. The supplementary questions may open up the debate and include:
• What are the barriers and influencers?
• What factors can promote or make discharge possible?
• Does recovery orientation promote discharge?
• Is the ‘danger’ recovery is an ‘excuse’ for discharge?
• Do recovery values and principles underpin change?
• Can recovery promote symbiosis at the heart of a collaborative interdependence between service providers, service providers and service users bring them together? [For example, working in partnership with social care?
Thank You
Andrew
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Hi Beatrice. Thank You.
Discharge, even defining discharge, is a complex issue of which stigma is a influential factor. If we consider Recovery and the impact of stigma the results of the studies seem show that the out of sight out of mind and not in my back yard are still an issue.
It seems that the results are positive and there has been a shift in attitudes in Sweden. Have Sweden engaged in public campaigns to inform the public about mental illness? In the UK we have the Time to Change Campaign that has resulted in a small positive change in attitudes. Although, the campaign has received criticism. It seems that Prejudice and Stigma are still live and well. Unconscious Bias or Prejudice are very influential. The studies you shared seem to support that attitudes have changed over time. They also seem to reflect the early work on stigma by Bruce Link, Patrick Corrigan and others especially the themes highlighted ‘Intention to Interact, Open-minded and Pro-Integration , Fearful and Avoidant , Community Mental Health Ideology’. These themes/factors are interesting. Are they taken from a Recovery Orientation? Are the campaigns co-produced?
The impact of stigma is a distinct issue and may have a direct or indirect impact. For example, the influence of the media and public perception of violence. It's interesting that the dynamics of stigma vary across age, gender and, even, marital status. Its seems the earlier works by Link, Corrigan etc, remain evident. For example, Corrgan and Penn (1999) (a) attempts to suppress stereotypes through protest can result in a rebound effect; (b) education programs may be limited because many stereotypes are resilient to change; and (c) contact is enhanced by a variety of factors, including equal status, cooperative interaction, and institutional support.
What do and others people think?
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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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The Critical Incident Technique (or CIT) is a set of procedures used for collecting direct observations of human behavior that have critical significance and meet methodically defined criteria. These observations are then kept track of as incidents, which are then used to solve practical problems and develop broad psychological principles. A critical incident can be described as one that makes a contribution—either positively or negatively—to an activity or phenomenon. Critical incidents can be gathered in various ways, but typically respondents are asked to tell a story about an experience they have had.
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On a mundane and national level, I think you may have a problem with this definition of critical incident in any UK based research, as our national health service has adopted this term to describe any adverse event that affects patient care. Following the identification of a critical incident/event we use an investigatory approach similar to systems analysis to identify areas for procedural or clinical team improvements.
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Hello, I want to use the Job related affective well being scale from 1999, Paul T. Van Katwyk, Suzy Fox, Paul E. Spector, and E. Kevin Kelloway, http://shell.cas.usf.edu/~pspector/scales/jawspage.html for my master Thesis. I Need a german Version of it. On the page is the german Version from a master Thesis. Is it okay to use this items? Or am i just allowed to translate englisch items to german to use them for my work?
Kind Regards
Kim
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Make sure you get an independent "back translation" into English to make sure that the content does indeed match the original.
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What is the chemical composition to be considered for Consequence modeling for heavier hydrocarbons like crude oil/Vacuum residue/Vaccum gas oil/Diesel,, etc.?
What is the general practice and referance guidelines?
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side_chain polyners with microfibrile protrusions....... i am morking on them along with Dr Koohgard.............
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Hello People!
I have a question regarding how researchers use the matrices from the sparse matrix marketplace(https://sparse.tamu.edu/) for solving linear systems of equations.
So given that we have to solve for x in : Ax = b
The matrices from the market are the A for the above equation. But what about the vector b? How do we decide on that? Do we just pre-select some random vector x and multiply A with it to give us the vector b, and use that vector b to recalculate x using some method (that's the focus of the researcher)? Or is it something else.
I've come across some papers where people mention the name of the matrices taken for testing and their initial guess vector x0. But I am confused as to how to they select a vector b? Is there a general practice? Or does it depend from author to author
There must be something I am missing, might be very silly, so I apologize in advance!
Some Papers for reference and example (with page numbers) :
Page 6-7 of:
Page 848 -849 of :
Thanks !
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In "Incomplete Cholesky factorizations with limited memory" (Lin, More, paragraph above formula (4.1)), it is said: "the vector b is the vector of all ones". Or you can look at https://github.com/vakho10/Sparse-Storage-Formats
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Masculin patient weighs 75 kg, with third nerve palsy after neuroendocrim surgical.
He wants fix the palsy if is posible.
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The first 18 months are the golden time for a damaged nerve to grow. I treated two Bell's palsy patients by acupuncture only. One had 3 years history, and one had far more than that I forget it's eight years? They all got big improvement and could eat, drink without dripping.
Post surgery improvement is also can be validated. There was a research report that I read before.
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Dear Experts,
I want to explore if whether a patient was given a medication or not varies depending on their individual characteristics (level 1) and those of their general practice (level 2). Level 1 covariates will be for e.g. education and age while level 2 covaraites will be practice size and urban/rural location.
I anticipate that medication use will vary depending on whether it was a nurse or GP who prescribed the medication. Ideally, I would include the GPs and Nurses as level 2 nested under their practice at level 3. However, the data I am allowed to access does not include individual prescriber id's. Instead, I will just know it was a GP or Nurse who prescribed the medication. With this limited data I cannot include the GP/Nurse prescriber as a level as GP and Nurse are the only 2 options for prescribers (not a random selection of all the possible prescribers.)
Is there any way for me to include the Nurse/GP prescriber information in my model? For each practice there will be Nurses and GPs prescribing medicatons.
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Use a dummy as a fixed effect for the gp/ nurse variable is the best that you can do.
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abcdefghijk abcdefghijk abcdefghijk
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The short answer is: you don't have to vent the instrument. However, some models will not let you put the machine in Operate mode if your nitrogen pressure is low (as in the Waters Synapt). Above comments are right: you should provide your manufacturer and model. What's wrong, by the way, with connecting a nitrogen tank temporarily, until your main supply is repaired?
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I have adapted a survey from another author (with permission), to ask about different methods that nurses use to obtain prescriptions in general practice and the frequency that they use them in different clinical circumstances.  I have already got all my 71 responses back.  I have tried to use cronbach's alpha on it but get a low score or am informed by SPSS that it couldn't perform it at all due to a negative covariance between items.  I have a sneaking suspicion that as my survey has no sets of questions which measure similar things, or at least not in big enough numbers, that I can't perform a reliability analysis on it.  Any suggestions on what I can do?
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Dear Jennifer
Reading your question shows that you are collecting data about facts rather than attitudes/opinions, i.e. a respondents are asked to determine their transportation methods rather than if they were comfortable.  If that is the case, therefore, you are not collecting data about items measuring the same concept, rather than facts like gender, which do not need reliability analysis.
Good luck with your research
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I want to know about the general practice of the reservoir engineering for Shale oil exploitation.
What is the basic industrial practice for the categorization of Shale Oil reserves ?
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Dear Mr. Audhkhasi,
                                    All I can tell you from our String Theoretic Econophysics analysis of mining reservoir engineering and management which we have tested on Jharkhand Coal Blocks in India but have chiral symmetry properties because of AGNNetwork Internetworked Physics we have developed , please see our publications on www.researchgate.net/Soumitra K. Mallick in collaboration with Mallick, Hamburger, Mallick (2016), and also E. Tjaland of NTNU, that the "Fracking potential" and thereby the Shale Oil Stock and Flow Quantum Mechanical Geophysics properties have been derived by discovering the Dbranes potential Riemmanised in terms of quantum mechanics in Hilbert Spaces (simple Strings) and using our developed MHM Dbranes String Functor Algebra Calculus (Millenium Prize Mini) we have derived the till Stock Exchange Functor Flows. This implies that in terms of complexity Algebra Calculus separate corporate and factory architectures need to be developed to implement the expanded Econophysical Efficiency properties by means of stock exchanges and networked mining solutions for Shale Oil. I hope this is of some help.
S.K.Mallick
for S.K.Mallick, N. Hamburger, S.Mallick
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The general practice I have observed is that a student, caught for the first time, cheating in an examination has the examination paper in the subject in question cancelled. In addition the student offender is given a ‘Z’ grade which is a punishment for life meted to him/ her. Does this practice not suggest the student cannot reform? The student’s examination paper is cancelled and he/ she has to rewrite the paper. He/ she is also given a ‘Z’ for cheating in an examination, Doesn’t this practice amount to punishing the student twice? Considering the roles of Tertiary education in the lives of students in the 21st Century, should the award of ‘Z’ grade be encouraged?
Education, School discipline, Grading, Tertiary institutions
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Dear Dr. Denis,
At the time I studied in the U.K.  in the late 1970s & early 1980s, the university student who was caught cheating during an exam was expelled from the university instantly plus giving his/her name to all the other U.K. universities so as the student cannot join any of them.
I really admired that system because the punishment was only applied on very rare cases but it was severe enough to prevent thousands of students from the dishonesty shame.
After all, the university student will be a product who will go to a career in the market. If he/she is a crook, then the society & humanity will be harmed in many aspects. Neither you or I would like to see our children taught or medicated by a villain person.
Mind you, I have been working for 33 years in my country and the punishment is more "soft" than that : zero mark + expulsion for one semester. There are "abnormal" students who are ready to cheat according to this formula & they do not mind bearing the stigma  " if caught" because they think that time will heal the wounds & the case will soon be forgotten. 
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task analysis can be useful for improving preservice or in-service education or regulation of health workers.
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What do you mean by task analysis, if it is an evaluation of quality of assistance, you can find the PCAT tool (Primary Health Care Tool), that have a section applied to practitioners. This tool evaluate how far or not they are from the essential attributes of primary health care.
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I need a kind of guideline, I've tried to extract data from a published graph with no success
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Am trying to ascertain the burden of administrative tasks (prescription writing, referral writing, processing of  letters etc) on general practice as a way of estimating how harmful errors in these processes are.  
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Really helpful link - thanks Sharon
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There is an elderly patient with idiopathic hypoparathyroidism. Serum calcium levels are from 6.8 to 12.1 mg/dL, and serum intact PTH levels are from 7 to 35 pg/mL. There are no calcification of basal ganglia, no metabolic problems, and no immunological problems.
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Is this variability in the calcium levels induced by the administered therapy?
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Never Events” are medical errors that should not occur if strong preventative measures exist. An example in secondary care is wrong-limb amputation. A list of "Never Events" for primary care is being researched in conjunction with clinicians. As a patient and public engagement activity, from personal experience can you think of any events that should never occur in general practice but have done so?
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Yours faithfully. In fact, to date, I have not had experience with "never events", but since 5 years I work in area of care for patients with diabetic foot
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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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In France, the prescription of benzodiazepines (BZD ) is a problem . Care for patients with chronic use is difficult. In terms of public health, it is particularly relevant to avoid this situation by prescribing these treatments wisely. A thesis carried out in 2012 resulted in the design of two brief first prescription of BZD guides , one to complaints for anxiety and the other for insomnia.
How would it be possible to assess the relevance of these guides, in actual practice conditions of general practice (GP) , knowing that the conditions of research in MG do not allow a large-scale intervention study ?
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I love this discussion because it's so important. I spent the 70's (my first decade in private practice) getting people OFF benzos. My "decision support" is simple: NEVER use these drugs (always remember never to say always or never). UNLESS you have no choice. I never, prescribe them EXCEPT in a few circumstances: EtOH withdrawal, certain phobic reactions (such as flying, and only for the duration, w/ the caveats of memory loss, DVT etc), and those who have already become addicted by other physicians' unwise (in my opinion) prescribing.  Now that we know that several if not most of the antidepressants are also excellent for anxiety, we can use other means, including NON-DRUG therapy, which also works very well. We certainly DO want to alleviate crippling anxiety or insomnia, but we'll never do it with benzos, though they "work" at first.  Also, now that the "powers that be" have begun to agree w/ me (I've been saying & doing this for YEARS), touting how the elderly (& all the rest of us) have more falls, more depression, more cognitive impairment w/ these drugs, it's much easier to reason with patients. I know this is a research site -- but it's really difficult to research Common Sense and the Art of Medicine.
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How do you compute cardio thoracic ratio if there's silhouetting? How about power ratio of cervical spine if the start & end points are hard to see?
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Luckily, it is just an academic exercise. But great to hear how it can be handled in a clinical setting!
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Pain scales exist for procedural pain (heelprick e.g.) or for prolonged pain (intubated babies or post-surgery). This difference should be highlighted
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In Mongolia we have Pain management guide, which was approved in the Mongolian Ministry of Health and according this guide,  before and after painful procedure for pain management, like epidural catheterization, celyac  block, neurolysis, we have to use pain scale  to assess the result of our procedure and we have to do documentation. 
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Intrinsic and extrinsic motivation are almost inseparable. At times they work dynamically. However, there are many examples of testing out the intrinsic motivation component in other fields, less so in healthcare. So is it possible to specifically isolate factors to measure intrinsic motivation amongst physicians?
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Thanks for your feedback Eswaran. Unfortunately, there are not fixed or validated questionnaire for 'intrinsic' motivation. There are lots of those for general motivation assessments.
I have already designed one and I am on the verge of testing it out but need to confirm if it is sound more a psychological point of view.
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This scale is difficult to get hold of.
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Then it is possible useless, that's my experience.
sincerely Dagfinn Winje
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We're looking at mapping out processes of care in the primary care setting. What should integrated care look like in General Practice? And how can we measure the extent of integration?
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I like Morgan's approach but he only lists professionals looking at health care. There is a body of work showing that 'episodes of unscheduled care' - that is emergency admission of ED attendance are due to a breakdown of social care support rather than new illness. The integrration of care once offered by general practitioner models of care in UK, Denmark, Netherlands and Ireland where there was continuity and integration of many aspects of care is now all but gone so read anything by Barbara Starfield and as Morgan says, keep the person who is the patient at the centre of your work.
You may already have found an American paper by Rosenthal in 2008 about medical homes (JABFM) but again is more focused on medical problems.
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Patient safety reporting systems despite their limitations are great source of deriving insights into the delivery of safer care. Over the last 10 years, the national reporting and learning system has accrued over 10 million reports of patient safety incidents in England and Wales; most are from hospitals. Why does primary care especially in general practice lag behind?
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Dr. Panesar - patients are more likely to know if something is wrong when they are in a serious condition (hospitalized) as opposed to when they are out-patients. This is primarily due to the urgent nature of treatment in a hospital setting versus more routine visits in primary care. I agree with Dr. Upadhyay that lack of awareness in many instances may be the reason for lack of reporting. Fear of reprisal is an unfortunate reality for some developing countries; however, I do not believe that is a barrier for patients in Wales or England. I think the latitude for physicians to cover-up mistakes is greater in an out-patient setting as opposed to critical care.
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Yes, I am working in a project evaluating the AUC of all echocardiography modalities in our general terciary level hospital in Brazil.
 
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This may seem like a foolish question and I admit I am a beginner, but it still baffles me how scientists can inject such tiny volumes! For example, there is a study that does the following in a nutshell:
Extract adipose tissue(liposuction)
Isolate Preadipocytes(which are in the SVF)
Inject preadipocytes intradermally into scalp of patient.
My question is simple. How do they even begin to inject such tiny amounts? After isolating the preadipocytes(SVF, which is a tiny pellet!), do they first mix it with PBS before injection? The particular study deals with regrowing hair on bald patients, so what I would like to know, is if you isolate the SVF containing preadipocytes and mix it with PBS, will that be sufficient in terms of cell number to help the bald patient? What volume of PBS would YOU mix the SVF with in this case?
They say for every 20ml's of adipose tissue, there is between 300,000 to 2 million preadipocytes(after full isolation). Would that be enough for a patients entire scalp? Or just one region such as the crown? And how much pbs would YOU mix with the preadipocytes/SVF?
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@B. Chandrashekhar Wow, that's a brilliant response! Thanks so much for that, very insightful! Maybe 4-5ml's would be sufficient, but I am weary that the number of cells in that 4-5ml's won't be enough. Do you think the 300,000 preadipocytes in the SVF mixed with 4-5ml's of PBS would be enough to induce adipogenesis?
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PPIs may interfere with vitamin B12 absorption in food substance. Does it also interfere with oral B12 supplements? Can PPI interfere with gastric intrinsic factors secretions the same way it interferes with acid productions?
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Oral vitamin B12 is in a crystalline form. It does not go through the normal processes involved in B12 absorption(eg intrinsic factor, R protein, etc). It is absorbed directly across the small intestinal mucosa.
PPIs reduce B12 absorption because acid is required to liberate B12 that is bound to food.
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Looking at good (and bad!) examples of successful CDSS implementation in primary care/general practice
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Our evaluation of a diabetes care patient dashboard. Physicians heartily endorsed it and it saved them time and improved their accuracy. The paper does not evaluate how it was implemented in practice, more of a usability evaluation.
A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care.
Richelle J Koopman, Karl M Kochendorfer, Joi L Moore, David R Mehr, Douglas S Wakefield, Borchuluun Yadamsuren, Jared S Coberly, Robin L Kruse, Bonnie J Wakefield, Jeffery L Belden
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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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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?
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Hi Ezequiel, Same sort of stuff happening over here but not quite as bad. The 2012 outbreak could not have come at a worse time, however, its impact during a time of austerity will hopefully attract some attention, However official government line at the moment is denial.
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Clinical reasoning skills are very important in primary care. Currently we use chart-stimulated recall, directly observed consultation skills, videotaped consultation and small group discussions to teach our postgraduates in family medicine. However, I would like to know other effective ways to teach clinical reasoning skills in the outpatient setting, particularly for postgraduates.
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In Canada (BC) for post-grad (residents) we mostly use real patients in clinical settings. As a teacher I think some of the key elements are:
- practice: they have to see volume to get the range and so they can try out new approaches.
- rapid feedback: going over aspects as soon as possible (i.e. during the case review and right after) allows the memories to link to the feedback and changes to be applied. We are starting to use Field Notes for this. Field Notes are short ~1/4 page feedback forms that target one aspect of the encounter.
- observation / review. This is harder for us to do in our setting but observation and video review is very good for people to see what they are doing.
- role rehearsal and simulated cases: we use these in a limited way in post-grad, mostly focused on teaching / practicing behavioural medicine skills (breaking bad news, managing a difficulty encounter) and in exam prep.
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Researchers from some developing countries do not work in same conditions as their colleagues from developed countries. They could suffer from bad running rules, poor political system control, weak educational system, laboratory equipment insufficiency or inadequacy, defective laboratory’s (or institute) administration policy or leadership, etc.
A researcher from international or developed laboratory could produce much more research papers with good quality than his/her colleague from substandard laboratory.
Could we measure their research endeavor and effort with same scheme, policy and rules?
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@Fairouz Bettayeb:...
I think a cooperation scheme with worldwide visiting professors and researchers with an open access to private universities and schools could be more beneficial.
Good post. With RG, we have an instance of virtual visiting professors. The exchanges and papers and books and datasets available via RG is astonishing and reaches to all corners of the globe.
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Can a general practitioner draw conclusions from a specific IgE test?
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Dear Joost ,
A specific IgE alone does not make an allergy diagnosis, unless it is backed up by family history and clinical symptoms, as well as allergy reaction provoked in real life by the respective allergen.But even if all that fits, a specific IgE may still not be the proof of a specific allergy since a patient may have specific IgE antibodies that do no harm( for example anti cow's milk IgE in adults) and on the other hand , one can be very allergic but have no specific IgE to any allergen ( his antibodies might sit on IgG sub classes).
Hence the final conclusion of allergy , yes or no, should be driven by an allergy specialist.
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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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Pictorial based education might help in those with low health literacy.
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ictorial based asthma self management plans may be used as an additional tool during a consultation to improve compliance and understanding or to provide self-management education. Other tools and information during consultations can improve compliance and understanding, such as provision of leaflets, pictorial aids and diagrams and providing further information links and leaflets post consultation. It has been shown that these consultation tools improve understanding for all patients as well as those with low literacy skills.
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I am looking for a simple screening tool for sexual dysfunction in general practice, to be administered as part of a comprehensive health assessment for older veterans. Thanks for your help.
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HI Stacey, I am doing research involvig older men with prostate cancer and we are also considering the IIEF, but was unaware of the IIEF-5, which we will consider. The other option for this group which may apply (but perhaps not to your group) is the EORTC30 P25 prostate module which gives sexual interest and sexual function domain scores.
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The lack of experimental details seems to be a problem for most posts I visit to try to offer advice. There needs to be a policy or standard set of information that is offered up to get proper advice. Check out some of the QA spaces in the computer science realms to see what I mean (eg. stackoverflow). The majority of replies to a post seem to always be clarification questions and then a few people to take a stab at an answer.
I sort of understand most peoples reluctance to provide details as they fear being scooped, but if your want help you have to give a sufficient amount of detail. Most problems stem from experimental artifacts or fundamental misunderstanding of biological principals. For example you can hide the name of a gene but should provide functional details like if it is a transcription factor or a kinase, I think the name of the sequencing platform or details on how a library is prepared are very pertinent pieces of information that will not deluge to the world your research.
The post on this system are too much like twitter. Its fine for quips or to point people at a resource/news article/event, but not okay for any serious conversation.
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Totally agree with the feeling. Many questions on Research Gate are of very poor quality (no background or goal/objective information, short and imprecise question). It reduces the overall quality of the entire site.
Guidelines, distributed to all members upon registrations AND shown upon adding a question or answer (as suggested by Stuart Jenkins) would be great.
Another thing that I have seen make a difference is for members to politely tell the OP that their question is poorly formed and would benefit from -More context-, -Goals/Objectives info-, -Being formulated at length, with care for important details-.
My suggestion is that you create a template in a text file and, any time you think the OP deserves the speach, copy-paste it as an answer, adding appropriate information about the OP (name...) or the question itself.
Now, as I type this, there is a notice that appears in the upper right region of my Answer box : "Add an answer. High-quality answers appreciated by your peers will help to increase your RG Score." Close, but no cigar. Maybe adding a link under "High-quality answers" linking to a policy page hinting at the elements of a great Answer / Question would bring us closer to high quality questions and answers.
This is all a question of "Forum Naivety or Newbieness". You can't just state: "Please be an advanced and well informed forum user". You have to explain at (some) length what that means and what is expected of you as a forum member.