1213 articles - 08.09.10
1: Can Fam Physician. 2010 Aug;56(8):778-84.
Anderson JE, Lowen CA.
Department of Family Practice at the University of British Columbia in Vancouver.
OBJECTIVE: To identify models of health care delivery that support youth access to health and mental health care. DATA SOURCES: Information was obtained from PubMed, Ovid MEDLINE, Web of Knowledge, and Sociological Abstracts (CSA Illumina). STUDY SELECTION: Studies reviewed in this article provided level I, II, or III evidence. SYNTHESIS: Youth access health care, with the support of parents and family, through families' existing health care providers or family physicians. Youth might be reluctant to involve parents or to consult family physicians for health concerns related to substance use, emotional problems, or reproductive concerns. Primary health care service models need to support youth access to care and ensure that youth feel comfortable seeking care for all of their health concerns. School-based and community-based health care centres might be better positioned to meet the needs of youth than traditional office-based practices are. CONCLUSION: There is a growing body of evidence on health service models that support effective and accessible delivery of health and mental health services for youth. The health needs and challenges of youth are often predictable. Available evidence highlights the importance of including youth experience and voices in planning, delivery, and evaluation of services.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20705886&dopt=ExternalLink
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PMID: 20705886 [PubMed - in process]2: Can Fam Physician. 2010 Aug;56(8):761-5.
Harrison AG, Rosenblum Y.
Department of Clinical Psychology, Queen's University, Kingston, ON K7L 3N6. harrisna@queensu.ca
OBJECTIVE: To update primary health care providers on the guidelines and standards for documentation of attention deficit hyperactivity disorder (ADHD) at the postsecondary level. QUALITY OF EVIDENCE: We synthesized information from consultations with other experts at postsecondary disability offices and from relevant research in this area (specifically, PsycLIT, PsychINFO, and MEDLINE databases were searched for systematic reviews and meta-analyses from January 1990 to June 2009). Most evidence included was level III. MAIN MESSAGE: Symptoms of ADHD can occur for many reasons, and primary health care providers need to be cautious when making this diagnosis in young adults. Diagnosis alone is not sufficient to guarantee academic accommodations. Documentation of a disability presented to postsecondary-level service providers must address all aspects of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for diagnosis of ADHD, and must also clearly demonstrate how recommended academic accommodations were objectively determined. CONCLUSION: Students with ADHD require comprehensive documentation of their disabilities to obtain accommodations at the postsecondary level. Implementing the guidelines proposed here would improve access to appropriate services and supports for young adults with ADHD, reduce the risk of misdiagnosis of other psychological causes, and minimize the opportunity for students to obtain stimulant medications for illicit use.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20705880&dopt=ExternalLink
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PMID: 20705880 [PubMed - in process]3: Can Fam Physician. 2010 Aug;56(8):e296-301.
MacKenzie MS, Berkowitz J.
Family Practice Residency Program, University of British Columbia, Chilliwack, BC V2P 4J1. mark.mackenzie@fraserhealth.ca
OBJECTIVE: To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. DESIGN: Survey involving self-assessment of procedural skills experience and competence. SETTING: British Columbia. PARTICIPANTS: Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. MAIN OUTCOME MEASURES: Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. RESULTS: Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. CONCLUSION: Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20705868&dopt=ExternalLink
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PMID: 20705868 [PubMed - in process]4: Can Fam Physician. 2010 Jul;56(7):639-48.
Ross SA, Ekoe JM.
University Of Calgary, AB, Canada. drross@telus.net
OBJECTIVE: To evaluate the emerging classes of antihyperglycemic agents that target the incretin pathway, including their therapeutic efficacy and side effect profiles, in order to help identify their place among the treatment options for patients with type 2 diabetes. QUALITY OF EVIDENCE: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched. Most evidence is level I and II. MAIN MESSAGE: Two classes of incretin agents are currently available: glucagonlike peptide 1 (GLP1) receptor agonists and dipeptidyl peptidase 4 (DPP4) inhibitors, both of which lower hyperglycemia considerably without increasing the risk of hypoglycemia. The GLP1 receptor agonists have a greater effect on patients' glycated hemoglobin A(1c) levels and cause sustained weight loss, whereas the DPP4 inhibitors are weight-neutral. CONCLUSION: The GLP1 and DPP4 incretin agents, promising and versatile antihyperglycemic agents, are finding their way into the therapeutic algorithm for treating type 2 diabetes. They can be used in patients not adequately controlled by metformin monotherapy or as initial therapy in those for whom metformin is contraindicated.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20631270&dopt=ExternalLink
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PMID: 20631270 [PubMed - in process]5: J Fam Pract. 2010 May;59(5):276-80.
Campos-Outcalt D.
Department of Family and Community Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA. dougco@u.arizona.edu
The USPSTF recommends aspirin for the prevention of stroke and heart attack for those at risk, and screening for major depression and childhood obesity.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20544048&dopt=ExternalLink
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PMID: 20544048 [PubMed - indexed for MEDLINE]6: J Fam Pract. 2010 May;59(5):E3.
Davis MG, Reape KZ, Hait H.
Rochester Clinical Research, Inc., Rochester, NY, USA.
BACKGROUND: Oral contraceptives (OCs) are the most widely used method of reversible contraception. Recent alterations of the standard 28-day regimen have included shortening the traditional hormone-free interval (HFI), supplementing the HFI with low-dose estrogen, or increasing the number of active pills administered, thus extending the time between withdrawal bleeding episodes by a variable number of months. In light of these changes in regimens, clinicians may be seeking evidence that the new regimens are safe and will not result in unexpected adverse events. METHODS: We initiated a long-term extension trial to evaluate the safety of a 91-day extended-regimen OC containing 150 mcg levonorgestrel/30 mcg ethinyl estradiol (EE) for 84 days, followed by 7 days of 10 mcg EE. After participation in a 1-year, open-label, phase 3 contraceptive program, 320 women qualified for enrollment in a multicenter, nonrandomized study of 91-day extended-regimen OCs for up to 3 additional consecutive years; 116 completed the study. We evaluated incidence of reported adverse events (AEs), rates of study discontinuation, and reported bleeding patterns. RESULTS: Total exposure was equivalent to 8292 28-day cycles. Participants reported no thromboembolic events. Thirty-one (9.7%) women discontinued treatment due to AEs. Unscheduled bleeding and spotting diminished during the course of the trial. Overall rates of study discontinuation and incidence of AEs were consistent with those observed in the phase 3 clinical program. CONCLUSION: This study demonstrated that the AE profile of the 91-day extended-regimen OC over 4 years was similar to that seen in the 1-year clinical trials, with no unexpected adverse events.
Publication Types: Clinical Trial Multicenter Study
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20544040&dopt=ExternalLink
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PMID: 20544040 [PubMed - indexed for MEDLINE]7: J Fam Pract. 2010 May;59(5):E2.
Cole S, Reed J.
St. John's Mercy Family Medicine Residency Program, St. Louis, MO, USA. sarah.cole@mercy.net
Consider osteopathic manipulation for low back pain that has not responded to customary care, and other musculoskeletal pain such as headache or neck pain.
Publication Types: Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20544039&dopt=ExternalLink
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PMID: 20544039 [PubMed - indexed for MEDLINE]8: Br J Gen Pract. 2010 Jun;60(575):258-65.
Gallagher H, de Lusignan S, Harris K, Cates C.
Division of Community Health Sciences, HunterWing, St George's, University of London, London SW17 0RE.
BACKGROUND: Chronic kidney disease (CKD) is a relatively recently recognised condition. People with CKD are much more likely to suffer from cardiovascular events than progress to established renal failure. Controlling systolic blood pressure should slow the progression of disease and reduce mortality and morbidity. However, no systematic review has been conducted to explore the effectiveness of quality-improvement interventions to lower blood pressure in people with CKD. AIM: To assess the effectiveness of quality-improvement interventions to reduce systolic blood pressure in people with CKD in primary care, in order to reduce cardiovascular risk and slow the progression of renal disease. METHOD: Papers were identified from the trial data bases of the Cochrane Effective Practice and Organisation of Care Group (EPOC) and Cochrane renal groups. In a three-round process, at least two investigators read the papers independently. Studies were initially excluded based on their abstracts, if these were not relevant to primary care. Next, full papers were read, and again excluded on relevance. Quantitative and, where this was not possible, qualitative analyses of the findings were performed. RESULTS: The selected studies were usually carried out on high-risk populations including ethnic minorities. The interventions were most often led by nurses or pharmacists. Three randomised trials showed a combined effect of a reduction in systolic blood pressure of 10.50 mmHg (95% confidence interval [CI] = 5.34 to 18.41 mmHg). One non-randomised study showed a reduction in systolic blood pressure of 9.30 mmHg (95% CI = 3.01 to 15.58 mmHg). CONCLUSION: Quality-improvement interventions can be effective in lowing blood pressure, and potentially in reducing cardiovascular risk and slowing progression in CKD. Trials are needed in low-risk populations to see if the same improvements can be achieved.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20529489&dopt=ExternalLink
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PMID: 20529489 [PubMed - in process]9: Can Fam Physician. 2010 May;56(5):417-23.
Macleod-Glover N, Sadowski C.
Saint-Vincent Hospital, Bruyere Continuing Care, 60 Cambridge St N, Ottawa, ON K1R 7A5. nmacleodglover@bruyere.org
OBJECTIVE: To review the evidence for the efficacy of products used for environmental or hand cleaning on the rates of Clostridium difficile-associated diarrhea (CDAD). QUALITY OF EVIDENCE: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for articles pertinent to the efficacy of cleaning products against C. difficile or studies with outcomes related to rates of CDAD. Evidence was level II. MAIN MESSAGE: Minimizing the incidence of CDAD in geriatric rehabilitation units is essential to achieving the goals of increasing patient function and independence for discharge into the community. Attention to environmental control of C. difficile and its spores by health care workers and patient visitors is an important secondary prevention strategy. CONCLUSION: Chlorine-releasing agents are more effective than detergents for killing spores produced by C. difficile. No level I evidence is available to determine if the use of chlorine-releasing agents has an effect on rates of CDAD. Hand-washing is currently the recommended strategy for reducing transmission of C. difficile. Alcohol gels do not inactivate C. difficile spores; however, increased use of alcohol hand gel has not been associated with higher rates of CDAD.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20463269&dopt=ExternalLink
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PMID: 20463269 [PubMed - in process]10: Can Fam Physician. 2010 Apr;56(4):333-9.
Andermann A, Blancquaert I.
Family Medicine Centre, St Mary's Hospital, McGill University, 3830 Lacombe Ave, Montreal, QC H3T 1M5. anne.andermann@mcgill.ca
OBJECTIVE: To provide a primer for primary care professionals who are increasingly called upon to discuss the growing number of genetic screening services available and to help patients make informed decisions about whether to participate in genetic screening, how to interpret results, and which interventions are most appropriate. QUALITY OF EVIDENCE: As part of a larger research program, a wide literature relating to genetic screening was reviewed. PubMed and Internet searches were conducted using broad search terms. Effort was also made to identify the gray literature. MAIN MESSAGE: Genetic screening is a type of public health program that is systematically offered to a specified population of asymptomatic individuals with the aim of providing those identified as high risk with prevention, early treatment, or reproductive options. Ensuring an added benefit from screening, as compared with standard clinical care, and preventing unintended harms, such as undue anxiety or stigmatization, depends on the design and implementation of screening programs, including the recruitment methods, education and counseling provided, timing of screening, predictive value of tests, interventions available, and presence of oversight mechanisms and safeguards. There is therefore growing apprehension that economic interests might lead to a market-driven approach to introducing and expanding screening before program effectiveness, acceptability, and feasibility have been demonstrated. As with any medical intervention, there is a moral imperative for genetic screening to do more good than harm, not only from the perspective of individuals and families, but also for the target population and society as a whole. CONCLUSION: Primary care professionals have an important role to play in helping their patients navigate the rapidly changing terrain of genetic screening services by informing them about the benefits and risks of new genetic and genomic technologies and empowering them to make more informed choices.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20393090&dopt=ExternalLink
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PMID: 20393090 [PubMed - in process]11: Can Fam Physician. 2010 Mar;56(3):229-38.
Konrad G.
Family Medical Centre, 400 Tache, Winnipeg, Manitoba. gkonrad@sbgh.mb.ca
OBJECTIVE: To determine whether dietary restrictions enhance the specificity of guaiac-based fecal occult blood tests (FOBTs) when screening for colorectal cancer. DATA SOURCES: PubMed-MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched. STUDY SELECTION: English-language case series, cohort studies, randomized controlled trials (RCTs), and meta-analyses were selected. Studies that did not include dietary manipulation or the use of guaiac-based FOBTs available in North America were excluded. SYNTHESIS: Ten case series, 5 cohort studies, 4 RCTs, and 1 meta-analysis were critically appraised. All studies used Hemoccult, Hemoccult II, or Hemoccult SENSA tests. Data from case series involving challenge diets showed no increase in positive FOBT results from high-peroxidase vegetables, but results varied with red-meat challenges depending on the amount of meat consumed and the test used. Case series, cohort studies, and RCTs comparing FOBT results during restricted versus unrestricted diets consistently showed no differences in positive FOBT results. CONCLUSION: Most of the evidence evaluating the effect of dietary restrictions on FOBT results is dated and of suboptimal quality. However, 4 RCTs and a meta-analysis of these data do not support dietary restrictions when screening for colorectal cancer. Because patient adherence can be an issue with FOBTs, and dietary restrictions can affect adherence in some populations, it is reasonable to abandon these recommendations without fear of substantially affecting specificity.
Publication Types: Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20228305&dopt=ExternalLink
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PMID: 20228305 [PubMed - in process]12: Can Fam Physician. 2010 Mar;56(3):e117-24.
Shields JF, Emond M, Guimont C, Pigeon D.
l'Universite Laval, Quebec.
OBJECTIVE: To review the management and follow-up of patients with minor thoracic injuries (MTI) treated by emergency or primary care physicians. DESIGN: A multicentre, retrospective study. SETTING: Three university-affiliated emergency departments of the metropolitan region of Quebec city, Que. PARTICIPANTS: Patients older than 16 years of age with suspected or proven rib fractures following traumatic events. MAIN OUTCOME MEASURES: Differences in admission and discharge proportions and disposition management following MTI. RESULTS: Four hundred and forty-seven charts were analyzed. Only 23 patients (5.2%) were admitted during the study period. Admission and discharge proportions were significantly different among the 3 surveyed hospitals, ranging from 1.3% to 15.2% (P < or = .001). There were no recommendations of follow-up noted in most (53.5%) of the charts and there were no differences after hospital stratification. Planned follow-up visits were scheduled for 5.7% of discharged patients. Being older than 65 years of age or having multiple rib fractures had no influence on management and follow-up recommendations. Eighty-two patients (18.6%) had unplanned follow-up visits in the emergency department, with inadequate pain relief as the principal reason for consultation (56.1%). There was no significant difference after stratification for age and type of analgesia. Other clinically significant delayed complications were recorded in 8.3% of all MTI patients. CONCLUSION: The proportion of patients admitted for rib fractures was lower than the expected 25%, based on previous publications, and varied across surveyed hospitals. A very low proportion of patients was offered planned follow-up visits or even any follow-up recommendations in view of possible delayed complications and disabilities. Further studies are needed to identify predictors of delayed MTI complications and enhance appropriate use of follow-up resources.
Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20228291&dopt=ExternalLink
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PMID: 20228291 [PubMed - in process]13: Br J Gen Pract. 2010 Mar;60(572):e128-36.
Khan NF, Harrison SE, Rose PW.
Department of Primary Health Care, University of Oxford, Oxford, UK. nada.khan@dphpc.ox.ac.uk
BACKGROUND: The UK-based General Practice Research Database (GPRD) is a valuable source of longitudinal primary care records and is increasingly used for epidemiological research. AIM: To conduct a systematic review of the literature on accuracy and completeness of diagnostic coding in the GPRD. DESIGN OF STUDY: Systematic review. METHOD: Six electronic databases were searched using search terms relating to the GPRD, in association with terms synonymous with validity, accuracy, concordance, and recording. A positive predictive value was calculated for each diagnosis that considered a comparison with a gold standard. Studies were also considered that compared the GPRD with other databases and national statistics. RESULTS: A total of 49 papers are included in this review. Forty papers conducted validation of a clinical diagnosis in the GPRD. When assessed against a gold standard (validation using GP questionnaire, primary care medical records, or hospital correspondence), most of the diagnoses were accurately recorded in the patient electronic record. Acute conditions were not as well recorded, with positive predictive values lower than 50%. Twelve papers compared prevalence or consultation rates in the GPRD against other primary care databases or national statistics. Generally, there was good agreement between disease prevalence and consultation rates between the GPRD and other datasets; however, rates of diabetes and musculoskeletal conditions were underestimated in the GPRD. CONCLUSION: Most of the diagnoses coded in the GPRD are well recorded. Researchers using the GPRD may want to consider how well the disease of interest is recorded before planning research, and consider how to optimise the identification of clinical events.
Publication Types: Research Support, Non-U.S. Gov't Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20202356&dopt=ExternalLink
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PMID: 20202356 [PubMed - indexed for MEDLINE]14: Can Fam Physician. 2010 Feb;56(2):137-41.
Birnie K, Robinson J.
Department of Psychosocial Resources, Tom Baker Cancer Center, Calgary, AB T2S 3C1. john.robinson@albertahealthservices.ca
OBJECTIVE: To highlight the role of psychosocial variables in treatment decision making for patients with localized prostate cancer and how family physicians can be of most help to such patients in facilitating good treatment choices. QUALITY OF EVIDENCE: PubMed was searched, and articles relevant to the psychosocial aspects of localized prostate cancer treatment decision making were included. Articles were excluded when they clearly specified inclusion of men with metastatic disease. This is not a systematic review, and recommendations made are drawn from studies of level II or III evidence. MAIN MESSAGE: The optimal strategy for managing localized prostate cancer has not been established and currently includes a number of potential options: active surveillance, radical prostatectomy, external beam radiotherapy, brachytherapy, and cryoablation. Consequently, men often struggle during the decision-making process, and some later regret their decisions. With an increased awareness of the psychosocial aspects of patient decision making, family physicians can help patients make better decisions. CONCLUSION: Family physicians can help minimize the decisional regret experienced by patients after treatment by encouraging patients to consider their values and social supports, as well as the accuracy and appropriateness of the information used in the decision-making process.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20154243&dopt=ExternalLink
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PMID: 20154243 [PubMed - in process]15: Br J Gen Pract. 2010 Feb;60(571):101-5.
Smith L, Ewings P, Smith C, Thompson M, Harnden A, Mant D.
East Somerset Research Consortium, Westlake Surgery, West Coker, Somerset. research@esrec.nhs.uk
BACKGROUND: National Institute for Health and Clinical Excellence (NICE) guidance to treat otitis media in older children immediately with antibiotics only if they have ear discharge is based on limited evidence. AIM: To determine the clinical significance and outcome of ear discharge in children with acute otitis media, in routine clinical practice. DESIGN OF STUDY: Observational cohort study of children with acute otitis media comparing those with and without ear discharge at presentation. SETTING: Primary care in East Somerset. METHOD: Two hundred and fifty-six children aged 6 months to 10 years were recruited from primary care. Clinical features and other characteristics were recorded at presentation. Follow-up was undertaken at 2 weeks and 3 months. RESULTS: Children with otitis media who present with ear discharge are much more likely to be treated with antibiotics irrespective of age (adjusted odds ratio 15, 95% confidence interval [CI] = 3 to 66). Most with discharge have proven bacterial infection (58%, 95% CI = 42 to 72%). They have a more severe systemic illness, with higher axillary temperature (80% increase in odds of ear discharge for each additional degree centigrade, P = 0.02), pulse rate (9% increase in odds for each extra beat, P<0.001), and Yale score (mean 10.5 versus 9.0, P = 0.003). They may also have an increased likelihood of adverse outcome (adjusted odds ratio of pain at 1 week 2.9; further episodes of acute otitis media 3.3; hearing difficulty at 3 months 4.7; all P<0.10). CONCLUSION: Ear discharge defines a group of children with otitis media who are sicker and may be at higher risk of adverse outcome. NICE guidance to treat them with antibiotics is supported.
Publication Types: Multicenter Study Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20132703&dopt=ExternalLink
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PMID: 20132703 [PubMed - indexed for MEDLINE]16: Br J Gen Pract. 2010 Feb;60(571):64-82.
Williams NH, Amoakwa E, Burton K, Hendry M, Lewis R, Jones J, Bennett P, Neal RD, Andrew G, Wilkinson C.
Department of Primary Care and Public Health, Cardiff University, School of Medicine, North West Wales Clinical School, Wrexham. williamsnh@cf.ac.uk
BACKGROUND: The pain and disability of hip and knee osteoarthritis can be improved by exercise, but the best method of encouraging this is not known. AIM: To develop an evidence-based booklet for patients with hip or knee osteoarthritis, offering information and advice on maintaining activity. DESIGN OF STUDY: Systematic review of reviews and guidelines, then focus groups. SETTING: Four general practices in North East Wales. METHOD: Evidence-based messages were developed from a systematic review, synthesised into patient-centred messages, and then incorporated into a narrative. A draft booklet was examined by three focus groups to improve the phrasing of its messages and discuss its usefulness. The final draft was examined in a fourth focus group. RESULTS: Six evidence-based guidelines and 54 systematic reviews were identified. The focus groups found the draft booklet to be informative and easy to read. They reported a lack of clarity about the cause of osteoarthritis and were surprised that the pain could improve. The value of exercise and weight loss beliefs was accepted and reinforced, but there was a perceived contradiction about heavy physical work being causative, while moderate exercise was beneficial. There was a fear of dependency on analgesia and misinterpretation of the message on hyaluranon injections. The information on joint replacement empowered patients to discuss referral with their GP. The text was revised to accommodate these issues. CONCLUSION: The booklet was readable, credible, and useful to end-users. A randomised controlled trial is planned, to test whether the booklet influences beliefs about osteoarthritis and exercise.
Publication Types: Multicenter Study Research Support, Non-U.S. Gov't Review
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20132695&dopt=ExternalLink
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PMID: 20132695 [PubMed - indexed for MEDLINE]17: Can Fam Physician. 2010 Jan;56(1):e30-5.
Rahim-Jamal S, Quail P, Bhaloo T.
Providence Health Care, Centres of Innovation, Centre for Healthy Aging, 4865 Heather St, Vancouver, BC V5Z 0B3. srahimjamal@providencehealth.bc.ca
OBJECTIVE: To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. DESIGN: A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. SETTING: Long-term care facilities in Canada randomly selected from regional clusters. PARTICIPANTS: Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. MAIN OUTCOME MEASURES: Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was "essential" or "desirable." RESULTS: An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be "essential" or "desirable," which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. CONCLUSION: The role description developed as a result of this study brings clarity to the medical director's role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20090058&dopt=ExternalLink
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PMID: 20090058 [PubMed - in process]18: Can Fam Physician. 2010 Jan;56(1):e13-9.
McCrate F, Godwin M, Murphy L.
Office for Aging and Seniors, Department of Health and Community Services, Newfoundland and Laborador, St. John's.
OBJECTIVE: To examine the degree to which targets for diabetes (blood pressure [BP], glycated hemoglobin [HbA1c], and low-density lipoprotein cholesterol [LDL-C]) are achieved in family practices and how these results compare with family physicians' perceptions of how well targets are being achieved. DESIGN: Chart audit and physician survey. SETTING: Newfoundland and Labrador. PARTICIPANTS: Patients with type 2 diabetes and their family physicians. INTERVENTIONS: The charts of 20 patients with type 2 diabetes were randomly chosen from each of 8 family physician practices in St John's, Nfld, and data were abstracted. All family physicians in the province were surveyed using a modified Dillman method. MAIN OUTCOME MEASURES: The most recent HbA1c, LDL-C, and BP measurements listed in each audited chart; surveyed family physicians' knowledge of the recommended targets for HbA1c, LDL-C, and BP and their estimates of what percentage of their patients were at those recommended targets. RESULTS: The chart audit revealed that 20.6% of patients were at the recommended target for BP, 48.1% were at the recommended target for HbA1c, and 17.5% were at the recommended target for LDL-C. When targets were examined collectively, only 2.5% of patients were achieving targets in all 3 areas. The survey found that most family physicians were aware of the recommended targets for BP, LDL-C, and HbA1c. However, their estimates of the percentages of patients in their practices achieving these targets appeared high (59.3% for BP, 58.2% for HbA1c, and 48.4% for LDL-C) compared with the results of the chart audit. CONCLUSION: The findings of the chart audit are consistent with other published reports, which have illustrated that a large majority of patients with diabetes fall short of reaching recommended targets for BP, blood glucose, and lipid levels. Although family physicians are knowledgeable about recommended targets, there is a gap between knowledge and clinical outcomes. The reasons for this are likely multifactorial. Further investigation is needed to better understand this phenomenon as well as to understand the foundation for physicians' optimistic estimates of how many of their patients with diabetes were reaching target values.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20090056&dopt=ExternalLink
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PMID: 20090056 [PubMed - in process]19: Br J Gen Pract. 2010 Jan;60(570):47-9.
de Ruijter W, de Waal MW, Gussekloo J, Assendelft WJ, Blom JW.
Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands. w.de_ruijter@lumc.nl
Secondary preventive drug treatment in patients aged > or =60 years with a history of myocardial infarction was investigated for age-dependent differences in time trends. Sixteen general practices in the Netherlands participated. Preventive treatment with at least three of four drugs (antithrombotics, statins, beta-blockers, and/or angiotensin-converting enzyme inhibitors) increased significantly over time in all three age strata of older patients. Although the greatest relative increase (2.2 times greater) took place in patients aged > or =80 years, these patients consistently had most room for improvement.
Publication Types: Multicenter Study
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20040168&dopt=ExternalLink
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PMID: 20040168 [PubMed - indexed for MEDLINE]20: Br J Gen Pract. 2010 Jan;60(570):40-6.
Voogdt-Pruis HR, Beusmans GH, Gorgels AP, Kester AD, Van Ree JW.
Department of Integrated Care, Care and Public Health Research Institute, Maastricht University Medical Centre/CAPHRI Maastricht, the Netherlands. helene.voogdt@mumc.nl
BACKGROUND: A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascular risk factors. According to the Dutch guideline for cardiovascular risk management, the heavy workload of cardiovascular risk management for GPs could be shared with advanced practice nurses. AIM: To investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascular risk management after 1 year of follow-up. DESIGN OF STUDY: Prospective pragmatic randomised trial. SETTING: Primary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated. METHOD: A total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascular risk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire. RESULTS: A larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, two-sided). CONCLUSION: Advanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascular risk management in Dutch primary care.
Publication Types: Comparative Study Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20040167&dopt=ExternalLink
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PMID: 20040167 [PubMed - indexed for MEDLINE]