journal article
Open Access Collection
Home
Willemsen, Robert TA; van Severen, Evie; Vandervoort, Pieter M; Grieten, Lars; Buntinx, Frank; Glatz, Jan FC; Dinant, Geert Jan
doi: 10.3109/13814788.2015.1013934pmid: 25751665
AbstractBackground: Most patients presenting chest complaints in primary care are referred to secondary care facilities, whereas only a few are diagnosed with acute coronary syndrome (ACS).Objective: The aim is to determine the optimal cut-off value for a point-of-care heart-type fatty acid binding protein (H-FABP) test in patients presenting to the emergency department and to evaluate a possible future role of H-FABP in safely ruling out ACS in primary care.Methods: Serial plasma H-FABP (index test) and high sensitivity troponin T (hs-cTnT) (reference test) were determined in patients with any new-onset chest complaint. In a receiver operating characteristic (ROC) curve, the optimal cut-off value of H-FABP for ACS was determined. Predictive values of H-FABP for ACS were calculated.Results: For 202 consecutive patients (prevalence ACS 59%), the ROC curve based on the results of the first H-FABP was equal to the ROC curve of hs-cTnT (AUC 0.79 versus 0.80). Using a cut-off value of 4.0 ng/ml for H-FABP, sensitivity for ACS of the H-FABP (hs-cTnT) tests was 73.9% (70.6%). Negative predictive value (NPV) of H-FABP for ACS in a population representative for primary care (incidence of ACS 22%) thus could reach 90.8%.Conclusion: In patients presenting chest pain, plasma H-FABP reaches the highest diagnostic value when a cut-off value of 4 ng/ml is used. Diagnostic values of an algorithm combining point-of-care H-FABP measurement and a score of signs and symptoms should be studied in primary care, to learn if such an algorithm could safely reduce referral rate by GPs.
Nijrolder, Iris; Leone, Stephanie S; van der Horst, Henriette E
doi: 10.3109/13814788.2015.1055556pmid: 26134092
AbstractBackground: General practitioners (GPs) and patients can have different ideas about the causes of fatigue, which may hinder management of fatigue.Objective: To investigate the causal attributions of patients and their GPs for fatigue, their level of agreement, and the association between patients’ attributions, and fatigue characteristics and other illness perceptions.Methods: Baseline data, collected between 2004 and 2006, of a prospective cohort study among 642 adult patients presenting to Dutch primary care practices (n = 147) with a main symptom of fatigue, were used. Patient causal attributions and illness perceptions were measured using the revised illness perception questionnaire (fatigue version). GP causal attributions were measured with an open question included in the form that was completed at the end of the patient's visit. Fatigue severity was measured using the checklist individual strength.Results: Psychosocial causes were among the most often reported causal attributions by both patients and GPs. In 33% of 519 cases, the GP had no idea about the cause whereas the patient did. Overall, the agreement between the first reported causal attribution of patients and GPs was low. Qualitative differences in the labelling of causes were also found. Type of attribution (physical vs psychosocial/psychological) was associated with duration of fatigue (40 vs 25 months), and personal control (score 17.4 vs. 18.9).Conclusion: Most patients and GPs had ideas about the causes of fatigue, but differences were found in the first reported causes and the labelling of causes. The findings may provide leads for optimizing communication about fatigue.
Vrdoljak, Davorka; Petric, Dragomir; Diminić Lisica, Ines; Kranjčević, Ksenija; Došen Janković, Sanja; Delija, Ita; Puljak, Livia
doi: 10.3109/13814788.2015.1046124pmid: 26108154
AbstractBackground: Regular use of evidence-based medicine (EBM) among general practitioners (GP) is insufficient.Objective: To analyse whether knowledge and attitudes about EBM can be improved among mentors in general practice by involving sixth-year medical students as academic detailers.Methods: An interventional non-randomized before-and-after study included 98 GPs (49 in the intervention group of mentors and 49 controls) and 174 medical students attending family medicine clinical rotations. A telephone survey on knowledge and attitudes towards EBM was conducted among participating physicians before, and six months after the rotation. During the rotation, each mentor chose two cases from real life, and the students’ task was to form an answerable clinical question, find the evidence-based answer and to write a brief report. The mentor reviewed the report and discussed it with the student.Results: Students’ EBM detailing intervention led to significant improvement in knowledge and attitudes about EBM in the intervention group of mentors in general practice compared to control GPs (relative increase in knowledge was 20 ± 46.9% vs 6 ± 12.1%, respectively; P = 0.042). Among participants with Ph.D. or specialization in family medicine, the observed effects of the intervention were similar as in the total sample, and statistically significant, but not in the group of participants with neither scientific degree nor specialization in family medicine.Conclusion: Knowledge and attitudes of GP mentors towards EBM can be improved by involving medical students as academic detailers. Further studies should explore the effectiveness of this method among GPs that are not mentors, and who do not have a specialization or research degree.
Leclercq, Raymond MFM; Van Barneveld, Kevin WY; Schreinemacher, Marc HF; Assies, Roxanne; Twellaar, Mascha; Bouvy, Nicole D; Muris, Jean WM
doi: 10.3109/13814788.2015.1055466pmid: 26161685
AbstractBackground: There is increasing interest among specialists in the complications after abdominal surgery due to adhesions.Objective: Exploration of experiences, attitudes and expectations of general practitioners concerning bowel obstruction and postoperative abdominal adhesions.Methods: In October 2012 a postal questionnaire was sent to a random sample of 800 Dutch GPs.Results: The response rate was 45%, 24% (n = 190) filled out the questionnaire completely, 12% (n = 99) had no experience with the subject and 7% (n = 57) had no time to respond.A history of abdominal surgery does play a part in more than 80% of GP's differential diagnosis of abdominal complaints. Seventy-five per cent consider some types of surgery to induce more adhesions. Eighty-five per cent ponder the differentiation between adhesion related complaints and IBS as clear, however difficult (78%) in specific patients. Intestinal transit problems likely due to adhesions are treated with extra fluid (n = 64), more fibres (n = 85) and laxatives (n = 153). Referral to a specialist for adhesiolysis is rarely considered (11%). Forty per cent of the GPs would refer a patient with abdominal pain and suspected adhesions. Seventy-six per cent denote knowledge gaps and low experience in the treatment of intestinal transit problems. Some (n = 23) indicate the need for information about adhesions and obstruction through CME papers.Conclusion: Respondents are well equipped to deal with abdominal complaints and intestinal transit problems due to postoperative adhesions. Some indicate the need for information about adhesions and prevention of obstruction through CME papers.
Ricci-Cabello, Ignacio; Violán, Concepció; Foguet-Boreu, Quinti; Mounce, Luke T. A.; Valderas, Jose M.
doi: 10.3109/13814788.2015.1046046pmid: 26232238
AbstractThe simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on ‘comorbidity’ (i.e. the ‘index disease’ approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on ‘multi-morbidity’ (i.e. multiplicity of problems) and ‘morbidity burden’ (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.
Klemenc-Ketis, Zalika; Kurpas, Donata; Tsiligianni, Ioanna; Petrazzuoli, Ferdinando; Jacquet, Jean-Pierre; Buono, Nicola; Lopez-Abuin, Jose; Lionis, Christos
doi: 10.3109/13814788.2015.1046376pmid: 26134091
AbstractResearch in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience.
Showing 1 to 10 of 11 Articles