Scandinavian journal of primary health care. Supplement最新文献

{"title":"Research in general practice--achievements in the past and possibilities for the future.","authors":"Denis Pereira Gray","doi":"10.1080/028134302317310688","DOIUrl":"https://doi.org/10.1080/028134302317310688","url":null,"abstract":"It is a great privilege to be asked to formulate some thoughts on research in general practice on this very special occasion, the 25th anniversary of the founding of the Research Unit of General Practice. It is also a privilege to mark the retirement of a particularly distinguished researcher in Denmark, Poul A. Pedersen, a man who has emerged across Europe as one of the research leaders. There have been many links between Denmark and Britain, and in the 1970s I met and greatly admired Flemming Frølund and, more recently, Frede Olesen, Honorary Fellow of the Royal College of General Practitioners, and the past President of WONCA Europe, a great Ž gure for uniting general practice across Europe. The Ž rst Postgraduate Department (now Institute) of General Practice in the United Kingdom was started in Exeter in 1973 and was followed within only 6 months by the corresponding institute in Denmark, so I have followed developments in Denmark with great interest. My background is that I have worked as a general practitioner (GP) in the same practice for more than 38 years. I am the son, the nephew, the grandson and the father of GPs, so if there is a general practice gene, I think I must have it! My practice has 6,000 patients and Ž ve partners. I work part-time in the practice and part-time as Professor of General Practice at the University of Exeter. The paper will look brie y at the achievements of general practice in the past and speculate, which is all that can be done, about the directions general practice may take in the future. General practice research actually had its beginnings in the late 18th century, and it is perhaps salutary to remember that our forefathers made discoveries of international signiŽ cance through general practice research. In the United Kingdom in the 1790s, crucial early experiments on smallpox were made by Jenner (1) which ultimately led to the eradication of the disease that had been a scourge of society. In 1841, near Exeter, Budd, working in a single-handed rural general practice, discovered the difference between typhoid fever and typhus (2). In the late 1890s, Sir James Mackenzie (3) discovered ways of measuring the rhythm of the heart, which was the forerunner of the ECG machine and what we now know about cardiac rhythms. A Ž nal example is William Pickles (4), who, in the 1930s, began to chart the pattern of infectious disease. A common feature of all these men is that they were single-handed GPs, working in one practice, concentrating essentially on one group of problems. They were able to make truly world-class research contributions . The organisationa l basis of general practice as it is today was laid in the middle of the 20th century with the establishment of Colleges and Academies of General Practice, starting in the USA in 1947; the Ž rst in Europe was the Royal College of General Practitioners in England in 1952, followed by colleges in Denmark and other countries throughout Europe. More recently, these ","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"20 1","pages":"2-5"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/028134302317310688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22022547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can general practitioners be randomised?","authors":"Niels de Fine Olivarius","doi":"10.1080/028134302317310732","DOIUrl":"https://doi.org/10.1080/028134302317310732","url":null,"abstract":"","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"20 1","pages":"23-4"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/028134302317310732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22022549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research opportunity in primary care.","authors":"Douglas M Fleming","doi":"10.1080/028134302317310697","DOIUrl":"https://doi.org/10.1080/028134302317310697","url":null,"abstract":"INTRODUCTION The importance of primary health care has been recognised by the World Health Organisation (WHO) and given a major boost by the Alma Ata statement (1). Inequalities in patient care and the economics of health care delivery are the underlying reasons giving primary care its current importance. Inequalities in health care delivery even within a country, whether regionally, ethnically , social class or income determined, are increasingly unacceptable in most civilised societies. It is difŽ cult to conceive of a health care system which can achieve equality unless it does so at the basic primary care level. From another perspective it is difŽ cult to see cost-effective health care delivery if primary care is bypassed, giving patients direct access to a secondary health care service with its inevitable increased level of resource. Increased emphasis on primary care brings increased opportunities for epidemiological research, because the information availabl e to the general practitioner (GP) about the health of an individua l is increasingly comprehensive. The link between illness episodes and life-time events included in the patient record provides a golden opportunity for the doctor interested in research. In those countries in which individua l patient-speciŽ c data can be set within the context of a registered population , there is the even greater opportunity of deriving population based rates – the heart of epidemiological research. This presentation uses information gathered in primary care mainly in the practices of the sentinel practice network of the Royal College of General Practitioners based in Birmingham and known as the Weekly Returns Service (WRS) (2). The examples are chosen to provide a perspective of research opportunities in primary care.","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"20 1","pages":"6-13"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/028134302317310697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22022551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Central Research Unit of General Practice: a personal review after 22 years.","authors":"Poul A Pedersen","doi":"10.1080/028134302317310705","DOIUrl":"https://doi.org/10.1080/028134302317310705","url":null,"abstract":"The Central Research Unit of General Practice in Copenhagen was established in 1978 and was one of many steps in the progress of academic general practice that had been taken during the previous 40 years. The social development of the health care system in Denmark, with ever-greater specialization of medicine, had increasingly pointed to the risk of fragmented, episodic, disease-oriented, specialized patient care, and of an expensively organized health care system. This had led to an awareness of the need for the generalist practitioner, and within the general practice profession of a need for a deeper understanding of the role and tasks of the general practitioner (GP). Activities to promote teaching and research in general practice were gradually initiated within the profession.","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"20 1","pages":"14-8"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/028134302317310705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22022546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poul A. Pedersen--the first among pioneers.","authors":"Hanne Hollnagel","doi":"10.1080/028134302317310723","DOIUrl":"https://doi.org/10.1080/028134302317310723","url":null,"abstract":"INTRODUCTION Poul A. Pedersen was a pioneer of general practice research in Denmark. He established the Central Research Unit of General Practice in 1978 and was its inspiring head until his retirement 22 years later, on 1 November 1999. In addition, Poul made important contributions to Danish and internationa l general practice research and, among other honorary positions, was President of the Royal College of General Practitioners, President of the Danish Medical Society and Vice-President of the European General Practice Research Workshop (EGPRW) from 1976 to 1983. At the same time, he continued to work in his own practice every morning and took care of his own patients. Fortunately, Poul is still active in Danish general practice research in the capacity of research consultant with the job of stimulating decentralised research. But more about Poul’s achievements.","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"20 1","pages":"20-2"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/028134302317310723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22022548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Situational disease: elements of a social theory of disease based on a study of back trouble.","authors":"Dorte Gannik","doi":"10.1080/028134302317310741","DOIUrl":"https://doi.org/10.1080/028134302317310741","url":null,"abstract":"According to the British general practitioner and anthropologis t Cecil Helman the biomedical model of disease can be characterized by body – mind dualism, scientiŽ c reductionism, and a predominant emphasis on biologica l rather than social-psycho logical information (1). This model is detailed out in biomedical everyday practice, where diseases are often conceived of as separate entities that can be fully described by way of a diagnosis – encompassing a name, pathology, etiology, prognosis , etc. In clinical work, this diagnostic description is considered objective knowledge with global validity (2). However, medical philosophers and metascientists in general do not subscribe to this view, and several medical disciplines (e.g. social medicine, general medicine, psychiatry) are only in part devoted to the biomedical model (3). Today, there is an increasing amount of medical theoretical work underway which offers new perspectives on the nature of disease. The biomedical model is no longer dominant in the theoretical discourse the way it still is in practice. In psychosomatics and in stress theory, in anthropolog y and sociology we are confronted with new ideas and new conceptualiza tions of disease, for instance the holistic model and the patient-centred model. What these concepts have in common is context – meaning that disease is inextricably bound up with time, with a person, with situations and with biography . This article presents one such contextual contribution to the ongoing theoretical discussion on the nature of disease. Here, the perspective of disease as a social and relational phenomenon – a phenomenon developed and shaped through the interaction of people in a social everyday world – emerges on the basis of an empirical study of the prevalence and handling of back troubles in a general adult population. The data are subsequently interpreted in the light of sociologica l theory. THEORETICAL BACKGROUND Around 1980, the American sociologis t Angelo Alonzo developed a model of illness behaviour which he labelled ‘‘a situational perspective’’ (4,5). This work will be brie y described. A premise of Alonzo’s theory is that bodily deviations – like symptoms and physical signs – are experiences that are typical of our everyday life. While we constantly interact with our environment and experience ourselves accordingly , we perceive a multitude of bodily sensations that must be interpreted, evaluated and eventually acted upon. Each person is involved in and goes through a number of daily social situations which demand some involve ment, and often some activity, from him. Normally, there is a certain repetitive pattern in the set of situations in which we involve ourselves day after day, week after week. A key issue is that of ‘containment’. In the  ow of bodily symptoms and sensations, the question arises: can these be contained within the situation so that the individual can preserve his core activity (e.g. working) in the situation? For ","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"20 1","pages":"25-30"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/028134302317310741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22022550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European code against cancer. A booklet for general practitioners.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"1 ","pages":"1-36"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19003307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of patient satisfaction assessment in medical audit.","authors":"A Hutchinson","doi":"10.3109/02813439308997644","DOIUrl":"https://doi.org/10.3109/02813439308997644","url":null,"abstract":"Minor Symptoms Evaluation Profile (MSE-profile) is an instrument for the assessment of subjective CNS-related symptoms and has recently been documented. This self-applied questionnaire includes 24 items and uses a visual analogue scale to record perceived symptoms. Based on a subjective grouping followed by a principal component analysis of the results of 374 individuals to confirm the grouping, 15 out of the 24 items were formed into three dimensions: Contentment (7 items), Vitality (5 items) and Sleep (3 items). The Cronbach's alpha coefficient used to evaluate the internal consistency of these dimensions was 0.81, 0.81 and 0.77, respectively. Compared with the equivalent dimensions of other questionnaires for measurement of health-related quality of life, the dimensions of the MSE-profile were found to be relevant. Furthermore, the MSE-profile showed good discriminative ability to distinguish symptom profiles of patients with other diseases/complaints than hypertension. It can be concluded that the MSE-profile is practically useful, reliable and sensitive enough for the assessment of subjective CNS-related symptoms that might affect the patient's well-being/quality of life.","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"1 ","pages":"19-22"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/02813439308997644","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19476330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coupling of perspectives in quality assessment.","authors":"I M Lunde","doi":"10.3109/02813439308997649","DOIUrl":"https://doi.org/10.3109/02813439308997649","url":null,"abstract":"","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"1 ","pages":"40-2"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/02813439308997649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19476335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative methods in quality assessment of doctor-patient meetings in general practice.","authors":"B Elverdam","doi":"10.3109/02813439308997650","DOIUrl":"https://doi.org/10.3109/02813439308997650","url":null,"abstract":"","PeriodicalId":77619,"journal":{"name":"Scandinavian journal of primary health care. Supplement","volume":"1 ","pages":"43-6"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/02813439308997650","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19476336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}