International journal of family medicine最新文献_第8页

Danish General Practitioners' Use of Prostate-Specific Antigen in Opportunistic Screening for Prostate Cancer: A Survey Comprising 174 GPs. 丹麦全科医生在前列腺癌机会性筛查中使用前列腺特异性抗原:一项包括174名全科医生的调查。

International journal of family medicine Pub Date : 2013-01-01 Epub Date: 2013-11-19 DOI: 10.1155/2013/540707

Kasper Jessen, Jens Søndergaard, Pia Veldt Larsen, Janus Laust Thomsen

{"title":"Danish General Practitioners' Use of Prostate-Specific Antigen in Opportunistic Screening for Prostate Cancer: A Survey Comprising 174 GPs.","authors":"Kasper Jessen, Jens Søndergaard, Pia Veldt Larsen, Janus Laust Thomsen","doi":"10.1155/2013/540707","DOIUrl":"https://doi.org/10.1155/2013/540707","url":null,"abstract":"Background. The use of prostate-specific antigen test has markedly increased in Danish general practice in the last decade. Despite the national guidelines advice against PSA screening, opportunistic screening is supposed to be the primary reason for this increased number of PSA tests performed. Aims. Based on the increase in the amount of PSA conducted, we aimed to analyse how GPs in Denmark use the PSA test. Methods. A self-administrated questionnaire concerning symptomatic and asymptomatic patient cases was developed based on the national and international guidelines and the extensive literature review, and an in-depth interview conducted with a GP was performed. Results. None of the GPs would do a PSA measurement for an asymptomatic 76-year-old man. For asymptomatic 55- and 42-year-old men, respectively, 21.9% and 18.6% of GPs would measure PSA. Patient request and concern could be potential reasons for measuring PSA for asymptomatic patients. Almost all GPs stated that a PSA measurement is indicated for symptomatic 49- and 78-year-old men, respectively, 98.9% and 93.8%. Conclusion. Opportunistic PC screening is being performed in general practice to a high degree. Hence, current guidelines are not followed, and intense focus should be on more effective implementation strategies in order to avoid overuse of PSA. ","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2013 ","pages":"540707"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/540707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31965101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 14

A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting. 药剂师主导的护理点INR诊所:优化家庭健康团队设置的护理。

International journal of family medicine Pub Date : 2013-01-01 Epub Date: 2013-12-12 DOI: 10.1155/2013/691454

Jennifer Rossiter, Gursharan Soor, Deanna Telner, Babak Aliarzadeh, Jennifer Lake

{"title":"A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting.","authors":"Jennifer Rossiter, Gursharan Soor, Deanna Telner, Babak Aliarzadeh, Jennifer Lake","doi":"10.1155/2013/691454","DOIUrl":"https://doi.org/10.1155/2013/691454","url":null,"abstract":"Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; P = 0.03). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings. ","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2013 ","pages":"691454"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/691454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32056589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 22

The Missing Evaluation at the End of GP's Consultation. 全科医生会诊结束时遗漏的评估。

International journal of family medicine Pub Date : 2013-01-01 Epub Date: 2013-01-08 DOI: 10.1155/2013/672857

Maisa Kuusela, Paula Vainiomäki, Anni Kiviranta, Päivi Rautava

{"title":"The Missing Evaluation at the End of GP's Consultation.","authors":"Maisa Kuusela, Paula Vainiomäki, Anni Kiviranta, Päivi Rautava","doi":"10.1155/2013/672857","DOIUrl":"https://doi.org/10.1155/2013/672857","url":null,"abstract":"Evaluation at the end of a consultation is an element of a successful encounter. The doctor should inquire if patient's expectations were fulfilled and sum up the information given, the examinations performed, and the decisions made with the patient. This way the patient would be fully aware of what has been decided and that the problems and expectations of the patient had been taken into account. Twenty consultations of four general practitioners (GPs) in Finland were videotaped. The doctors were men and women, two of them had a long experience and two were trainees in general practice. The data (videotapes, questionnaires, and interviews) were analysed by multiple research methods with investigator and methodological triangulation. MAAS-Global Rating List was used as an assessment tool. The evaluation of the consultation was often missing or having shortages; only one-third was assessed to be better than doubtful. The assessments done by experienced GPs and the medical student were similar. According to the result of this study as well as the information in the current literature, doctors in all periods of their career should repeatedly be reminded about the importance of the evaluation at the end of the consultation.","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2013 ","pages":"672857"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/672857","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31200629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Ethical diversity and the role of conscience in clinical medicine. 伦理多样性和良心在临床医学中的作用。

International journal of family medicine Pub Date : 2013-01-01 Epub Date: 2013-12-12 DOI: 10.1155/2013/587541

Stephen J Genuis, Chris Lipp

{"title":"Ethical diversity and the role of conscience in clinical medicine.","authors":"Stephen J Genuis, Chris Lipp","doi":"10.1155/2013/587541","DOIUrl":"https://doi.org/10.1155/2013/587541","url":null,"abstract":"In a climate of plurality about the concept of what is \"good,\" one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience-by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. ","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2013 ","pages":"587541"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/587541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32056588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Risk of Burnout in Danish GPs and Exploration of Factors Associated with Development of Burnout: A Two-Wave Panel Study. 丹麦全科医生的职业倦怠风险及与职业倦怠发展相关因素的探索:一项两波面板研究。

International journal of family medicine Pub Date : 2013-01-01 Epub Date: 2013-12-07 DOI: 10.1155/2013/603713

Anette Fischer Pedersen, Christina Maar Andersen, Frede Olesen, Peter Vedsted

{"title":"Risk of Burnout in Danish GPs and Exploration of Factors Associated with Development of Burnout: A Two-Wave Panel Study.","authors":"Anette Fischer Pedersen, Christina Maar Andersen, Frede Olesen, Peter Vedsted","doi":"10.1155/2013/603713","DOIUrl":"https://doi.org/10.1155/2013/603713","url":null,"abstract":"Background. We assessed risk of burnout in GPs during a 7-year followup and examined whether (1) thoughts about changing medical specialty increased the risk of burnout and (2) burned out GPs had higher job turnover rates than burnout-free GPs. Methods. In 2004 and 2012, all GPs in the county of Aarhus, Denmark, were invited to participate in a survey. Retirement status of physicians who participated in 2004 was obtained through the Registry of Health Providers in 2012. Results. 216 GPs completed both surveys. The risk of developing burnout during the 7-year followup was 13.2% (8.2-19.6%). GPs who in 2004 were burnout-free and reported that they would not select general practice as medical specialty again had a statistically significant increased risk of burnout in 2012 (OR = 4.5; 95% CI = 1.2-16.5; P = 0.023). Among GPs with burnout in 2004, 25.0% had withdrawn from general practice during followup compared to 28.8% of burnout-free GPs in 2004 (adj. OR = 0.99; 95% CI = 0.48-2.02; P = 0.975). Conclusion. The 7-year incidence of burnout was 13%. Thoughts about changing medical specialty were an important predictor of burnout. Burned out GPs had not higher job turnover rates than burnout-free GPs. ","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2013 ","pages":"603713"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/603713","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 39

Patient attitudes to tonsillectomy. 患者对扁桃体切除术的态度。

International journal of family medicine Pub Date : 2012-01-01 Epub Date: 2012-12-24 DOI: 10.1155/2012/735684

Kishan Ubayasiri, Ravi Kothari, Lisha McClelland, Mriganka De

{"title":"Patient attitudes to tonsillectomy.","authors":"Kishan Ubayasiri, Ravi Kothari, Lisha McClelland, Mriganka De","doi":"10.1155/2012/735684","DOIUrl":"https://doi.org/10.1155/2012/735684","url":null,"abstract":"Introduction. Recent changes to primary care trusts' Procedures of Limited Clinical Value (PLCV) policy mean that otolaryngologists must now follow policy rather than exercising clinical judgment when listing patients for tonsillectomy. Objectives. To gauge perception within the general public of when tonsillectomy is acceptable and to compare this to the current policy. Method. All patients or their parents attending the adult and paediatric outpatient ENT departments were asked to anonymously complete questionnaires. Results. One hundred and twenty-five completed questionnaires were collected. Thirty-one percent of respondents thought tonsillectomy should be offered solely on patient request, 19% after one to three bouts, and 35% after four to six bouts of tonsillitis. Only 9% thought the current guidelines were reasonable. Patients who had suffered recurrent tonsillitis or had undergone previous tonsillectomy generally thought tonsillectomy advisable after more bouts of tonsillitis than those who had not. Fourteen patients fulfilled the SIGN guidelines for tonsillectomy for recurrent tonsillitis. Of these, 13 (93%) felt that suffering 4-6 bouts of tonsillitis was reasonable before tonsillectomy. Conclusion. All patients we surveyed who meet the current PLCV and SIGN guidelines regarding the appropriateness of tonsillectomy for recurrent tonsillitis perceive that they are excessive, believing that 4-6 bouts of recurrent tonsillitis are adequate to justify tonsillectomy.","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"735684"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/735684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31162936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Access and Barriers to Healthcare Vary among Three Neighboring Communities in Northern Honduras. 洪都拉斯北部三个相邻社区获得医疗保健的机会和障碍各不相同。

International journal of family medicine Pub Date : 2012-01-01 Epub Date: 2012-06-19 DOI: 10.1155/2012/298472

Catherine A Pearson, Michael P Stevens, Kakotan Sanogo, Gonzalo M L Bearman

{"title":"Access and Barriers to Healthcare Vary among Three Neighboring Communities in Northern Honduras.","authors":"Catherine A Pearson, Michael P Stevens, Kakotan Sanogo, Gonzalo M L Bearman","doi":"10.1155/2012/298472","DOIUrl":"https://doi.org/10.1155/2012/298472","url":null,"abstract":"Objective. The aim of this study is to describe and compare access and barriers to health services in three proximal yet topographically distinct communities in northern Honduras served by the nonprofit organization the Honduras Outreach Medical Brigada Relief Effort (HOMBRE). Methods. Study personnel employed a 25-item questionnaire in Spanish at the point of care during HOMBRE clinics in Coyoles, Lomitas, and La Hicaca (N = 220). We describe and compare the responses between sites, using Chi-squared and Fisher Exact tests. Results. Respondents in Lomitas demonstrated the greatest limitations in access and greatest barriers to care of all sites. Major limitations in access included \"never\" being able to obtain a blood test, obtain radiology services, and see a specialist. Major barriers were cost, distance, facility overcrowding, transportation, being too ill to go, inability to take time off work, and lack of alternate childcare. Conclusions. Despite being under the same local health authority, geographically remote Honduran communities experience greater burdens in healthcare access and barriers than neighboring communities of the same region.","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"298472"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/298472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30750235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Secrecy and the pathogenesis of hypertension. 高血压的发病机制与保密。

International journal of family medicine Pub Date : 2012-01-01 Epub Date: 2012-07-03 DOI: 10.1155/2012/492718

Randi Ettner, Frederic Ettner, Tonya White

引用次数: 11

What, in Fact, Is the Evidence That Vaccinating Healthcare Workers against Seasonal Influenza Protects Their Patients? A Critical Review. 为医护人员接种季节性流感疫苗可保护患者的证据究竟是什么？批判性评论。

International journal of family medicine Pub Date : 2012-01-01 Epub Date: 2012-11-11 DOI: 10.1155/2012/205464

Zvi Howard Abramson

{"title":"What, in Fact, Is the Evidence That Vaccinating Healthcare Workers against Seasonal Influenza Protects Their Patients? A Critical Review.","authors":"Zvi Howard Abramson","doi":"10.1155/2012/205464","DOIUrl":"10.1155/2012/205464","url":null,"abstract":"Background and Methods. Vaccination of all healthcare workers is widely recommended by health authorities and medical institutions and support for mandatory vaccination is increasing. This paper presents the relevant literature and examines the evidence for patient benefit from healthcare worker vaccination. Articles identified by Medline searches and citation lists were inspected for internal and external validity. Emphasis was put on RCTs. The literature on self-protection from vaccination is also presented. Results. Published research shows that personal benefit from vaccinating healthy nonelderly adults is small and there is no evidence that it is any different for HCWs. The studies aiming to prove the widespread belief that healthcare worker vaccination decreases patient morbidity and mortality are heavily flawed and the recommendations for vaccination biased. No reliable published evidence shows that healthcare workers' vaccination has substantial benefit for their patients-not in reducing patient morbidity or mortality and not even in increasing patient vaccination rates. Conclusion. The arguments for uniform healthcare worker influenza vaccination are not supported by existing literature. The decision whether to get vaccinated should, except possibly in extreme situations, be that of the individual healthcare worker, without legal, institutional, or peer coercion.","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":"2012 ","pages":"205464"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31098228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors That Influence HIV Risk among Hispanic Female Immigrants and Their Implications for HIV Prevention Interventions. 影响西班牙裔女性移民艾滋病毒风险的因素及其对艾滋病毒预防干预的影响。

International journal of family medicine Pub Date : 2012-01-01 Epub Date: 2012-02-08 DOI: 10.1155/2012/876381

Amy M Hernandez, William A Zule, Rhonda S Karg, Felicia A Browne, Wendee M Wechsberg

{"title":"Factors That Influence HIV Risk among Hispanic Female Immigrants and Their Implications for HIV Prevention Interventions.","authors":"Amy M Hernandez, William A Zule, Rhonda S Karg, Felicia A Browne, Wendee M Wechsberg","doi":"10.1155/2012/876381","DOIUrl":"https://doi.org/10.1155/2012/876381","url":null,"abstract":"Hispanics are the fastest growing minority group in North Carolina with increasing incidence of HIV infection. Gender roles, cultural expectations, and acculturation of women may explain some of Hispanic women's risks. The perspectives of Hispanic female immigrants and community-based providers were sought to identify services they offer, understand HIV risk factors, and support the adaptation of a best-evidence HIV behavioural intervention for Hispanic women. Two sets of focus groups were conducted to explicate risks and the opportunities to reach women or couples and the feasibility to conduct HIV prevention in an acceptable manner. Salient findings were that Hispanic female immigrants lacked accurate HIV/AIDS and STI knowledge and that traditional gender roles shaped issues surrounding sexual behaviour and HIV risks, as well as condom use, partner communication, and multiple sexual partnerships. Intervention implications are discussed such as developing and adapting culturally appropriate HIV prevention interventions for Hispanics that address gender roles and partner communication.","PeriodicalId":89569,"journal":{"name":"International journal of family medicine","volume":" ","pages":"876381"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/876381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40169115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 26