London journal of primary care最新文献

{"title":"Promoting Mental Health and Preventing Mental Illness in General Practice.","authors":"Steve Thomas,&nbsp;Rachel Jenkins,&nbsp;Tony Burch,&nbsp;Laura Calamos Nasir,&nbsp;Brian Fisher,&nbsp;Gina Giotaki,&nbsp;Shamini Gnani,&nbsp;Lise Hertel,&nbsp;Marina Marks,&nbsp;Nigel Mathers,&nbsp;Catherine Millington-Sanders,&nbsp;David Morris,&nbsp;Baljeet Ruprah-Shah,&nbsp;Kurt Stange,&nbsp;Paul Thomas,&nbsp;Robert White,&nbsp;Fiona Wright","doi":"10.1080/17571472.2015.1135659","DOIUrl":"https://doi.org/10.1080/17571472.2015.1135659","url":null,"abstract":"<p><p>This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 1","pages":"3-9"},"PeriodicalIF":0.0,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1135659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776179","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}

{"title":"Community-oriented collaboration for mental health care and mental health promotion.","authors":"Paul Thomas,&nbsp;David Morris","doi":"10.1080/17571472.2015.1136127","DOIUrl":"https://doi.org/10.1080/17571472.2015.1136127","url":null,"abstract":"partnership between schools and clusters of general practices, how music and the arts can contribute to healing and building communities. We will highlight the social and occupational impacts on mental health at all stages of life – parents, schools, workplace, retirement, the third age, end of life. We will argue that primary care does not have to do all of this, but that it is key to orchestrating it. Together we need to define a curriculum of skills and systematic ways for health care practitioners and managers to learn how to do this in sustainable, enjoyable ways. The central role of primary care in integrating mental health care and mental health promotion was noted over a decade ago by the much-missed Helen Lester, in a British Journal of General Practice paper titled ‘Integrated primary mental health care: threat or opportunity in the new NHS?’.[1] She and her co-authors explained that:","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1136127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776177","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}

{"title":"Wally Neuzil : a special woman and a therapist","authors":"F. Carelli","doi":"10.1080/17571472.2015.1113712","DOIUrl":"https://doi.org/10.1080/17571472.2015.1113712","url":null,"abstract":"Wally Neuzil was Egon Schiele’s companion for just four years. She was also the model who posed for many of his drawings and watercolors. Thinking about this woman, there is one thing that is particularly striking: it is her gaze – her strangely reticent, quietly searching gaze. It emanates from her bright, open eyes, barring the way to nothing and no one, perhaps almost seen as light emerging from them. Through her gaze she conveyed not only an inner calm, but also a mirror that neither distorted nor suppressed. \u0000 \u0000Wally had a quiet power – something we can still see today in the eyes of the portraits that Schiele created of her. \u0000 \u0000The exhibition that Leopold Museum in Vienna dedicated to Wally’s biography and her professions describes the fate of a woman at the fin de siecle living a life without taboos and with a profound humanity. \u0000 \u0000Wally Neuzil was not only Egon Schiele’s model from early 1911 but also his lover and faithful companion until the spring of 1915. While a model for Schiele, Wally also worked as a sales assistant, a cashier and mannequin at a clothing store.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"118 - 119"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1113712","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60418162","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":"A network of activists for community-oriented integrated care","authors":"P. Thomas, D. Morris","doi":"10.1080/17571472.2015.1113713","DOIUrl":"https://doi.org/10.1080/17571472.2015.1113713","url":null,"abstract":"This Issue of LJPC includes papers written by LJPC editors that challenge primary care practitioners and managers in the UK to lead a renaissance of the NHS through the language of community-oriented integrated care – team-based, locality-based care that has health as its focus as well as disease management. This challenge will be made repeatedly throughout 2016 as LJPC papers explore what it is to be healthy at various stages of life, and how primary care can enhance this. \u0000 \u0000In this Issue, Olivia Martin, a fourth year medical student, felt moved to write about her observation of a GP consultation that was entirely about helping a patient to think through a difficult decision. The role of a GP as facilitator of sense-making is obvious to experienced GPs, because this is how they help people to find health. It lies at the heart of the GP role. Yet it is rarely described either in the popular explanation of what GPs do or, as in the case of this particular student’s training, in content of the professional training curriculum. The challenge is to make this sense-making role widely understood – in training, in strategy and in evaluation. \u0000 \u0000 \u0000Peter Toon, retired GP and LJPC editor, picks up the theme of GP as sense-maker through the language of flourishing narratives and the lens of virtue ethics. He writes: \u0000 \u0000most ethical problems which practitioners face are not caused by cutting edge technology or extraordinary situations, but by the normal messy complexities of human life and relationships … [people] are not merely looking for a life which is the longest string of pleasurable experiences possible with the minimum number of unpleasant ones, but for a life which makes sense and has a purpose and a shape. \u0000 \u0000 \u0000 \u0000 \u0000The challenge is to use consulting styles that help individuals to make sense of the breadth of their diseases, and help groups of people to make sense of their health as whole communities. Primary care practitioners of the future need to be skilled at techniques that help people to help themselves – things, like family conferences, self-help and community development initiatives. \u0000 \u0000Alison While, Emeritus Professor of Community Nursing and LJPC editor, invites us to practice the health promotion we preach. The healthcare workforce, including primary healthcare staff, exhibits the same health behaviours as the general population – like everyone else we struggle to maintain healthy lifestyles, healthy relationships and healthy organisations. We need to give realistic advice; and in doing so, draw on ourselves as human beings and not merely our roles as professionals. We need to be better at putting ourselves into the shoes of others. \u0000 \u0000In 2016, LJPC will continue the theme of ‘putting one-self into the shoes of others’. When doing this it becomes obvious that different perspectives help to see more of the whole picture of health. Valuing and drawing on multiple perspectives underpin the kind of teamworking that is needed to manage compl","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"107 - 108"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1113713","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60417828","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":"Holistic General Practice: A Student`s Perspective","authors":"Olivia Martin","doi":"10.1080/17571472.2015.1113714","DOIUrl":"https://doi.org/10.1080/17571472.2015.1113714","url":null,"abstract":"Abstract This patient was a lady in her 50s who had previously been diagnosed with anxiety, depression and rectal cancer. She had undergone neo-adjuvant chemotherapy designed to shrink the tumour before it was removed surgically. However, the cancer responded better than expected to the chemotherapy, and the oncologists could no longer find evidence of active cancer within the patient. The oncologist had recently been speaking with the patient about whether or not she should continue with the surgery they had originally planned. The oncologist was keen to go ahead with the surgery, as it offered the best chance of long term disease free survival. The patient, however, was extremely nervous about going through major surgery, and was less sure that it was the right option now that she had been told that there was no evidence of active cancer. However, she had been unable to come to a definitive decision despite 3 consultations with her oncologist and the surgeons ready to perform the operation and the oncologist had written to the patients GP to this effect. This patient taught me a variety of things. Firstly, the background given to me about this patients’ first consultation opened my eyes to the importance of certain parts of the medical history. For example, the rectal cancer was only picked up due to additional symptoms found during the review of systems. The patient consultation that I witnessed was regarding a decision the patient was struggling to make over whether or not to have surgery following seemingly successful neo-adjuvant chemotherapy. The patient was struggling to make this decision due to a lack of support and the GP had scheduled this appointment to help her come to terms with the decision that she needed to make.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"109 - 111"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1113714","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60418182","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":"Promoting healthy behaviours – do we need to practice what we preach?","authors":"A. While","doi":"10.1080/17571472.2015.1113716","DOIUrl":"https://doi.org/10.1080/17571472.2015.1113716","url":null,"abstract":"Abstract The UK faces a public health challenge arising from unhealthy behaviours. Some health care workers engage in the same unhealthy behaviours as the general population. This paper explores the issues arising from some primary care staff adopting unhealthy behaviours upon healthcare organisations, professional practice and patient perceptions in terms of the promotion of health in the primary care setting.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"112 - 114"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1113716","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60417914","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":"What is healthcare for?","authors":"P. Toon","doi":"10.1080/17571472.2015.1113715","DOIUrl":"https://doi.org/10.1080/17571472.2015.1113715","url":null,"abstract":"Why this matters to me I find the lack of clarity about the fundamental purpose of health care which causes moral conflict and inappropriate clinical activity, damaging clinicians and patients alike, very disturbing. use, distribution, and reproduction in any medium, provided the original work is properly cited. What is medical ethics? If you read the newspapers or listen to Radio 4 you would get the impression that medical ethics is the discussion of moral problems posed by modern medical technology or bizarre situations – whether and when it is permissible to turn off life support machines [1], the implications of ever more sophisticated techniques in assisted conception [2] or whether to amputate a normal leg because the patients asks for it [3]. This I call 'tabloid ethics'. If you work in primary health care however you will know that most ethical problem which practitioners face are not caused by cutting edge technology or extraordinary situations, but by the normal messy complexities of human life and relationships. Exactly what do you write and how do you phrase it when asked about a health problem in a medical report which may affect someone's insurance, mortgage or job?[4] How hard should you try (if at all) to persuade someone with a high cholesterol of the benefits of statins? How do you handle information which you obtain from one person in confidence which has implications for the health or well-being of someone else? Although they still do not get the attention they deserve, there is increasing recognition within the health professions, if not in the media, of the importance of these and the many other questions which make up 'everyday ethics' [5] or 'the ethics of the ordinary' [6], and there are conferences, workshops, books, journal articles and websites [7] which try to help practitioners deal with them. However, a more fundamental question even more rarely discussed underlies both tabloid and everyday ethics. What is health care for? We spend lots of time and money making sure our practice is as efficient and evidence based as possible, but rarely stop to consider why we do what we do. Many people would say the answer was obvious: saving lives and preventing or relieving pain and suffering. But lives are never saved. Mortality remains 100%, and death is merely postponed. An expression originally used to refer to saving someone from drowning or other sudden traumatic death …","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"12 1","pages":"115 - 117"},"PeriodicalIF":0.0,"publicationDate":"2015-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1113715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60418306","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":"Steroid-induced hyperglycaemia in primary care.","authors":"Edouard Mills, Senan Devendra","doi":"10.1080/17571472.2015.1082344","DOIUrl":"10.1080/17571472.2015.1082344","url":null,"abstract":"","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"103-106"},"PeriodicalIF":0.0,"publicationDate":"2015-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60417669","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}

{"title":"Singling out the double effect - sexual health advice and contraception are ethically distinct","authors":"S. Bow","doi":"10.1080/17571472.2015.1082341","DOIUrl":"https://doi.org/10.1080/17571472.2015.1082341","url":null,"abstract":"Abstract This article is a response to an article previously published in LJPC, which employed the doctrine of double effect to explain the Gillick judgement and exculpate health care workers who provide contraceptives and sexual health advice to under-16s. In this analysis, the two acts: provision of contraceptives and provision of sexual health advice are examined separately against the four criteria of the doctrine of double effect. In conclusion, whilst sexual health advice provision fits into the doctrine reasonably well, in the case of contraceptive provision, the validity of the doctrine of double effect is more doubtful.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"92 - 95"},"PeriodicalIF":0.0,"publicationDate":"2015-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1082341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60417735","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":"Singling out the double effect – some further comment","authors":"A. Papanikitas, J. Spicer","doi":"10.1080/17571472.2015.1082346","DOIUrl":"https://doi.org/10.1080/17571472.2015.1082346","url":null,"abstract":"Abstract We comment on a paper published in the same issue of the London Journal of Primary Care. We applaud Bow’s engagement with the ethical issues in a previous LJPC paper but argue that further work is needed to establish the everyday moral concerns of health care workers in primary care. We also suggest that the ethical distinction between advice and medication and devices may be artificial if both have an effect on a patient.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"7 1","pages":"96 - 96"},"PeriodicalIF":0.0,"publicationDate":"2015-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2015.1082346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60418063","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}