London journal of primary care最新文献

{"title":"Considering change.","authors":"Kate Mtandabari","doi":"10.1080/17571472.2017.1410312","DOIUrl":"https://doi.org/10.1080/17571472.2017.1410312","url":null,"abstract":"It was a beautiful summer’s afternoon. I remember this because, earlier, I had walked across the river from the South Bank to Charing Cross. It is one of my favourite views – looking down towards St Paul’s on the right, the Houses of Parliament on the left, walking away from the thrill of the SouthBank and joining the mass of activity on the walk from Embankment to Trafalgar Square. I was in a meeting. The wonderful director I was working with was introducing me to a colleague. ‘When I met Kate it was as a GP’ my boss was saying, ‘but now, of course, I realise she is a change agent’. This made me stop. I felt this over­riding relief. All these ideas I have, people I connect with and the things I do in my professional and personal life, they are all bound in change. Change for the better. Change to make a difference. At times, I think it is an aspiration to make life the best it can be, physically or emotionally, for as many people as possible. At others times I recognise something about navigating the turbulent river of the human condition. I could explore why I am interested in change more. And, being psychologically minded, I naturally do. However, most of the time I simply embrace my interest in change and do the ‘doing’ of change. After that meeting, with that wonderful director, on that beautiful summer’s day, that’s exactly what I did. I am still not sure about the words “change agent”, but I certainly love what I do and “change” is the theme. If you would like to read more about Coaching for change, I have included a brief bibliography and my thoughts about the books below. John Whitmore’s ‘Coaching for Performance’ (2009) is a gentle introduction to coaching and his GROW model. I found it’s simplicity refreshing and enjoy the book for some light, yet effective, reading. Many will be familiar with Jenny Roger’s ‘Adult Learning’ text. Her ‘Coaching Skills. A Handbook’ is a deeper consider­ ation of coaching and helped me find Coaching’s meaning and place when I was coming from a therapeutic – clinical background. The NHS is investing in Coaching – to under­ stand what internal caching schemes are about, the strengths and challenges – Katherine St John­Brook’s book is excellent. Finally, so much is being said about resilience and it is such an interesting concept. To consider resilience within different paradigms Carol Pemberton’s book is a great start. Why this matters to me i am passionate about enabling people to articulate what they want to change and feel Coaching tools, in particular, can help people navigate change. ultimately this is with the aim of helping people fulfil their potential, improve their performance and be happier both in the workplace and their personal lives.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"10 1","pages":"14-15"},"PeriodicalIF":0.0,"publicationDate":"2017-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1410312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35838027","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":"Are we enabling the next generation to thrive?","authors":"Emma McKenzie-Edwards","doi":"10.1080/17571472.2017.1402496","DOIUrl":"https://doi.org/10.1080/17571472.2017.1402496","url":null,"abstract":"Child health and development are clearly top priorities on most parent’s minds, yet parents and non-parents alike we all share concern about these issues. Well managed, they form part of the bedrock of a stable, thriving society. Once we reach adulthood we risk losing connection with what it means to be a child. This sense of disconnection has become even more noticeable with the emergence of the ‘iPad generation’ whose engagement with the world is shaped through technology rather than interpersonal interaction. As part of our initiative to explore these issues, LJPC has previously looked with interest at concepts to do with young minds and their healthy development and how critical connected communities are to their citizens well-being. In LJPC 8.1 Robert Winston and Rebecca Chicot’s paper on children’s mental health and resilience highlighted the importance of early bonding to help develop long-lasting, harmonised, integrated thinking [1]. Susan Hallam, who published her findings from the music for life project in LJPC 8.2, discussed in her work ‘The Power of Music’ the significant positive impact of music on the child’s developing mind [2,3]. We have also looked at how art can influence and enhance learning in Francesco Carelli’s reflections. Dr. Younie opens this issue with her thoughtful piece ‘Beginners mind’[4], an engaging and fresh look at the ideas around patient engagement focusing on the ideas of an inductive, flow based approach. Flow is an interesting concept. Hungarian psychologist Michaly Csikszentmihalyi described it as a state of heightened focus and immersion in activities such as art, play and work which can allow us to feel fulfilled and happy in our endeavours [5].Children seem to have natural propensity for this beneficial state. Remastering it as an adult is a challenge. LJPC is interested to explore the value of approaches such as mindfulness to enhance flow, mental health and wellbeing. With the worrying trend of increased numbers of child mental health consultations in primary care, Ryan et al. discuss the relative effectiveness of the most widely used parenting programmes on children’s behavioural problems and mental health [6]. The evidence base for the use of programmes in older preschool and school age children is promising. As a number of studies indicate that the first signs of behavioural problems can appear as early as infancy, forthcoming research for programmes targeting the first two years of life may yet encourage us to consider these interventions from an early stage. Should we be exploring attachment and early childcare arrangements more fully in this context? Xiajuan Tan invites us to consider the efficacy of intensive home-based intervention, Multisytematic Therapy, when managing young people with severe antisocial behaviour and emotional disorders [7]. Significant, positive effects on delinquency, incarceration and suicide attempts are discussed in the systematic review. Antisocial behaviour and conduct","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 6","pages":"81-82"},"PeriodicalIF":0.0,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1402496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35595057","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":"The trouble with illness. How illness and disability affect relationships","authors":"P. Thomas","doi":"10.1080/17571472.2017.1397589","DOIUrl":"https://doi.org/10.1080/17571472.2017.1397589","url":null,"abstract":"If you are in a relationship with someone who is sick and you can’t understand why you are unhappy, you will find this book helpful. The book shows that it is common when illness strikes to develop a habit of negative thoughts and harmful actions. Case studies in the book show that many become angry and confused from incapacity, pain, rejection and loss, and these change the way we think. The author uses quotes and anecdotes from people she has counselled over 35 years to show how anxiety caused by illness can warp our subconscious minds and lead us to behave towards others in damaging ways. We project our inner ‘phantasies’ (p.44) – ideas, beliefs, stories, mental models, that we use to make sense of the world – onto others, behaving in rejecting, un-listening, unkind and unfair ways towards them. This behaviour is common in sick people and in their families and carers. As well as helping people to understand the damaging effects that illness can have on relationships, the author wants to contribute to ‘understanding how people feel and react in the context of illness or damage to the body.... not simply to understand the world but to change it’ (p.13). This aim to facilitate positive change is particularly interesting to me as a GP since I often see patients who want to find positive things in their otherwise negative illness experience. I have often seen illness stimulate positive, revitalisation of relationships, so I know it is possible. But I have also seen it precipitate negative distancing, sometimes even frank abuse, both from the sick to the carer and the carer to the sick. I want to know how to chart a positive course. I found this aim to be less well served by the book, perhaps because the book focuses on those who sought counselling rather than those who did not, and perhaps because it focuses on the feelings of individuals rather than actions people can take together to build happy, loving relationships. The book does suggest some actions that people can take to enhance relationships during illness for example, quality communication and doing creative things together. Humour can help to say distressing things in more tolerable ways (p.97). Intimacy is especially important, including cuddles, hugs and touch as well as sexual intimacy to affirm that ‘the body as well as the mind is wanted, loved, cared for and functioning in a good way’ (p.135). The book reminds us to be honest but gentle when explaining to children what is happening, and avoid projecting our anxieties onto them (p.247). I found particularly interesting the description of two common ways that people respond to anxiety that cause them to dissociate themselves from others and become inward-looking – depressive and paranoid-schizoid ‘positions’. The depressive position passively weakens relationships through withdrawal that sucks the joy out of relationships. The paranoid-schizoid (p-s) position actively destroys relationships underlying panic and ‘massive fears’ cause t","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"10 1","pages":"13 - 13"},"PeriodicalIF":0.0,"publicationDate":"2017-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1397589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49379921","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":"Preschool growth and nutrition service - addressing common nutritional problems: a community based, primary care led intervention.","authors":"Samantha Ross,&nbsp;Charlotte Wright","doi":"10.1080/17571472.2017.1391460","DOIUrl":"https://doi.org/10.1080/17571472.2017.1391460","url":null,"abstract":"<p><p>Childhood obesity has been prioritised by the World Health Organization in a recent report, which calls for a holistic multiagency approach to tackling and reducing future risks of obesity and its associated co-morbidities. This article examines a health service approach to improving recognition and management of pre-school nutritional problems as part of training health care professionals. It explores the practicalities of setting up a local pathway for managing cases in the community with appropriate specialist support. This model, developed for the management of weight faltering, has now been adapted to tackle childhood obesity.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 6","pages":"104-108"},"PeriodicalIF":0.0,"publicationDate":"2017-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1391460","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35595061","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":"Benefits, harms and evidence - reflections from UK primary healthcare.","authors":"Margaret McCartney","doi":"10.1080/17571472.2017.1384610","DOIUrl":"10.1080/17571472.2017.1384610","url":null,"abstract":"<p><p>In this paper I examine the relationship between benefits, harms and evidence-based medicine in the context of British primary healthcare. First, I will examine: 'What is a benefit and what is a harm?' Second, what should we know about where the balance of risk and benefit appear to lie? Third, what should we do with this knowledge, particularly in the context of the biopsychosocial gaze of primary care? I conclude that even perfect knowledge about benefits and harms requires to be translated in the context of the individual patient: it also requires to be interpreted according to what that persons' wishes are.</p><p><strong>Why this matters to me: </strong>By reiterating again and again how biases are stacked in favour of recommending treatments and interventions well beyond their rational evidence, my hope is that more honest medicine will result in less but higher value medicine. Stopping doing things that don't work, or work rarely, or come with an unacceptable burden of side effects or appointments should make room for the pleasure of practicing medicine.</p><p><strong>Key messages: </strong>•Even perfect knowledge about benefits and harms requires to be translated in the context of the individual patient: it also requires to be interpreted according to what that persons' wishes are.•In the real, messy frontline world of general practice, we will always have uncertainty about where the balance of risk and benefit might lie.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"10 1","pages":"8-12"},"PeriodicalIF":0.0,"publicationDate":"2017-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35838026","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":"Beginner's mind.","authors":"Louise Younie","doi":"10.1080/17571472.2017.1370768","DOIUrl":"https://doi.org/10.1080/17571472.2017.1370768","url":null,"abstract":"<p><p>The concept of 'beginner's mind' invites the expert medical professional to be present to their patients, remaining curious and responsive in the face of the individuality of illness. Each patient is a universe of unknowns, presenting with suffering which cannot always be classified with a diagnosis. Improvisation and openness may not just benefit our patients enduring their patient journeys but may also revive and reconnect us with our own humanity.</p><p><strong>Why this matters to me: </strong>My experience as cancer patient brought home to me the value of encountering a doctor who was present and able to listen and respond to me as an individual. It did not necessarily take longer, but was about an attitude of heart.Like any professional, as GPs we are at risk of presumption and habitual thinking. Beginner's mind, that is recapturing the openness and curiosity modelled to us by children, can powerfully transform the medical encounter, allowing space for emergence of patient perspective and doctor response.</p><p><strong>Key message: </strong>Embrace curiosity and learning into our expert clinical practice.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 6","pages":"83-85"},"PeriodicalIF":0.0,"publicationDate":"2017-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1370768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35595058","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":"Introduction to LJPC Issue 9.5.","authors":"Paul Thomas","doi":"10.1080/17571472.2017.1364742","DOIUrl":"https://doi.org/10.1080/17571472.2017.1364742","url":null,"abstract":"Issue 9.5 of LJPC combines two essential aspects of modern-day primary care – good clinical care and leadership of integrated care. Victoria Tzortziou Brown and seven co-authors review six innovations designed to bring specialist expertise about Chronic Kidney Disease and Chronic Obstructive Airway Disease right into primary care. They discuss transferable lessons for shared care at local, community level for other long-term conditions. In the second of their series, the Hurst/Kelley-Patterson/ Knapton team show how clever data gathering can help us to ask the right kind of questions about the design of integrated care. In this paper they reveal a close association between Emergency Department attendances and low patient satisfaction with their general practices. But there are some important twists to the story. Read it to get your mind thinking beyond the obvious. Cheong, Alexiadou and Devendra elegantly review the causes and treatments of foot neuropathy. The discussion was triggered by a case study of a man who was found by the practice nurse to have absent monofilament sensation at his routine diabetic check. This is a helpful reminder for clinicians to be alert to silent things going wrong in the legs. OPEN ACCESS","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 5","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2017-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1364742","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35556885","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":"Absent monofilament sensation in a type 2 diabetic feet.","authors":"Julia Cheong,&nbsp;K Alexiadou,&nbsp;Senan Devendra","doi":"10.1080/17571472.2017.1370813","DOIUrl":"https://doi.org/10.1080/17571472.2017.1370813","url":null,"abstract":"<p><p>Neuropathy is a common complication which can affect up to 90% of patients with diabetes mellitus. Asymptomatic neuropathy is a common presentation. We present a case that emphasises the importance of foot screening in people with diabetes. It also highlights that patient education is key to prevent development of foot ulceration which can lead to amputations. In addition, pharmacological therapy (as per NICE guidance) can be offered for pain relief. Patients with diabetic neuropathy are at high risk of falling and sustaining fractures.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 5","pages":"73-76"},"PeriodicalIF":0.0,"publicationDate":"2017-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1370813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35556888","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":"Carelli on art 'The Dali Universe'.","authors":"Francesco Carelli","doi":"10.1080/17571472.2017.1364743","DOIUrl":"https://doi.org/10.1080/17571472.2017.1364743","url":null,"abstract":"<p><p>Interactive and multimedia methods are the future, already developing in teaching and learning modules in Medicine. It happens and has to happen because: 1) It improves tools for the teacher in preparing and showing the bulk of materials on which students must study and learn; it enables interactivity with learners both in formative pathway and in final assessment. 2) It improves attention, interest and involvement of students and learners, and acts as a guideline to progressive broadening in researches, studies, considerations, and information exchanges among different learners. 3) The rapid progress in application of technology, WEB area and sources researches allows such a deepening and widening interactivity that before was never possible to imagine. It is the same thing also in CME, sometimes so dry, and dropped from above, while the new methodology may/must get rid of negative and boring features, often not useful in producing particular improvements in knowledge and quality. The Professional Doctor needs to feel a protagonist part in situation to be investigated, where interaction with all what media tools can offer may produce an \"educative\" improvement, much faster, effective and pleasant/rewarding.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 6","pages":"109-110"},"PeriodicalIF":0.0,"publicationDate":"2017-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1364743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35595062","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":"Scarlet fever: a guide for general practitioners.","authors":"S Basetti,&nbsp;J Hodgson,&nbsp;T M Rawson,&nbsp;A Majeed","doi":"10.1080/17571472.2017.1365677","DOIUrl":"https://doi.org/10.1080/17571472.2017.1365677","url":null,"abstract":"<p><p>There has been an increase in the incidence of scarlet fever with most cases presenting in General Practice and Emergency Departments. Cases present with a distinctive macro-papular rash, usually in children. This article aims to increase awareness of scarlet fever by highlighting key symptoms and stating potential complications if untreated. In patients who have the typical symptoms, a prescription of a suitable antibiotic such as phenoxymethylpenicillin (Penicillin V) should be made immediately to reduce the risk of complications and the spread of infection.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 5","pages":"77-79"},"PeriodicalIF":0.0,"publicationDate":"2017-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1365677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35556889","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}