London journal of primary care最新文献

{"title":"Brueghel: his art and his syndrome.","authors":"Francesco Carelli","doi":"10.1080/17571472.2017.1317405","DOIUrl":"https://doi.org/10.1080/17571472.2017.1317405","url":null,"abstract":"The exhibition is a fascinating journey into the Golden Age of Flemish Paintings of the seventeenth century, in a search for the visionary genius of as many as five generations of artists. They are able to embody as one, like as nobody before or after them, the style and trends of more than a century of history of art. While the Italian Renaissance focuses attention on the human figure’s noble and virtuous ideal through the experiences of Michelangelo, Leonardo and Tiziano, in Flanders the perspective radically changes. Pieter Brueghel the Elder, the family’s ancestor who knew well Italian painting, addresses himself to the daily reality of human life, and investigated all its aspects without exclusion. He dwelled on peasants’ and merchants’ shadows and vices, on living labour, but also on people’s cheeriness, often coarse and rough. It was inevitably both crude and realistic. And if in Italian Renaissance, nature is restricted to be the background for the magnificent plastic and aesthetic superiority of man; in Flemish painting, and in Brueghel’s style, nature fully takes on the role of the true protagonist of human history. It is presented with a visual wealth, an attention to detail and a compositional beauty never seen before in the history of painting. Pieter Brueghel the Elder, and his rich progeny after him, were the inventors of a pictorial code soon to become the brand of his articulate family that since the middle of sixteenth century were active for two centuries. Brueghel’s gaze settled on simple humanity, free but at the same time the slave of its needs, continuously moving between spiritual trends and the virtuous and vicious carnal seductions. The Brueghel are tellers of facts and stories. In their works there is a telling of true life, as peasants bent by their living fatigue, drunks or beggars. There are also individuals represented only from behind, as anonymous characters going on their way of existence, being unaware and indifferent to the by standing observer looking at the painting. One of these very realistic characters, painted by Peter Brueghel the Elder, is of the action of yawning widely, in the work named De Gaper. It was taken by the English neurologist David Marsden as the paradigm of Brueghel’s Syndrome, in a medical article issued in 1976 about blepharospasm and oromandibular dystonia.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 3","pages":"43-44"},"PeriodicalIF":0.0,"publicationDate":"2017-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1317405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35024574","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":"Ethical religion in primary care.","authors":"Malcolm Torry","doi":"10.1080/17571472.2017.1317407","DOIUrl":"https://doi.org/10.1080/17571472.2017.1317407","url":null,"abstract":"<p><p>Religion is increasingly significant in UK society, and is highly significant for many patients and primary care practitioners. An important task for the practitioner is to ensure that the place of religion in the patient/practitioner relationship is treated with the same ethical seriousness as every other aspect of that relationship. The article finds the 'four principles of biomedical ethics' to be applicable, and recent GMC guidelines to be consistent with the four principles. The article applies the four principles to the particular case of practitioners wearing religious symbolism.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 4","pages":"49-53"},"PeriodicalIF":0.0,"publicationDate":"2017-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1317407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35324655","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":"Human immunodeficiency virus and type 2 diabetes.","authors":"P Avari,&nbsp;S Devendra","doi":"10.1080/17571472.2017.1302872","DOIUrl":"https://doi.org/10.1080/17571472.2017.1302872","url":null,"abstract":"<p><p>The prevalence of diabetes is higher amongst individuals infected with HIV. The major contributor to hyperglycaemia is thought to be iatrogenic, with protease inhibitors being most commonly associated to insulin resistance. This article is to update general practitioners on the diagnosis and management of diabetes in HIV-infected patients. Specific considerations are highlighted including interactions of particular diabetic drugs with antiretroviral therapy (ART). We articulate why the use of Hemoglobin A1c (HbA1c) testing is not recommended as a diagnostic tool.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 3","pages":"38-42"},"PeriodicalIF":0.0,"publicationDate":"2017-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1302872","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35024573","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":"New Care Models revisited.","authors":"Paul Thomas","doi":"10.1080/17571472.2017.1299163","DOIUrl":"https://doi.org/10.1080/17571472.2017.1299163","url":null,"abstract":"This Issue of LJPC (9.2) is deliberately short, to complement a Virtual Issue on New Care Models, also presented in March 2017. The Virtual Issue highlights 18 previously published LJPC papers that have explored different aspects of integrated care and health promotion at local, community level. These papers will support discussions at the 30 March 2017 London City Health Conference, hosted by RCGP London in collaboration with LJPC. The City Health Conference focuses on New Models of Care – ways to integrate care and health promotion at local, community level. Simply put, general practice cannot achieve on its own everything that general practice needs to achieve. Its traditional values of whole person, community-oriented care and health promotion need to be embedded within whole communities, networks and systems. This means systems to support a grand alliance for health and care – horizontally for inter-disciplinary team-working that builds communities for health, and vertically for generalist/specialist collaboration for good medical care. The question is, how we do this in sustainable and efficient ways? The two papers in Issue 9.2 build from the 18 papers in the Virtual Issue on New Care Models • Lee and Titchener describe the GSTT@home service. This initiative brings specialist care into patients homes to treat relapse of chronic conditions, infections requiring IV therapy, heart failure, urinary tract infections, falls, community acquired pneumonia, diabetes and blood monitoring. It provides a transferable model of complex collaborations for the care of sick people at home. • Kelley-Patterson, Knapton and Hurst describe ways to generate comparative data from large databases to demonstrate the effect of complex collaborations such as hospital at home, to scrutinise and defend variation, and to take ownership of decision-making at a local level. It would be possible to use such data in annual cycles of learning and change to see the combined effect of multiple initiatives for health and care.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 2","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2017-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1299163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867275","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":"Does attending general practice prior to the emergency department change patient outcomes? A descriptive, observational study of one central London general practice.","authors":"S Morton,&nbsp;R Hames,&nbsp;I Kelso,&nbsp;A Newth,&nbsp;S Gnani","doi":"10.1080/17571472.2017.1280893","DOIUrl":"https://doi.org/10.1080/17571472.2017.1280893","url":null,"abstract":"<p><strong>Background: </strong>The challenge of keeping Emergency Department (ED) attendances down continues and timely access to general practice (GP) is often portrayed as a potential solution.</p><p><strong>Setting: </strong>One London general practice (registered population = 4900).</p><p><strong>Question: </strong>Does seeing a GP before attending the ED affect the outcome of a patient's ED care?</p><p><strong>Methods: </strong>Routine clinical data were extracted using SystmOne primary care computer system for all registered patients with an ED attendance between 1 October 2014 and 31 September 2015. The scanned discharge summaries from the ED and GP notes were reviewed and outcome measures extracted.</p><p><strong>Results: </strong>227 patients (121 female; 104 male) attended the ED. The most common presentation was abdominal pain (<i>n</i> = 11). 25% of patients had seen (<i>n</i> = 50), or contacted by phone (<i>n</i> = 6), a GP about the same presenting complaint before attending the ED. Of those, 73% (<i>n</i> = 41/56) were referred to the ED and 49% (<i>n</i> = 20/41) were admitted versus 33% (<i>n</i> = 60/184) who self-presented (statistically significant, <i>p</i> = 0.05). An additional 32% of those who saw the GP first (<i>n</i> = 13/41) received specialist ED treatment.</p><p><strong>Discussion/conclusion: </strong>Only 25% of patients see their GP prior to attending the ED. The majority of patients who were referred by their GP required admission or specialised ED treatment. It remains unclear why the majority of patients did not choose to contact their GP prior to attending the ED, despite urgent appointments being offered; research into patients' health beliefs in this group is required for greater understanding.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 3","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1280893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35024571","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 9.1.","authors":"Paul Thomas","doi":"10.1080/17571472.2016.1274935","DOIUrl":"https://doi.org/10.1080/17571472.2016.1274935","url":null,"abstract":"Happy New Year everyone. Issue 9.1 signals a 2017 new development for LJPC as we start to develop collaborating sites to illuminate community-oriented integrated care and health promotion (COIC) in different contexts. The four papers are written by LJPC editors and have arisen from discussions at the LJPC Board about how to support authors to evaluate COIC, to highlight emerging issues in ways that reveal practical ways forward, and to learn from colleagues in different places about how to work with skill and humanity in complex situations.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2017-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1274935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867270","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":"Collaborating sites for community-oriented integrated care and health promotion.","authors":"Paul Thomas","doi":"10.1080/17571472.2016.1271491","DOIUrl":"https://doi.org/10.1080/17571472.2016.1271491","url":null,"abstract":"<p><p>London Journal of Primary Care wishes to develop a network of collaborating sites to better understand how to achieve <i>community</i>-<i>oriented integrated care and health promotion</i> in different contexts. A collaborating site can do more than submit papers. It can develop its own domain on the LJPC website, contribute to the development of LJPC policy, and stimulate discussions with other collaborating sites. At any time a collaborating site can opt out. In addition to securing papers for publication, a site might nurture a network of supporters, teach people to use multiple research and quality improvement methods, develop a system of governance for locally led inquiries, develop case studies of community-oriented integrated care and health promotion and facilitate within-site and between-site learning and change.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2017-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1271491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867271","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 use of case studies to drive bottom-up leadership in community-oriented integrated care and health promotion (COIC).","authors":"John Sanfey","doi":"10.1080/17571472.2016.1271497","DOIUrl":"https://doi.org/10.1080/17571472.2016.1271497","url":null,"abstract":"<p><p><i>London Journal of Primary Care</i> is supporting a collaborative network of multidisciplinary colleagues with an interest in community-oriented health care and health promotion (COIC). Case study methodology is well suited to generating knowledge from the frontline of health and social care service delivery and is a much under-developed resource. It is most effective when dealing with <i>wicked</i> problems, namely, the sort of complex, entangled and multi-faceted problems that successful COIC programmes must overcome. Used collaboratively, it supports effective networking across professional and community boundaries.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 1","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"2017-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1271497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867272","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":"A review of specialist palliative care provision and access across London - mapping the capital.","authors":"Sarah Cox, Fliss E M Murtagh, Adrian Tookman, Andrew Gage, Nigel Sykes, Maureen McGinn, Meeta Kathoria, Hilary Wilderspin, Liz Chart","doi":"10.1080/17571472.2016.1256045","DOIUrl":"10.1080/17571472.2016.1256045","url":null,"abstract":"<p><p>Palliative care provision varies by diagnosis, geography, and setting. The Minimum Data-set provides high-level data on provision, but comprehensive comparative information about specialist palliative care (SPC) provision is lacking. The London Cancer Alliance - now RM Partners' Accountable Cancer Network - palliative care group (West/South London) and PallE8 (North/East London), with Marie Curie, sought to address this gap. The aim was to provide comparative data on SPC provision across London to support commissioners and providers to assess provision, identify gaps, and reduce inequity. A data-collection template was developed through expert consensus. Demographic, diagnostic, and service data was collected, plus models of care, staffing levels, and use of clinical outcome/experience measures. Results were collated by organisation and CCG. Cleaned data was provided back to each organisation for verification before final analyses.</p><p><strong>Results: </strong>All 50 adult SPC providers in London participated, representing hospitals, hospices and community services. •Patients in all 32 CCGs have access to hospice beds, with 322 beds from 15 providers (4 NHS) for a population of 9,323,570 (with 47,583 deaths annually).•SPC in London sees more non-cancer patients than is reported nationally; 79% of hospital advisory, 74% of community, and 88% of hospice in-patient services have higher proportions of non-cancer patients.•Considerable variation in out-of-hours availability of both hospital SPC and community SPC services across London; only 9 of 30 hospital and 17 of 26 community services provide seven-day visiting.•Wide variation in the models of community-based SPC; proportions of community patients attending day services vary from 1 in 4, to 1 in 17, just 13 CCGs have H@H-type provision, with few Rapid Response or Care Coordination services.</p><p><strong>Conclusions: </strong>This detailed survey demonstrates important gaps in availability and provision of SPC services. Recommendations are made for commissioners and providers to join together to address these. It also gives a comprehensive view of rapidly changing models of community-based care, to inform innovation and service development.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 3","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2016-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35024572","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":"Henri de Toulouse-Lautrec's talent - and troubles - were larger than life.","authors":"Francesco Carelli","doi":"10.1080/17571472.2017.1274936","DOIUrl":"https://doi.org/10.1080/17571472.2017.1274936","url":null,"abstract":"[The Toulouse – Lautrec Collection of the Budapest Museum of Fine Arts at Ara Pacis, Rome, December 2015].Taking 170 works from the Museum of Arts in Budapest, Ara Pacis in Rome has produced a majo...","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 1","pages":"14-15"},"PeriodicalIF":0.0,"publicationDate":"2016-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2017.1274936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867274","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}