London journal of primary care最新文献

{"title":"Introduction to LJPC issue 8.6.","authors":"Paul Thomas","doi":"10.1080/17571472.2016.1256044","DOIUrl":"https://doi.org/10.1080/17571472.2016.1256044","url":null,"abstract":"(1) Papanikitas discusses how to use health care conferences to combine the study of ethics with efforts for ethical change. He concludes a need for workshops at conferences coupled with a facility to continue conversations in between conferences. He followed his own advice by leading a LJPC workshop at the 2016 RCGP conference that debated the need for both survival and flourishing of general practice – a theme to be continued in LJPC in 2017 when considering new models of care. (2) Wiles et al. present a partially fictional case of a mother with HIV to illustrate how multidisciplinary groups can learn about ethical issues through reflection on their experiences and debate. What would you do if you came across a mother who was HIV positive? (3) Clark presents an evaluation of the USHAPE (Ugandan Sexual Health and Pastoral Education) initiative to improve family planning services in Uganda. Their initial survey revealed many cultural, religious, social and practical barriers to women accessing family planning mean, even though half had an unmet need for it. By engaging local leaders, they were able to train 68 members of staff at a local hospital to a basic level, and a further 32 members of staff to the higher Level Two.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 6","pages":"95"},"PeriodicalIF":0.0,"publicationDate":"2016-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1256044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776165","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":"Ethics in the interface between multidisciplinary teams: a narrative in stages for inter-professional education.","authors":"Katherine Wiles,&nbsp;Nawal Bahal,&nbsp;Hilary Engward,&nbsp;Andrew Papanikitas","doi":"10.1080/17571472.2016.1244892","DOIUrl":"https://doi.org/10.1080/17571472.2016.1244892","url":null,"abstract":"<p><p>An ethically problematic clinical case is used to illustrate the potential importance of understanding clinical ethics in an interdisciplinary context. Whilst much has been written on ethics education for multidisciplinary and interdisciplinary teams, we argue that it is important that both healthcare professions and healthcare teams are able to look outside their own disciplinary ethos and sometimes outside their formal teams when considering the ramifications of an ethical issue. A complex (fictional but based on the authors' pooled experiences) case involving the delivery of a new-born from a mother with HIV is used to illustrate this, because multiple clinical teams will be involved at different times and in parallel with one another.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 6","pages":"100-104"},"PeriodicalIF":0.0,"publicationDate":"2016-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1244892","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776018","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":"Education and debate: a manifesto for ethics and values at annual healthcare conferences.","authors":"Andrew Papanikitas","doi":"10.1080/17571472.2016.1244152","DOIUrl":"https://doi.org/10.1080/17571472.2016.1244152","url":null,"abstract":"<p><p>In this paper I discuss the ways in which the conference stream ethics and values manifested at the 2015 RCGP Annual Conference in Glasgow, and the ways in which it is planned for the 2016 RCGP Annual Conference in Harrogate. The 2015 RCGP had plenaries, oral presentations, breakout symposia, a debate, and a poster stream. I briefly discuss each in turn before offering a manifesto (a public statement of aims and proposed policy) for ethics and values at healthcare conferences. It is my hope that others will critique this, flesh it out further and even consider how ethics and values relate to conferences for healthcare workers of various specialities. A conference provides opportunities for ethics and values discussion that are potentially distinctive from any other kind of forum. Because conferences offer the potential for knowledge and attitudes to be revisited and revised, issues can be 'unsettled' in a way that permits different perspectives to be more fully discussed.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 6","pages":"96-99"},"PeriodicalIF":0.0,"publicationDate":"2016-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1244152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776017","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":"Whole system quality: local benchmarking to improve workforce planning.","authors":"Deirdre Kelley-Patterson, Andy Knapton, Keith Hurst","doi":"10.1080/17571472.2016.1245241","DOIUrl":"10.1080/17571472.2016.1245241","url":null,"abstract":"","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 2","pages":"23-25"},"PeriodicalIF":0.0,"publicationDate":"2016-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867277","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":"Family planning in a rural setting in Uganda, the USHAPE initiative.","authors":"Emily Clark,&nbsp;Clare Goodhart","doi":"10.1080/17571472.2016.1241302","DOIUrl":"https://doi.org/10.1080/17571472.2016.1241302","url":null,"abstract":"<p><strong>Background: </strong>The total fertility rate in Uganda is 5.9 children per woman, and women admit to having nearly two more children than they actually want. The maternal mortality rate remains stubbornly high. Family planning saves lives. It prevents maternal deaths by delaying motherhood, helping women limit their family size and avoid unwanted pregnancies. It also reduces infant mortality.</p><p><strong>Setting: </strong>USHAPE (Ugandan Sexual Health and Pastoral Education) is an initiative run in conjunction with the Royal College of General Practitioners in south-west Uganda. USHAPE aims to disseminate positive messages about modern contraception in an attempt to dispel fears and misconceptions and address the high rate of unmet need.</p><p><strong>Question: </strong>The aim was to determine the rate of unmet need for family planning among women of reproductive age in the population local of Kisiizi hospital and to use the successful USHAPE model to train health workers to address this need.</p><p><strong>Methods: </strong>100 patients were screened in the outpatient department to determine the level of unmet need by asking 2 questions. Level 1 training aims enhance every staff member's knowledge, so that the responsibility for family planning is adopted by the whole institution. Level 2 trains clinicians to become full family planning providers, with the necessary communication, educational and practical skills.</p><p><strong>Results: </strong>The screening for unmet need for contraception revealed that 51% have an unmet need, which is higher than the national average of 38%. Sixty-eight members of staff at Kisiizi trained to a basic level and a further 32 staff have been trained to Level 2 higher level.</p><p><strong>Conclusions/discussion: </strong>The USHAPE approach has begun to tackle some of the barriers to accessing family planning, but there are further areas which need development. Our cascade model of training, involves training Ugandan USHAPE trainers with the aim of future scale up and long-term development.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 6","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2016-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1241302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776019","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":"Treatment in patients' best interests.","authors":"Lindsay Gee","doi":"10.1080/17571472.2016.1225627","DOIUrl":"https://doi.org/10.1080/17571472.2016.1225627","url":null,"abstract":"<p><p>A note on the current state of the law as regards balancing the autonomy, and personal values, of a mentally incapacitated patient against treatment plans with which they do not agree. The author summarises the outcomes of two medical treatment cases heard by the Court of Protection, with similar facts and different results, by way of adding to the advice to practitioners for their communications with patients and families in such situations.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 5","pages":"91-92"},"PeriodicalIF":0.0,"publicationDate":"2016-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1225627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776163","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":"'<i>Generalistas'</i>: the GPs of Madrid.","authors":"Hajra Siraj","doi":"10.1080/17571472.2016.1225630","DOIUrl":"https://doi.org/10.1080/17571472.2016.1225630","url":null,"abstract":"The Hippokrates exchange was an eye-opening experience for me, enabling me to get a unique insight of primary care in another country.1 It really broadened my experiences, and taught me practical and new ideas to bring home. Colleagues I have spoken to about the scheme since returning have been inspired to participate. I hope my article will increase awareness and encourage others to get involved with this fantastic program. Despite the similarities between the healthcare systems of Spain and the UK, a number of subtle yet significant distinctions exist, with the power to alter one’s perspective on the realities of life as a GP. As a final-year GP trainee, I was fortunate enough to experience life as a Spanish GP through the Hippokrates Exchange Program. This allows trainees, and GPs within five years of qualification, to shadow a family doctor in one of twenty-eight European countries. I spent two weeks in Madrid shadowing a seasoned GP named Dr Francisco Camarelles. My placement was at the ‘Infanta Mercedes’ health centre, overlooking the world famous San Bernabeu football stadium. It is a large clinic of eighteen GPs, each paired with a nurse, seven trainees, two paediatricians, and ten administrative staff. The patient population is a diverse group of thirty-two thousand, and I saw patients from Camarelles’ list of two thousand. Unlike the UK, the GPs here are only allocated seven minutes per appointment. Patients can also ‘walk in’ if their problem is urgent, which means that – on average – a staggering forty patients are seen in a single day. These GPs also have no allocated time for paperwork; it’s all done during the consultation. Patients bring in copies of their discharge summaries, clinic letters and results, which are then interpreted and recorded electronically. Likewise, referral letters are written then and there. I liked the way this system hands over some responsibility to the patient; by managing their own healthcare, it helps to bridge the gap between primary and secondary sectors. But though the working hours here are fewer (with doctors either working 8am–3pm or 2pm–9pm) compared to the UK, there is little flexibility in the schedule. In the UK there’s now a trend towards portfolio careers, where doctors combine clinical work with other interests – like teaching, research, medico-legal work and media. This, I feel, reduces the risk of ‘burnout’ and promotes the development of new skills. At ‘Infanta Mercedes’, however, doctors work at the practice five days a week – special interests are fulfilled outside working hours. Nevertheless, the advantage of such an intense working regime is an astonishing continuity of care. Registered patients are always seen by their named doctor or nurse. As Camarelles put it, ‘I’ve been looking after the same patients for over nineteen years. I know some of them better than my own family.’ But despite Camarelles’ commitment to the practice, he has little say in how it is run or who works in his ","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 5","pages":"93-94"},"PeriodicalIF":0.0,"publicationDate":"2016-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1225630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776164","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":"In this Issue – 8.5","authors":"P. Thomas","doi":"10.1080/17571472.2016.1226268","DOIUrl":"https://doi.org/10.1080/17571472.2016.1226268","url":null,"abstract":"This Issue of LJPC displays the breadth of matters that primary care practitioners routinely care about. Howells, McKay, Hussein and Majeed provide guidance on how to manage people who are at high risk of developing diabetes. ‘Intermediate’, or ‘non-diabetic hyperglycaemia’ are those whose HbA1c level is between 42 and 47 mmol/mol (6.0–6.4%) or have fasting blood glucose measurement of 5.5–6.9 mM. They need to be monitored. Thorne examines ways that the quality and outcomes framework could do more to tackle health inequalities. This is a hot topic, exposed by the BMJ in August 2016. Thorne suggests ways to address the challenge. Ma and Shah discuss the shortage of training places and long waiting list for clinicians who wish to train in sexual and reproductive healthcare. Their survey of medical educators identified considerable numbers of GP already trained and interested in having such roles. They signal a need for us all to be aware of the untapped potential sitting under our noses. In a comparison of two legal cases that arrived at exactly opposite conclusions, Gee elegantly describes how to think about doing the right thing by a patient who has lost mental capacity. It is important to weigh up the wishes, feelings, beliefs and values of a mentally incapacitated patient when deciding what treatment to give. This paper is worth reading simply to see the quality of thinking of our judges as well as how we make decisions about patient care. Through the Hippokrates Exchange Program, Siraj shadowed an experienced GP in Madrid. She found considerable similarities with what a GP does in the UK and some interestingly different things, including an intense working regime (7 min with a patient) and excellent continuity of care. Siraj makes the point that the paternalistic consultation style, less favoured these days, can be effective when applied appropriately and respectfully, but it does increase referral rates!","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 1","pages":"75 - 75"},"PeriodicalIF":0.0,"publicationDate":"2016-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1226268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60419849","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":"General practice nursing: who is cherishing this workforce?","authors":"Alison E While,&nbsp;Carol Webley-Brown","doi":"10.1080/17571472.2016.1220961","DOIUrl":"https://doi.org/10.1080/17571472.2016.1220961","url":null,"abstract":"<p><p>The remodelling of the NHS requires a strong general practice nurse (GPN) workforce within general practice. The challenges facing general practice nursing are set within the current policy context and recent available evidence and illustrated by drawing upon the experience of a current GPN working in London. It is argued that there is a need to support the professional development of GPNs and nurture the next generation of potential GPNs if the current shortage of GPNs is to be addressed.</p>","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"9 1","pages":"10-13"},"PeriodicalIF":0.0,"publicationDate":"2016-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1220961","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34867273","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":"Editorial.","authors":"Jean Ledger","doi":"10.1080/17571472.2016.1216728","DOIUrl":"https://doi.org/10.1080/17571472.2016.1216728","url":null,"abstract":"London Journal of Primary Care brings together clinical and non-clinical knowledge to help understand issues that sit at the interface between clinical practice, public health and policy. As such, the journal remains open to multidisciplinary sources of knowledge and opinion whilst offering a focal point for a dispersed learning community to share findings from research. This approach is evidenced in this Issue. Morton and colleagues span public health, sports sciences and primary care; they come together to benchmark knowledge levels of physical activity recommendations among patient groups. Lawless et al. observe the difficulties in evaluating service interventions in primary care across multiple sites, bringing together unique perspectives from commissioning, public health and general practice. Latif and colleagues describe how a voluntary organization supported health education in the British-Bangladeshi community. We also welcome Professor Francesco Carelli who reviews the life of artist, Sonia Delaunay. LJPC will continue to welcome papers such as these that illuminate the rich multidisciplinary nature of primary care.","PeriodicalId":89823,"journal":{"name":"London journal of primary care","volume":"8 4","pages":"47"},"PeriodicalIF":0.0,"publicationDate":"2016-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17571472.2016.1216728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34776155","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}