Journal of general practice (Los Angeles, Calif.)最新文献

{"title":"Benefits of Neoadjuvant Hypofractionated Radiotherapy in the Treatment of Locally Advanced Adenocarcinomas","authors":"M. Abid, Mohamed Amine Mansouri, A. Bataiche, Yousri Ballah, M. Brahimi, Zakia Kordjani, A. Hammani","doi":"10.4172/2329-9126.1000315","DOIUrl":"https://doi.org/10.4172/2329-9126.1000315","url":null,"abstract":"Background: The current treatment of locally advanced lower and middle rectum’s adenocarcinoma is well codified. It is based on neoadjuvant radiotherapy (NRT) followed by surgical excision. However, two broad radiotherapy approaches are being debated: short course of hypo-fractionated radiation therapy “SRT” (5 GY × 5 days) and long course concomitant radio-chemotherapy “CRT” using higher radiation dose (45-50 GY over 5 weeks) combined with chemotherapy. The first approach allows taking care of about 4 times more patients compared to the second in a same period. SRT was introduced at a large scale at the Pierre ET Marie Curie center (Algiers) in May 2010 by a new multidisciplinary board (Rectum board), aiming to reduce long-lasting schedules. Purpose: The aim of the current study is to evaluate the SCR introduction effect on the access rate to NRT and also to define its impact on treatment efficacy by assessing the primary tumor response (downsizing and downstaging) and the complete resection margin R0 rates. Patients and methods: In this study, the feasibility of short-course radiotherapy was evaluated. A specimen from 297 patients was studied over 10 years. We took May 2010 as a reference point to divide this specimen into two groups, group 1 in care before May 2010 (n=130) and group 2 treated after May 2010 (n=167). Three therapeutics protocols were used: long-course chemoradiation, short-course radiotherapy and long-course radiotherapy. Results: In the group 1, only 33% (43/130) of patients received NRT (SRT=2.5%, CRT=60.5%, LCR=37%). In the second group (after May 2010), 65% (113/167) of patients were able to access an NRT (SRT=73%, CRT=21%, LCR=6%) (p<0.001). Complete response (ypT0N0) was obtained in 13 patients (30%) of Group 1 and 2 patients (2%) of group 2 (p<0.001). Conclusions: The large scaled introduction of short course radiotherapy and the creation of the rectum board have allowed doubling the number of patients which benefited from neoadjuvant radiotherapy. Although, the complete responses rate had significantly dropped.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":"5 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2329-9126.1000315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42759374","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":"Differences in Verbal Behaviour Style in Interviews of Patients Females with Patients Companion (Triads) and Without Patient's Companion (Dyads) in Family Medicine","authors":"J. Turabián, Luis Enoc Minier-Rodriguez, S. Moreno-Ruiz, Francis Eliant Rodriguez-Almonte, R. Cucho-Jove, A. Villarín-Castro","doi":"10.4172/2329-9126.1000313","DOIUrl":"https://doi.org/10.4172/2329-9126.1000313","url":null,"abstract":"Objective: To describe differences in verbal behaviour style in interviews of patients females with patient's companion (triadic consultations) and patient’s females without patient's companion (dyadic consultations) in family medicine. \u0000Participants and Methods: Secondary analysis of existing dataset coded to explore patient-clinician verbal communication during ambulatory visits in a family medicine office in a health Centre in Toledo (Spain) was carried out. A qualitative study was performed by audio recording of the consultations and verbal content analysis of the interviews, based on the identification of 6 categories of classification of behaviours of the interaction process (Proposing, Supporting/Agreeing, Disagreeing, Giving Information, Seeking Information, and Building). A convenience sample was carried out. A suitable sample number was considered when saturation occurred. Quantitative methodology was used as a technique to control the reliability and biases. \u0000Results: 5 unaccompanied consultations and 7 consultations with companion were included in the analysis. The female patients with a companion show 2/3 more verbal behaviours (165 vs. 101) with slightly more behaviours of “Supporting or Agreeing” (42% vs. 34%), but less of “Giving Information” (43% vs. 53%) than when the female patients go unaccompanied, predominating these two types of behaviours in both modalities. Consultation with female patients with a companion shows almost twice as many verbal behaviours of the doctor vs. the consultation with unaccompanied women (186 vs. 100), and is longer (6.4 ' vs. 7.7'). \u0000Conclusions: This study shows that consultations of female patients with a companion are longer and more verbal behaviours are performed. In patients female the triadic consultations have more agreements, but less information is obtained than in the dyadic, and in general there is mixed results. Female patients show a clear predominance of verbal behaviours of “Giving information” and “Supporting or Agreeing”, both with or without companion in the consultation.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":"2017 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43415194","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":"Implementation of the Obstructive Sleep Apnea (OSA) Treatments by Mandibular Advancement Appliances","authors":"M. Amoric","doi":"10.4172/2329-9126.1000312","DOIUrl":"https://doi.org/10.4172/2329-9126.1000312","url":null,"abstract":"The herbst mandibular advancement orthosis on thermoformed gutters is a recognized device for its effectiveness in reducing the apnea-hypopnea index. But its effect may be undermined by poor attendance on the part of the patient. This article poses this problem between the expected effects and those obtained by the healthcare team. It describes some practical solutions to solve them.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2329-9126.1000312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47974053","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":"The Central Venous Pressure Causality Factors","authors":"R. Das","doi":"10.4172/2329-9126.1000E116","DOIUrl":"https://doi.org/10.4172/2329-9126.1000E116","url":null,"abstract":"The pressure which is measured in the central veins located near to the heart is known as the central venous pressure (CVP). The CVP denotes mean right atrial pressure which is for the most part considered as a gauge of right ventricular preload. It doesn't specifically compute blood volume, yet it is regularly used to assess for this reason. Generally, the CVP value is calculated by the right heart function and the venous blood (situated in the vena cava) pressure. Note that the CVP is not only influenced by venous return and intravascular volume, but also by intra-thoracic pressure and venous tone, along with myocardial compliance and right heart function. Generally, CVP is used for the hypotension patients who do not respond to primary clinical management. The present note examines the CVP causality factors of shock patients [1-3]. Interested hypotheses are: What are the causal components of CVP? How are the causal variables related with the CVP? What are their effects on CVP? Answers of these speculations are minimal known in the cardiology literature. These issues are addressed in the present note with a real data set which is displayed in [1].","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":"2017 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42933039","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":"Breakfast Habits and Its Relationship to Body Mass Index, Cognitive Function among Final Year Medical Students","authors":"G. Liyanage, H. Siriwardana, C. A. Wettasinghe, Kumarasiri Mkhn, Niwanthika Tki","doi":"10.4172/2329-9126.1000311","DOIUrl":"https://doi.org/10.4172/2329-9126.1000311","url":null,"abstract":"Background: Balanced and healthy nutrition is needed in order to avert adverse effects of poor eating practices. Children and adults often miss breakfast due to many reasons including lack of time. Evidence indicates that breakfast consumption is more beneficial than skipping breakfast following a long overnight fast. Its effect on cognitive function is still under debate. Our aim was to conduct a preliminary study to investigate breakfast habits and its effect of certain aspects of cognition in medical students in a university in Colombo, Sri Lanka. Methods: This study was a descriptive cross-sectional study. We assessed breakfast eating practices of final year medical students. Self-administered and questionnaire and trail making test for visual attention, task switching, speed of processing, and executive functioning were used as study instruments. Results and Conclusions: We recruited 121 clinical students. Majority (55.4%) skipped breakfast at least one or more days per week. Most consumed rice or wheat flour based meals and snacks and only a minority consumed cereals. We did not find any significant difference in trail making test between the two groups of students who skipped and consumed breakfast. A more comprehensive study exploring this topic is recommended.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43277661","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":"Inflammatory Bowel Disease and Clostridium difficile Infection: A Report from a Tertiary Care Center of North India","authors":"C. Vaishnavi","doi":"10.4172/2329-9126.1000310","DOIUrl":"https://doi.org/10.4172/2329-9126.1000310","url":null,"abstract":"Clostridium difficile infection (CDI) is reported to be frequently associated with inflammatory bowel disease (IBD). Because of the common characteristics of the clinical appearance of CDI and IBD the diagnosis and treatment of the same becomes complicated. We analyzed the prevalence of CDI in patients with IBD along with their demographic and clinical profile from our meticulously maintained laboratory records. During analysis, the IBD patients (n=721; M:F=1.10:1) comprised of test group and an equal number of gender-matched patients with no indication of IBD was included as non-IBD controls. The demographic and clinical data as well as fecal C. difficile toxin status of all the patients were retrieved from laboratory records. The number of C. difficile positivity was more in the non-IBD group (20%) compared to IBD patients (16%) with non-significant difference (p 0.063) in the frequency of diarrhea between the two groups was observed. Blood in stool and abdominal pain symptoms were found to be significantly higher (p<0.001) among the IBD group whereas watery diarrhea and fever were significantly linked (p<0.001) with non-IBD group. Significant improvement was seen in most of the parameters during the time of follow-up. Though the prevalence of CDI in both IBD and non-IBD groups were almost comparable, clinical symptom and age of presentation varied in them.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":"5 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2329-9126.1000310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45700808","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":"Severe Infantile Cholestasis as a Cause of Silent Rib Fractures","authors":"Irini D Batsis, Mi-Ryoung Hwang, W. Karnsakul","doi":"10.4172/2329-9126.1000I004","DOIUrl":"https://doi.org/10.4172/2329-9126.1000I004","url":null,"abstract":"Despite biliary drainage, she had significant cholestasis, ascites, malnutrition, and transient melena. Subsequently she was evaluated for a liver transplantation. A chest X-ray and an abdominal CT scan were obtained with an incidental finding of healing right sixth and seventh lateral rib fractures with callus formation and healing left seventh lateral rib fracture with callus formation (Figures 3 and 4).","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43634302","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 a Good Consultation in General Medicine","authors":"J. Turabián","doi":"10.4172/2329-9126.1000E115","DOIUrl":"https://doi.org/10.4172/2329-9126.1000E115","url":null,"abstract":"The General practitioner/Family doctor in his or her daily practice often has to make decisions on a multitude of subjects with no more support than his ability to judge and reason. In daily practice we continually have to decide the greatest good for the patient [1]. But, how we can define and identify the concept of the “good” for the patient? What are good and bad health behaviours? Where are the \"gold standards\" of good clinical practice? [2-4]. Evidence-Based Medicine, clinical trials and quantitative studies, which are indispensable for medical science, however they do not give us much information on what a good consultation is, since specifically that qualification refers to specific contexts, not general [5].","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48100209","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":"Involvement of Gynaecologists in Colorectal Cancer Screening","authors":"N. Král, Seifert Bohumil, Š. Štěpán, Zavoral Miroslav, Májek Ondřej, Ngo Ondrej, Dušek Ladislav","doi":"10.4172/2329-9126.1000308","DOIUrl":"https://doi.org/10.4172/2329-9126.1000308","url":null,"abstract":"Background and study aims: Primary care physicians play a principal role in colorectal cancer (CRC) screening \u0000 in many countries that are using a two-step program; faecal occult blood test (FOBT)+colonoscopy. In order to \u0000 improve the screening uptake in the Czech Republic ambulatory gynaecologists in addition to GPs were involved in \u0000 FOB testing in 2009. Our objective was to describe the contribution of gynaecologists to the provision of CRC \u0000 screening. \u0000Methods: Data reported to health insurance companies and aggregated by the Czech National Reference Centre \u0000 were used to monitor the screening process. We focused on the coverage by FOBT examination and positive FOBT \u0000 rate. We describe time trends in the number and proportion of people tested, describe regional variations and show \u0000 differences according to sex and age. \u0000Results: The target population for CRC screening above age 50 in the Czech Republic was 3,955,968 (37.7% of \u0000 total population) in 2014. The number of all FOBT performed in primary care (by GPs and gynaecologists) increased \u0000 from 357,893 in 2008 (417,364 - 2009) to 744,015 in 2014. In 2012, the total coverage of the target population was \u0000 25.5%; 23% of men and 27.5% of all women and in 2014 30.8%, 28.5% of men and 32.8% of women. In the years \u0000 2009, 2012, 2014 the total contribution of gynaecologists was 3.6%, 8% and 6.4% respectively, of all FOBT \u0000 performed. Overall in the female target population it was 6.2% in 2009 (out of 236987) 13.6% in 2012 (out of \u0000 325,631 FOBT) and 11.2% in 2014 (out of 423660), while in the 50-54 age group 24.4% women were screened by \u0000 gynaecologists in 2012 and 18.9% in 2014. The data showed significant variations between the 14 regions of the \u0000 country. The overall positivity rate of FOBT has increased from 4.6% in 2009 to 7.2% in the year 2014. \u0000Conclusions: The participation of gynaecologists has contributed significantly to the higher participation of \u0000 women in the real life Czech CRC screening program, particularly in the 50-54 years old age group, nevertheless \u0000 the key responsibility stays with GPs. This measure is likely to be applicable in health care systems with a network \u0000 of ambulatory gynaecologists, as is the case in the Czech Republic and in most Central and Eastern European \u0000 countries.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43548872","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":"The Variation of Seasonal Diseases in Family Medicine Depends on Infectious Diseases and these are Mainly Respiratory Diseases","authors":"J. Turabián","doi":"10.4172/2329-9126.1000309","DOIUrl":"https://doi.org/10.4172/2329-9126.1000309","url":null,"abstract":"Family medicine is a major source of information about health problems and their variation. For most illnesses the general practitioner is the first point of contact in the health care system and he looks after a population whose age \u0000 and sex composition is known. He is therefore in an ideal position to conduct inquiries about seasonal variations of \u0000 diseases. There are diseases where possible patterns of seasonal variation have been established: psychiatric \u0000 disorders, allergies, heart disease, etc. It has long been accepted that morbidity patterns in general practice vary \u0000 seasonally, which mainly depends on the acute pathology of infectious origin. In addition, it can be affirmed that \u0000 respiratory infections represent the most important percentage of infections. So, seasonal variability of diseases in \u0000 family medicine can be attributed to the variability of respiratory infections. Infectious disease dynamics offer a wide \u0000 variety of intriguing and unexplained phenomena. There is a gap in how diverse studies encompassing immunology, \u0000 mathematics, epidemiology, and virology combine to form a complete picture of seasonality. This may be due to the \u0000 daunting complexity of seasonality itself, which is likely to reflect the actions of a vast multitude of variables. An \u0000 understanding of what drives seasonal trends may allow: 1) better understanding of transmission dynamics, leading \u0000 to better methods of prevention, health education, triage, diagnosis and management; 2) generate causal and risk \u0000 factor hypotheses; 3) awareness of risks and surveillance systems; 4) monitoring the effects of intervention studies \u0000 such as immunization programs; 5) identifying the specific environmental and socioeconomic factors underlying \u0000 seasonal transmission; 6) better Interpretation of prevalence or incidence studies; And 7) redistribution of resources \u0000 for the care of the demand in family medicine and health care system.","PeriodicalId":90594,"journal":{"name":"Journal of general practice (Los Angeles, Calif.)","volume":" ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47492473","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}