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[Clinical and epidemiologic study of "generalized anxiety" in general practice].

Recent studies have shown that 16 to 43% of general practice attenders express minor psychiatric disorders (Barrett et al. 1988). The present survey was carried out among a sample of 1,177 patients seen by 121 private general practitioners through out France. Its purpose was: to rate the point-prevalence of general anxiety disorders (GAD) according to DSM III criteria, to evaluate sociodemographic and clinical status of patients with a GAD, to identify the anxiety symptoms that were the most frequently exhibited in a primary-care practice. 181 patients (15.4%) were assessed a GAD diagnosis. 217 patients (18.4%) were assessed a "secondary anxiety" diagnosis ie anxiety associated with an affective disorder (14.8%), phobia (2.5%), panic disorder (1%). Patients with a GAD were predominantly female, between the age of 35-50 years. They tended to be widowed, separated or divorced and of an average socio-economic level. They also had more previous psychiatric disorders. The GAD appeared to start at the middle age of the life (36 years), to be chronic (lasting over one year) in half of the cases, and to be recurrent. The somatic expression of anxiety was frequent (21%) but 34% of the patients expressed directly their psychological distress. Psychotropic drugs were prescribed to 75% of the subjects. Benzodiazepines were prescribed in 34% of the cases. More surprisingly, antidepressive drugs were prescribed more often when a GAD was diagnosed. This results confirm the high point-prevalence rate of anxiety disorders in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Development of consensus guidelines for conditions commonly managed in general practice. Royal Australian College of General Practitioners.

OBJECTIVE: Initially, the project objective was to develop audit protocols for commonly managed conditions in general practice. However, as the nature of the project evolved these objectives changed to developing consensus guidelines. METHOD: An iterative process was undertaken using mail-outs to gain items for potential inclusion in an audit protocol. This resulted in a change of direction to management guidelines. Consensus, as to the validity of inclusion of items in each guideline, was then achieved by continuing to use an iterative process. RESULTS: Guidelines for 30 presenting complaints were developed. Because a number of differential diagnoses were possible for each complaint, a total of 105 guidelines were developed. A total of 263 general practitioners participated. CONCLUSION: The concept of discriminant actions was developed. It was agreed that this described the clinical decision making that occurs in the general practices of participating practitioners. It is feasible to use an iterative method undertaken by mail to develop consensus guidelines for conditions that are commonly managed by general practitioners.

Australia↗
PubMed1997

[Expectations from a system of personal general practitioners. A questionnaire study among general practitioners in the municipality of Bergen].

Four municipalities in Norway have tested out a system of personal general practitioners, where all inhabitants aged 12 or more could choose their personal doctor. The doctor's responsibility, work-load and economy were determined by his/her specified list of patients. Doctors employed in primary health care showed a significant interest in the subject, and the ongoing personal doctor trial. To prepare for possible reorganization to this new system in the municipality of Bergen, a survey was carried out in January 1995 among all 145 general practitioners in Bergen, of whom 70% responded. Data from the survey indicated that a larger share of women than men had low expectations concerning a system of personal general practitioners. Only 19 out of 101 general practitioners were positive to introducing such a system.

Attitude of Health Personnel↗
PubMed1996

Insomnia in general practice. Results from NSW General Practice Survey 1991-1992.

OBJECTIVE: To assess whether an educational visit to GPs providing information about the non-drug and drug management of anxiety and insomnia can reduce subsequent rates of benzodiazepine prescription. METHOD: A randomised controlled trial of 286 NSW general practitioners conducted during 1991 and 1992. RESULTS: The educational visit was statistically significant in reducing the number of new prescriptions recorded by general practitioners for new diagnoses of insomnia. However, the majority of benzodiazepine prescriptions were for patients continuing treatment for insomnia or anxiety/depression. Overall, benzodiazepines were the sole management of insomnia recorded by the surveyed GPs in most cases (93.5%). In comparison, non-drug management for anxiety and depression was offered to more than a third of patients with anxiety and depression. (Benzodiazepines were the only management of anxiety and depression in just over 50% of cases.) DISCUSSION: This study shows general practitioners can change their management of insomnia and that change is most likely to occur when the problem is new, rather than old. The decreased emphasis on drug treatment in the general practice management of anxiety and depression may reflect the change in psychiatric teaching for these conditions. Further, most of the publicity about benzodiazepines has been in relation to their use for anxiety disorders. Doctors were interested in learning about advances in the understanding of sleep disorders and their non-drug management.

Australia↗
PubMed1998

Four years' experience of a senior house officer rotation in general medicine including general practice.

A four-month post in general practice was included as an option available to doctors applying for a year-long medical senior house officer (SHO) rotation since August 1993. This study sought the views of SHOs before and after undertaking the general practice post. SHOs gained an understanding of modern general practice and changed their views about certain aspects of general practice. They reported gaining a range of generic skills, which included communication, consultation, and clinical skills. These perceived benefits suggest that such experience merits wider adoption and further evaluation.

Adult↗
PubMed1998

The role of the general health questionnaire in general practice consultations.

BACKGROUND: The patient self-rating questionnaire is commonly used as a research tool to identify patients with 'unrecognized' depression. There is no evidence to support its use as a clinical tool in general practice. AIM: To determine whether use of the 30-item general health questionnaire (GHQ) is a practical means of increasing identification of 'new' episodes of emotional distress among patients consulting their general practitioner (GP). METHOD: A randomized controlled trial was carried out in a Scottish new town practice with eight partners. In the waiting room, 1912 patients aged over 14 years and consulting over a 10-month period attempted to complete the GHQ. The 'clinical judgement' group posted the questionnaire into a box then attended the doctor as normal. The 'screened' group presented the questionnaire to the doctor. After the consultation, the doctor completed an assessment questionnaire. The main outcome measures were GHQ scores and doctors' assessments of mental health. RESULTS: In total, 1589 patients were eligible to participate. However, 207 patients in the screened group were excluded because the doctor did not look at the questionnaire. The clinical judgement group (59.7% patients) and the screened group (40.3%) were compared. Although the doctors' diagnoses of distress were low in the clinical judgement group (8.1%), they were significantly greater in the screened group (13.9%) where the diagnosis of depression was doubled. The percentage of patients scoring greater than or equal to 9 (GHQ+) was 21.5% and 21.0% respectively. The level of agreement between the doctors' diagnoses of distress and the questionnaires scoring GHQ+ rose from 19% in the clinical judgement group to 35% in the screened group. CONCLUSIONS: The general health questionnaire used in a practice setting increases the identification of patients with emotional distress. However, the use made of the questionnaires in the screened group raises questions of doctor and patient acceptability.

Adult↗
PubMed2002

Large-scale molecular dynamics simulations of general anesthetic effects on the ion channel in the fully hydrated membrane: the implication of molecular mechanisms of general anesthesia.

Interactions of volatile anesthetics with the central nervous system are characterized by low yet specific binding affinities. Although neurotransmitter-gated ion channels are considered the primary anesthetic targets, the mechanism of action at the molecular level remains elusive. We consider here the theoretical implications of channel dynamics on anesthetic action in a simplified membrane-channel system. Large-scale 2.2-ns all-atom molecular dynamics simulations were performed to study the effects of halothane, a clinical anesthetic, on a gramicidin A (gA) channel in a fully hydrated dimyristoyl phosphatidylcholine membrane. In agreement with experimental results, anesthetics preferentially target the anchoring residues at the channel-lipid-water interface. Although the anesthetic effect on channel structure is minimal, the presence of halothane profoundly affects channel dynamics. For 2.2-ns simulation, the rms fluctuation of gA backbone in the lipid core increases from approximately equal 1 A in the absence of anesthetics to approximately equal 1.5 A in the presence of halothane. Autocorrelation analysis reveals that halothane (i) has no effect on the subpicosecond librational motion, (ii) prolongs the backbone autocorrelation time in the 10- to 100-ps time scale, and (iii) significantly decreases the asymptotic values of generalized order parameter and correlation time of nanosecond motions for the inner but not the outer residues. The simulation results discount the viewpoint of a structure-function paradigm that overrates the importance of structural fitting between general anesthetics and yet-unidentified hydrophobic protein pockets. Instead, the results underscore the global, as opposed to local, effects of anesthetics on protein dynamics as the underlying mechanisms for the action of general anesthetics and possibly of other low-affinity drugs.

Anesthesia, General↗
PubMed1992

The use of general anaesthesia and sedation in general dental practice: a survey in Glasgow, United Kingdom.

One hundred and sixty four of the 240 general dental practitioners on the Greater Glasgow Health Board family practitioner list returned a postal questionnaire on the current use of General Anaesthesia and sedation in their practices. Thirty three per cent offered GA sessions but nearly a half were in the process of withdrawing the service. The majority of the respondents (74.4 per cent) felt that a simple sedation method would attract patients. An inhalation technique was considered the most appropriate for general dental practice by 62 per cent of the dentists.

Anesthesia, Dental↗
PubMed2005

Provision of care for older people with co-morbid mental illness in general hospitals: general nurses' perceptions of their training needs.

INTRODUCTION: There are high levels of co-morbid mental illness amongst older people in general hospitals; this study explored the training needs of general nurses to care for this group. METHOD: Focus groups with general nurses were analysed using framework analysis. FINDINGS AND CONCLUSION: Nurses wanted training, but did not believe that training alone was sufficient to improve care, expressing that more integrated working between acute and mental health services was also needed. Liaison mental health services provide a way to deliver both training and a more integrated service.

Aged↗
PubMed2006

Orthodontic treatment provided by general dentists who have achieved master's level in the Academy of General Dentistry.

INTRODUCTION: The purposes of this study were to document orthodontic treatment currently provided by general dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. METHODS: A 21-item survey was mailed to 750 master's level members of the Academy of General Dentistry. Surveys returned within 8 weeks were included for statistical analysis. RESULTS: The response rate was 62%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Many provided orthodontic treatment in the permanent dentition, and the most common conditions or malocclusions treated were space maintenance, anterior crossbite, rotation, habits, molar uprighting, and posterior crossbite. The most common orthodontic appliances used were removable Hawley appliances with finger springs, straight wire orthodontic therapy, rapid palatal expanders, and functional appliances. CONCLUSIONS: The number of general dentists providing comprehensive orthodontic treatment has not changed since previous surveys; practitioners also do not expect a change in the next 5 years. Factors that influenced the orthodontic treatment provided included the primary source of orthodontic training, the number of orthodontic continuing education hours earned per year, the practitioner's location, and the proximity to the nearest orthodontist.

Adult↗
PubMed2004

General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial.

BACKGROUND AND OBJECTIVE: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design. METHODS: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5-6 level was performed with a local anaesthetic mixture (0.30 mL kg(-1)). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 microg mL(-1)) and clonidine 2 mL (150 microg mL(-1)). Postoperative pain and consumption of opioids were assessed during the first 72 h. RESULTS: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6h (1.56 +/- 1.58 vs. 4.78 +/- 1.67), at 12 h (1.52 +/- 1.58 vs. 3.81 +/- 1.63), at 24 h (1.16 +/- 1.34 vs. 2.71 +/- 1.50), at 36h (0.68 +/- 1.02 vs. 2.29 +/- 1.41), at 48h (0.60 +/- 1.04 vs. 1.61 +/- 1.33) and at 72 h (0.40 +/- 0.86 vs. 1.19 +/- 1.16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19). CONCLUSION: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.

Analgesics↗
PubMed2001

General anesthesia in an office-based plastic surgical facility: a report on more than 23,000 consecutive office-based procedures under general anesthesia with no significant anesthetic complications.

The popularity of elective office-based plastic surgery has increased significantly over the past two decades. The continuing demand for improved aesthetic results has stimulated the development of ever more complex plastic surgical techniques. These techniques may require extended periods of operative time spent under anesthesia. Patients have come to expect an almost perfect anesthetic and surgical experience, with safety and comfort being their foremost concerns. Because of increasingly complex and lengthy operations, the authors believe that intravenous sedation, used for many years in their plastic surgery practice, is now suboptimal for most longer and complex surgical procedures. In their experience, under most circumstances, general anesthesia provides the optimal anesthetic experience for the patient, anesthesiologist, and surgeon. The authors present a consecutive 18-year study of general anesthesia in more than 23,000 procedures in an accredited, office-based plastic surgical facility that offers a very safe and uniformly pleasant anesthesia experience for patients. There were no intraoperative or postoperative deaths and no significant complications. The authors' experience differs from the common perception that general anesthesia is too risky for aesthetic surgery procedures.

Ambulatory Surgical Procedures↗
PubMed2004

Are "generalized" seizures truly generalized? Evidence of localized mesial frontal and frontopolar discharges in absence.

PURPOSE: To determine whether specific regions of cerebral cortex are activated at the onset and during the propagation of absence seizures. METHODS: Twenty-five absence seizures were recorded in five subjects (all women; age 19-58 years) with primary generalized epilepsy. To improve spatial resolution, all studies were performed with dense-array, 256-channel scalp EEG. Source analysis was conducted with equivalent dipole (BESA) and smoothed linear inverse (LORETA) methods. Analyses were applied to the spike components of each spike-wave burst in each seizure, with sources visualized with standard brain models. RESULTS: For each patient, the major findings were apparent on inspection of the scalp EEG maps and waveforms, and the two methods of source analysis gave generally convergent results. The onset of seizures was typically associated with activation of discrete, often unilateral areas of dorsolateral frontal or orbital frontal lobe. Consistently across all seizures, the negative slow wave was maximal over frontal cortex, and the spike that appeared to follow the slow wave was highly localized over frontopolar regions of orbital frontal lobe. In addition, sources in dorsomedial frontal cortex were engaged for each spike-wave cycle. Although each patient showed unique features, the absence seizures of all patients showed rapid, stereotyped evolution to engage both mesial frontal and orbital frontal cortex sources during the repeating cycles of spike-wave activity. CONCLUSIONS: These data suggest that absence seizures are not truly "generalized," with immediate global cortical involvement, but rather involve selective cortical networks, including orbital frontal and mesial frontal regions, in the propagation of ictal discharges.

Adult↗
PubMed1984

General anaesthesia with halothane and drug absorption. The effect of general anaesthesia with halothane and diazepam on postoperative gastric emptying in man.

The effect of general anaesthesia with halothane on postoperative absorption of paracetamol was measured in seven patients, after minor surgery on the extremities. Gastric emptying, estimated indirectly by the rise in serum paracetamol following oral administration of the drug, was significantly delayed after general anaesthesia with halothane compared with gastric emptying when general anaesthesia with halothane was not administered. It was furthermore demonstrated that absorption of paracetamol and therefore gastric emptying were normal or nearly normal when diazepam 15 mg was given orally to the same patients 2 weeks later.

Acetaminophen↗
PubMed2006

Learning priorities and attitudes towards computer-assisted learning of general medical practitioners, general dental practitioners and dental hygienists.

OBJECTIVES: The objectives of this survey were to assess the attitudes and learning priorities of general medical practitioners (GMPs), general dental practitioners (GDPs), and dental hygienists (DHs) working at Jordan University of Science and Technology (JUST), Irbid, Jordan in relation to post-graduate education, to gather information on their attitudes and skills in using computers and computer-assisted learning (CAL) and to see whether the material in this form is acceptable to participate as a means of teaching. METHODS: Data for this study was gathered via a questionnaire distributed to 63 health professionals including GMPs, general dental practitioners and DHs (mean age 24.79 +/- 2.69 years) working at JUST. RESULTS: Of the 63 participants, 80% of the participants have home computers, 38% have office computers at work and only 25% have both home and office computers. Approximately 53% of the participants had their first CAL experience at home. Seventy-three of the participants indicated that connection to Internet is necessary for their work. Seventy-one of the participants were interested in the possibility of using CAL to further improve and increase their medical knowledge. The most important topic for doctors was 'learning about new techniques which may supersede those in current use', for DHs it was 'improve knowledge or skill in radiology', and for dentists it was 'reinforcement of well established techniques commonly used in dental practice'. CONCLUSIONS: It is necessary for practicing health care professionals to update themselves by taking continuous education courses after graduation more conveniently via CAL methods.

Adult↗
PubMed2005

General anesthesia versus epidural and general anesthesia in radical cystectomy.

INTRODUCTION: The aim of this study is to compare two different anesthetic techniques in radical cystectomy with regard to blood loss, transfusional requirements, intraoperative complications and the quality of analgesia. MATERIALS AND METHODS: 50 patients scheduled for radical cystectomy were randomized to two groups: group GA - general anesthesia, n = 25 and group CEGA - combined epidural and general anesthesia. The patients were monitored and hemodynamic changes, intraoperative bleeding, transfusional requirements, quality of analgesia and postoperative complications were evaluated. RESULTS: There were no significant differences between the demographic characteristics of the two groups. Intraoperative bleeding which was 874.8 +/- 190.7 ml in the CEGA group and 1,248.3 +/- 343.4 ml in the GA group was statistically different (p < 0.05). Significantly more intraoperative blood transfusions in terms of units were required in the GA group. Analgesia was better in the CEGA group, with VAS values at 0, 1, 2, 4, 6, 12 and 24 h significantly (p < 0.05) lower than those observed in the GA group. No significant differences in intraoperative hemodynamic parameters or postoperative complications were noted between the two groups. CONCLUSIONS: Statistically significant differences in intraoperative bleeding were observed between the two groups: CEGA provides lower intraoperative bleeding and a better postoperative analgesia. Major operations such as radical cystectomy, which also is associated with considerable blood loss, a combination of general and epidural anesthesia may allow for less blood loss, with a better postoperative analgesia and without any increase in complications.

Anesthesia, Epidural↗
PubMed1993

Combined epidural and general anaesthesia versus general anaesthesia for abdominal aortic surgery: a prospective randomised trial.

Fifty patients undergoing elective abdominal aortic surgery were randomised to receive either combined epidural and general anaesthesia and postoperative epidural analgesia (CEGA) or general anaesthesia and postoperative intravenous morphine infusion (GA). Prospective data was collected in order to compare the two groups. This included intraoperative cardiovascular changes and postoperative complications. The use of intraoperative vasopressors was significantly higher in the CEGA group (P < 0.01) but the use of intravenous glyceryl trinitrate was significantly lower (P < 0.01). There was no significant difference between groups in regard to blood loss, volume replacement or in the number of patients requiring postoperative ventilation. Two patients in the CEGA group died postoperatively compared to one in the GA group (not significant). There was no significant difference between groups in the total number or type of postoperative complications. Combining epidural anaesthesia with general anaesthesia altered intraoperative cardiovascular management but did not affect postoperative outcome.

Aged↗
PubMed1989

Facilitating generalized requesting behavior in Broca's aphasia: an experimental analysis of a generalization training procedure.

The effects of a generalization training procedure on requesting by 4 subjects with chronic Broca's aphasia were examined using a multiple baseline design across behaviors and subjects. Subjects were trained to request information on three topics sequentially. Generalization across topics and persons was assessed in weekly probe sessions consisting of 5-min conversational interactions with trainers and unfamiliar volunteers in a nontreatment setting. Results revealed generalization effects were greatest when trainers, as opposed to unfamiliar volunteers, served as conversational participants. Nevertheless, subjects' requests increased with all conversational participants to a level comparable to a normal comparison group assessed under conditions identical to the experimental probes. Social validation of treatment effects using a subjective evaluation procedure revealed significant improvement on the parameters of talkativeness, inquisitiveness, and conversational success.

Aphasia↗