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PubMed2000

Renin-aldosterone system alterations during abdominal gynaecological operations under general or combined general and epidural anaesthesia.

Alterations of plasma renin-activity and aldosterone levels were comparatively studied in 41 premenopausal patients who were subjected to total abdominal hysterectomy. Twenty-one women received general anaesthesia (group A) and 20 received a combination of general and epidural anaesthesia (group B). Five blood specimens were drawn from each patient in order to determine plasma aldosterone levels (PA) and plasma renin activity (PRA) by radioimmunoassay (RIA). The rise of PA levels in group A occurred 30 min after the initiation of surgery and at that time there was a statistically significant difference as compared with the epidural anaesthesia (EA) group (p < 0.001). PRA levels in both groups showed a rise of limited statistical significance at 30 minutes after the initiation of surgery (p < 0.05). During the remaining time intervals, group A did not show any significant changes, whereas group B showed a reduction of limited statistical significance (p < 0.05). General anaesthesia for gynecological abdominal surgery without the use of volatile agents significantly increases plasma aldosterone levels. Combined anaesthesia does not totally inhibit intraoperative hyperaldosteroism but it is much slower and is of great advantage for the patient.

Adult↗
PubMed2000

From district general hospital to local general hospital.

Much debate has centred around the future of acute services in the NHS in the UK with particular reference to the role and function of the District General Hospital. This paper explores a new model of hospital development--the 'Local General Hospital' which lies somewhere between the DGH and the cottage or community hospital. The paper uses the case study of Neath General Hospital in South Wales which moved to a LGH model. The paper explores the functional content of the LGH balancing accessibility with cost and clinical effectiveness. The paper makes particular reference to the development of clinical networks which cross organisational boundaries and the support of GPs and consultant medical staff as key success factors in the transition from DGH to LGH.

Comprehensive Health Care↗
PubMedDate not supplied

Effect of intravenous flumazenil on reversal of the central effects of midazolam used with short-acting opioids for general anesthesia in hospitalized patients: report of a multicenter, double-blind clinical study. The Flumazenil in General Anesthesia in Hospitalized Patients Study Group I.

Midazolam, a short-acting benzodiazepine central nervous system (CNS) depressant widely used for the induction and maintenance of general anesthesia, is often supplemented with short-acting opioids for general anesthesia. Administered postoperatively, flumazenil, a specific benzodiazepine antagonist, reverses the CNS sedative effects of midazolam. In a double-blind clinical trial in hospitalized patients, flumazenil, administered postoperatively at an average intravenous dose of 0.89 mg (range: 0.4 mg to 1 mg), was more effective than placebo in reversing sedation and other residual effects of benzodiazepines in patients recovering from general anesthesia induced by midazolam (mean dose 29 mg) in conjunction with fentanyl (mean dose 0.4 mg) or sufentanil (mean dose 0.056 mg). Five minutes posttreatment, 87 (83%) of 124 flumazenil-treated patients and 6 (10%) of 60 placebo-treated patients had attained the criterion response for reversal of sedation. Of these patients, 60% in the flumazenil group, compared with 100% in the placebo group, retained their degree of alertness throughout the 3-hour observation period. Between-group differences were significant until 60 minutes posttreatment, when the effect of the benzodiazepines had spontaneously waned in the placebo group. The Physician's Global Efficacy Rating, providing an overall measure of efficacy 5 minutes after test drug administration, was good or excellent for 86% of the flumazenil-treated patients, as compared with 7% of the placebo-treated patients evaluated. Measurements of psychomotor function and memory also showed significant between-group differences. Flumazenil, compared with placebo, was not associated with a substantially greater frequency of operative-site pain. These results demonstrate that the efficacy and safety of flumazenil were not compromised by the addition of a short-acting opioid to the anesthetic regimen.

Adolescent↗
PubMed1963

The adequacy of medical education for general practice: a general practitioner's viewpoint.

Medical education as a preparation for general practice is assessed from the viewpoint of the general practitioner. The historical development of Canadian medical education and its present functioning are reviewed. The doctor in general practice, although aware of the existing inadequacies of his system of preparation, is loath to relinquish control of the pattern he has built up for himself. It has served the community well and he fears many of its advantages will be lost if replacement, rather than repair, is attempted. Certain inadequacies are discussed and the correction of these is urged as of vital importance to the Canadian people.

Canada↗
PubMed1992

An audit of non-insulin-dependent diabetics attending a district general hospital diabetic clinic: implications for shared care between hospital and general practice.

An audit of all 466 non-insulin-dependent diabetic patients first diagnosed between 1979 and 1981 at a district general hospital in Fife was carried out. This involved the retrospective examination of their medical records and follow up of the patients to 1989 with particular reference to mortality and the development of complications. Throughout the study period the hospital, which has a total catchment population of about 160,000, operated a policy of encouraging all newly diagnosed diabetics to be referred to hospital for assessment and management. One hundred and eighty-nine diabetics (41%) died during the follow-up period. In both sexes they had an excess mortality, compared with the Scottish population of the same sex and age in 1981, of approximately 20% at 40 years of age. This increased to double or above between the ages of 60 and 70. The principal underlying cause of death was attributed to macrovascular disease, including 70 (37%) certified as ischaemic heart disease, 33 (17%) as cerebrovascular disease and 10 (5%) as other diseases of circulation. Thirty-five (8%) diabetics developed macrovascular and 23 (5%) microvascular complications during follow-up. We conclude that non-insulin-dependent diabetics have a high mortality, principally from macrovascular causes. A simple audit of mortality is suitable for measuring their care. General practitioner diabetic mini-clinics for the follow-up of non-insulin-dependent diabetic patients will have smaller numbers of patients to review compared with the traditional follow-up clinics seen in most district general hospitals. These may allow earlier detection and treatment of hypertension and dyslipidaemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

[Comparison of changes in plasma catecholamines between general anesthesia and general anesthesia plus epidural block].

To investigate the stress-response during anesthesia-operation, 16 patients were allocated into either of two groups. Eight cases in Group A underwent an operation on the abdomen under general anesthesia, while the other eight cases in Group B were operated under general anesthesia plus epidural block. Plasma catecholamine levels were measured in all subjects during anesthesia operation procedure. A significant increase in the levels of plasma catecholamines was observed at 45 min after incision in Group A (1.82 +/- 0.48 vs. 0.94 +/- 0.19 ng/ml, P less than 0.05, paired t-test), while no change was seen in Group B during the whole procedure. The result may indicate that an operation on the abdomen rather than general anesthesia itself is responsible for the observed increase in plasma catecholamines level.

Adult↗
PubMed1989

Combined epidural and general anesthesia versus general anesthesia in patients having colon and rectal anastomoses.

Three retrospective studies were conducted at St. Vincent's Hospital to compare the outcomes of colorectal anastomoses, with and without resections, with respect to anesthetic technique. Operations were performed upon patients anesthetized with either combined regional (epidural) and general anesthesia (CRAG) or general anesthesia alone (GA). Postoperative pain relief was achieved with either continuous epidural analgesia (CEA) in the CRAG group or with postoperative narcotics in the GA groups (GA/PN). In one group, a different regimen was introduced: combined epidural and general anesthesia with postoperative epidural morphine (CRAG/EDM). Overall, anastomotic leak rates and death rates were lower in the CRAG group, and the lowest incidence of anastomotic leak was reported in the patients receiving CEA. Thus the reduced leak rate was associated more with the postoperative analgesia regimen than with the anesthetic technique. An increased incidence of wound dehiscence occurred with postoperative epidural morphine analgesia.

Analgesia, Epidural↗
PubMed1988

[Caudal anesthesia combined with general anesthesia in comparison with general anesthesia in ambulatory circumcision].

In 100 boys (5.9 +/- 3.2 years old) undergoing outpatient circumcision, analgesia was provided with 0.375% bupivacaine 1 ml/year of age by caudal injection (group I), administered after induction of general anesthesia. This group was compared with 100 boys (6.3 +/- 3.4 years old), who received only general anesthesia (group II). The puncture technique described was free of complications and the caudal blocks were 98% successful. There was a great difference with regard to the levels of general anesthesia: the average enflurane concentrations required to block autonomic reactions during surgical intervention was 1.3 vol% in group I and 2.7 vol% in group II. The amount of pethidine needed for perioperative pain relief was 8 mg (+/- 5.7) in 17/100 of group I and 17.3 mg (+/- 6.8) in 91/100 of group II. In addition, paracetamol was given in 10/100 of group I and 30/100 of group II. The boys in group I showed calm postoperative behavior. In both groups there were only slight differences in hemodynamic parameters. Of the parents who answered our questionnaire (50 answers to 60 questionnaires), 68% were amazed at the duration of analgesia. During the late postoperative period, in group I there was an almost total absence of vomiting (4%), with an associated rapid return to normal feeding. In 83% the effect of late postoperative analgesia worked so well that no subsequent analgesic was given. In 15% the pain relief lasted 6.3 +/- 2.5 h. The excellent postoperative pain relief produced by caudal anesthesia justifies its frequent use for children subjected to genital surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen↗
PubMed2005

Multilevel generalized linear models for modelling age-related gender difference in violent behaviour and associated factors in the general household population.

It is preferable to use longitudinal data when studying patterns of violence and antisocial behaviour over the lifespan together with the associated risk factors in the general population. From the statistical modelling perspective, random samples of cross-sectional data, representative of the population, can be a reliable alternative. Sampling, weighting, and possible geographical clustering of the behaviour must be considered in the analysis together with correct choice of model as a function of age, although cohort effects and age effects are not separated from the analysis. This paper demonstrates the use of multilevel generalized linear models in the British National Survey of Psychiatric Morbidity in 2000. A multilevel logistic model as a special case of a generalized linear model with individual weightings was adapted for a dichotomous measure of violence and extended to Poisson and negative binomial outcomes. Three types of age function, discrete age effects, continuous age effects, and piecewise polynomial function of age intervals were evaluated for goodness of fit, and for their practical advantages and disadvantages. Models were developed for possible risk factors in relation to specific age groups of interest.

Adolescent↗
PubMedDate not supplied

Non-steroidal anti-inflammatory drug prescribing patterns in general practice: comparison of a general practitioner-based survey and a pharmacy-based survey in France.

PURPOSE: In order to assess biases occurring in primary care prescription studies, we compared non-steroidal anti-inflammatory drug (NSAID) prescribing patterns reported by general practitioners directly (GP-based survey) and from a pharmacy-based survey of general practitioner prescribing (pharmacy-based survey). METHODS: Volunteer GPs of the administrative area of Côte d'Or (France) returned a mailed questionnaire on NSAID prescribing patterns for consecutive patients seen during a 2-month period. In order to obtain a reference basis, pharmacies of the same administrative area provided all prescriptions that included NSAIDs during a 1-week period originating in general practice. RESULTS: The rate of participation was 25% for the GPs and 40% for the pharmacies. Participant GPs were representative of GPs of the area with regard to sex, year of graduation and practice area but pharmacies from rural areas were over-represented. The GP-based survey and the pharmacy-based survey provided respectively 770 and 1050 prescriptions. There were no differences between either survey in the type of NSAIDs prescribed and in the most frequently associated drugs. GPs who volunteered in the GP survey prescribed NSAIDs more frequently orally and at higher doses than GPs involved in the pharmacy-based survey. They also prescribed more gastroprotective drugs, especially in the elderly. None of these results could be explained by differences in patient characteristics and GP practice areas. CONCLUSION: GPs who actively participate in prescription surveys exhibit prescribing patterns that fit better with official recommendations than the average. Although selection biases cannot be ruled out, it is suggested that some changes in GP prescription habits may have been induced by the survey itself.

Adolescent↗
PubMedDate not supplied

Perception of the risks of smoking in the general population and among general practitioners in Ireland.

BACKGROUND: Data on perception of smoking risk amongst the Irish population are sparse. AIMS: To study the accuracy and determinants of the perceived risk of premature death due to smoking in the general population and amongst general practitioners (GPs). METHODS: Telephone surveys of a representative sample of Irish adults (1,247) and GPs (171; 85% response rate) asked participants to estimate how many of 1,000 20-year-old life-long smokers would die from smoking-related disease before the age of 70 and to identify the main cause of death from a list of seven causes: smoking, road traffic accidents, accidents at work, AIDS, homicide, illicit drugs and alcohol misuse. RESULTS: In the population and GP samples, perception of the risk of smoking-related death was similar (median 200 and 150 deaths per 1,000 smokers respectively, epidemiological estimates 250/1000). Only 43% of the population identified smoking as the most important cause of death compared with 87% of GPs. Current smoking status, younger age, female gender, lower educational attainment and lower income were associated with failure to identify smoking as the main cause of death. CONCLUSION: Despite decades of health promotion, the general public underestimates the relative importance of smoking as a cause of death.

Adult↗
PubMed2003

Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain.

OBJECTIVE: The prevalence of antibiotic resistance in a country reflects the local consumption of antibiotics. The majority of antibiotics are prescribed in general practice and most prescriptions are attributable to treatment of respiratory tract infections (RTIs). The aim of this study was to compare general practitioners' (GPs') prescribing of antibiotics for respiratory tract infections in a country with a high prevalence of antibiotic resistance (Spain) with a country with a low prevalence of antibiotic resistance (Denmark). METHODS: A group of GPs in Copenhagen and Barcelona registered all contacts ( n=2833) with patients with RTIs during a 3-week period between 1 November 2001 and 31 January 2002. RESULTS: Overall, Spanish GPs treated a higher proportion of patients than Danish GPs. After adjusting for unequal distribution of age and sex, we found that Spanish GPs prescribed significantly more antibiotics to patients with focus of infection in tonsils and bronchi/lungs. Narrow-spectrum penicillin was the most used antibiotic in Denmark, representing 58% of all prescriptions issued, followed by macrolide and broad-spectrum penicillin. In Spain, prescriptions were distributed among a great number of compounds, with broad-spectrum penicillins and combinations of amoxicillin plus beta-lactamase inhibitors most frequently used. CONCLUSION: The substantial difference in the way GPs manage respiratory tract infections in Denmark and Spain cannot be explained by different patterns of RTIs in general practice. The discrepancies indicate variations in national recommendations, different treatment traditions or different impact of pharmaceutical marketing.

Adolescent↗
PubMed1990

Towards a typology of general practitioners' attitudes to general practice.

Current knowledge about the origins of variations in general practitioners' (GPs') prescribing and referral behaviour is limited. Differences are as yet unexplained by demographic factors such as list size or geographic location. Drawing on social psychological theory it is suggested that attitudes towards general practice held by GPs may be predictive of GP behaviour. A classification of GP types on the basis of expressed attitudes may represent the first step towards this goal. This research demonstrates that GPs in Avon have identifiable attitudes to general practice which can be classified into separate types. Uses of such a classification and implications for further research are also discussed.

Adult↗
PubMed1990

Long-term patterns of general practice consulting behaviour: a qualitative 9-year analysis of general practice histories of a working-aged rural Finnish population.

The 9-year practice histories of 100 working-aged residents of the rural municipality of Kaavi in Finland were analysed. Based upon an analysis of these histories, an interview of the 81% who participated and the personal patient knowledge of the author from his work as a general practitioner for 7 years in the community, 78% of the persons studied could be classified into six categories in a qualitative typology of consulting patterns. The descriptive names of the categories, together with their proportionate sizes and the mean annual consultation rates within the categories were: (1) 'Healthy and competent' (16%; 1.03); (2) 'Contented returners' (12%; 3.28); (3) 'Information seekers' (8%; 4.08); (4) 'Support seekers' (15%; 4.62); (5) 'Drifters' (21%; 2.21) and (6) 'Those hard to convince' (6%; 3.59). The rest (22%; 1.15) could not be classified. The implications of the typology are discussed from two standpoints: (1) In view of the current Finnish debate on the need for fee deterrents for the use of public general practitioner's services. (2) The potentials and limitations of different broad strategies suggested for general practice.

Family Practice↗
PubMed1994

Consequences of mental distress recognition in general practice in Italy: a follow-up study. Italian Cooperative Group on Mental Distress in General Practice.

Many reports have been recently published on the accuracy of mental distress detection by general practitioners. Recognition of 'caseness', irrespective of its accuracy, nevertheless determines the implementation of therapeutic interventions. This paper reports the results of a naturalistic study describing the consequences for the patients of being identified as 'cases' in the general practice (in terms of referral strategies at recruitment and outcome 3 months and 1 year later), in the context of care provision generated by the 1978 Italian psychiatric reform. Sixty-eight GPs recruited 878 'cases' according to implicit criteria. Overall 20% of the patients were referred the psychiatric setting; only half of these for psychiatric care. After 3 months and 1 year from recruitment respectively 12% and 23% of the subjects were no longer 'cases'. The factors contributing to predict the outcome at three months were age, symptom duration, comorbidity, presence of social context risk factors and prior psychiatric history (or presence of 'major' symptoms); after one year the predictors of caseness were caseness status at 3 months, and clinical severity, symptom duration and presence of somatization at recruitment. GPs remain the main care providers in the short- and long-term. The results of the study indicate the need for a reappraisal of the emphasis to be put on caseness recognition and on the development of standardized instruments for the identification of mental distress. Non-clinical variables concurring in the definition of caseness in general practice, and the factors influencing physicians' decision-making in the implementation of alternative intervention strategies should be further clarified by ad hoc studies.

Adult↗
PubMed2005

Supplementation of general endurance exercise with stabilisation training versus general exercise only. Physiological and functional outcomes of a randomised controlled trial of patients with recurrent low back pain.

BACKGROUND: Determination of the mode of action of new exercise techniques in different back pain populations is lacking. The effectiveness of supplementing an exercise programme with stabilisation exercises concerning physiological and functional parameters in non-specific back pain patients is unknown. METHODS: Randomised controlled trial, comparing a general trunk muscle endurance exercise approach enhanced with specific muscle stabilisation exercises (S&G group) with a general exercise approach only (G group). 55 patients with recurrent back pain were randomised in S&G group (n=29) and G group (n=26). Both groups received an 8-week exercise intervention and written advice. Paraspinal muscle strength and electromyographic fatigue of the erector spinae and multifidus were measured. Additionally, 3 functional speed tests were assessed. Outcomes were collected pre- and post-intervention. FINDINGS: No differences were detected for any of the paraspinal fatigue characteristics either within or between groups, apart from a significant decrease in normalised median frequency slope of the erector spinae for the G group. Paraspinal muscle strength and all functional tests have demonstrated significant within-group improvements for both groups, without any between-group differences. INTERPRETATION: An 8-week stabilisation exercise-enhanced approach presented equal benefits to a general endurance-based exercise programme for patients with recurrent non-specific back pain. A slightly steeper slope for the erector spinae in the G group was the only electromyographic fatigue alteration noted. Concomitant strength improvement probably reflects neural input changes rather than histochemical muscle changes. Physical exercise alone and not the exercise type was the key determinant for improvement in this patient group.

Back↗
PubMed2005

Self-rated general health and psychiatric disorders in a general population sample.

The purpose of this study was to explore the relationships between nicotine and alcohol dependence, depressive, anxiety and somatoform disorders with self-rated general health (GH). A cohort study of a random sample of the non-institutionalised general population aged 18-64 with a participation rate of 70.2% was carried out in a German area (n = 4075 at baseline). A follow-up of tobacco smokers or heavy drinkers (n = 1083, 79.4% of those who had given consent to be followed-up) was conducted 30 months after baseline measurement. The assessments included self-ratings of GH and Diagnostic and Statistical Manual (DSM-IV) diagnoses based on the Composite International Diagnostic Interview. The results show that nicotine dependence, anxiety disorders and somatoform disorders moderately predicted self-rated GH at follow-up (general linear model, R(2) = 0.12). We conclude that psychiatric disorders may contribute to the prediction of a low self-rated GH.

Adolescent↗
PubMed2006

Investigations in generalized osteoarthritis. Part 2: special histological features in generalized osteoarthritis (histological investigations in Heberden's nodes using a histological score).

OBJECTIVE: In accordance with the literature, our previous epidemiological, clinical and genetical investigations have confirmed a correlation between generalized osteoarthritis (GOA) and Heberden's nodes. Heberden's nodes can be considered as genetic markers for the existence of a generalized osteoarthritic predisposition. The present study's concern was to establish whether there are special histological features in this disease. METHODS: Layered sections of 218 distal finger joints from 56 deceased persons were investigated using a histological-histochemical score modified by Mankin. RESULTS: In Heberden's nodes, we found all the typical degradative sequences of the osteoarthritic process but also some specific modifications. The osteoarthritis (OA) starts with a subchondral ossification and manifests a reactive tidemark flaking. At this time, the surface of the cartilage is not yet destroyed. Later on, there is progression of general degradation. Significant differentiation from the control group is possible using a histological score. CONCLUSIONS: In patients with Heberden's nodes, the OA starts with the subchondral ossification. Heberden's nodes are the specific manifestation of GOA in the distal finger joints. Further studies are therefore required to assess whether the same pathogenetic mechanism can be seen in OA of the large joints in GOA.

Age Distribution↗