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PubMed2004

[General practitioners' health care for disabled patients: a survey among a panel of general practitioners in Southeastern France, in 2002].

OBJECTIVES: This article presents a study on General Practitioners' (GPs) knowledge, attitudes and practice towards disabled patients. MATERIAL: A sample of 600 private general practitioners practising in Southeastern France was selected in 2002 with a random sampling approach stratified according to age, sex, and size of the urban unit. METHOD: A standardised questionnaire was used to collect data by telephone. Results are presented as percentages. Comparisons used Pearson's chi2 test. RESULTS: Ninety percent of the GPs reported that they had to provide social assistance to their disabled patients (protecting their rights, administrative assistance, family counselor, etc.) as well as coordinating care by various other professionals. GPs frequently reported the presence of barriers that compromised the health care of disabled patients: lack of information (62.8%), time (50.2%), co-ordination between health professionals (37.7%), and training (37.7%), as well as communication problems (20.7%) and the need for assistance in clinical examinations (16.2%). More than 25% of the GPs suggested breast cancer screening (27.6%), contraceptive prevention (29.5%) or hepatitis B vaccination (29,3%) less often to their disabled than non disabled patients and 25.8% reported they had not evaluated the patients' dependency levels. CONCLUSION: This study suggests that GPs face several barriers in caring for disabled persons. A lack of knowledge may explain inappropriate care for this population. GPs need more support and guidance in dealing with disabled patients, and coordination with other health professionals must be encouraged.

Adult↗
PubMed2006

A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample.

BACKGROUND: High rates of co-morbidity between Generalized Social Phobia (GSP) and Generalized Anxiety Disorder (GAD) have been documented. The reason for this is unclear. Family studies are one means of clarifying the nature of co-morbidity between two disorders. METHODS: Six models of co-morbidity between GSP and GAD were investigated in a family aggregation study of 403 first-degree relatives of non-clinical probands: 37 with GSP, 22 with GAD, 15 with co-morbid GSP/GAD, and 41 controls with no history of GSP or GAD. Psychiatric data were collected for probands and relatives. Mixed methods (direct and family history interviews) were utilised. RESULTS: Primary contrasts (against controls) found an increased rate of pure GSP in the relatives of both GSP probands and co-morbid GSP/GAD probands, and found relatives of co-morbid GSP/GAD probands to have an increased rate of both pure GAD and co-morbid GSP/GAD. Secondary contrasts found (i) increased GSP in the relatives of GSP only probands compared to the relatives of GAD only probands; and (ii) increased GAD in the relatives of co-morbid GSP/GAD probands compared to the relatives of GSP only probands. LIMITATIONS: The study did not directly interview all relatives, although the reliability of family history data was assessed. The study was based on an all-female proband sample. The implications of both these limitations are discussed. CONCLUSIONS: The results were most consistent with a co-morbidity model indicating independent familial transmission of GSP and GAD. This has clinical implications for the treatment of patients with both disorders.

Adolescent↗
PubMed2004

The general secretory pathway: a general misnomer?

The term general secretory pathway (GSP) has been usurped and misused in the literature over the past few years. The concept of GSP is discussed from an historical perspective, and the definitions of the general export pathway (GEP), the main terminal branch (MTB) of the GSP, the unified GSP nomenclature and the type II, IV and V secretion pathways are also described to show how they have fuelled the confusion. By putting the record straight and using novel findings within the field of bacterial protein secretion, we hope to bring clarity to this area of science and prevent further promulgation of incorrect terminologies.

Bacterial Proteins↗
PubMed2002

Application of the general rate model and the generalized Maxwell-Stefan equation to the study of the mass transfer kinetics of a pair of enantiomers.

The general rate model of chromatography can be coupled with the generalized Maxwell-Stefan equation that describes the surface diffusion flux. The resulting model is useful to describe the behavior of two enantiomers during their separation on chiral phases, cases in which the mass transfer kinetics is known to be sluggish. A case in point is the modeling of the elution profiles of the racemic mixture of the two enantiomers of 1-phenyl-1-propanol on cellulose tribenzoate coated on silica, a popular chiral stationary phase. The competitive equilibrium isotherm behavior of the two enantiomers on the chiral stationary phase was described using the competitive Tóth isotherm model. An excellent agreement between the experimental and the calculated profiles was observed in the whole range of experimental conditions investigated, at low and high column loadings.

Kinetics↗
PubMed1997

Can general internal medicine be taught in general practice? An evaluation of the University College London model.

There is national and international interest in increasing the community-based component of undergraduate medical education, but more research is needed on its potential, practicability and effectiveness. The objective of the study was to examine the feasibility and efficacy of general practitioners teaching basic clinical skills to first year clinical medical students in the community. The structure and methods of evaluation of the programme are described. Evaluation tools included semistructured interviews of general practitioner tutors; student questionnaires; assessment of student performance; and costs of the programme. The great majority of the students found the programme enjoyable (81 out of 81, 100%) and educational (79 out of 81, 97%). Students' performance in the end of rotation Objective Structured Clinical Examination suggested that clinical skills are acquired at least as well in the community as in the hospital. Tutors identified the personal benefits of this teaching as development of their own clinical skills and the stimulation of teaching. The programme has been successfully expanded from 24 students to 230 students annually and has demonstrated that community-based teaching can usefully contribute to undergraduate medical education in the area of clinical skills teaching. Key practical issues for schools contemplating similar initiatives are presented.

Adult↗
PubMed2003

Factor structure of the 12-item General Health Questionnaire in the Japanese general adult population.

The 12-item General Health Questionnaire (GHQ-12) has been extensively used in a variety of settings across countries. The main aim of the present study was to assess the factor structure of the GHQ-12 for the Japanese general adult population. Data came from a sample of 1808 Japanese aged 20 years or older who were randomly selected based on the 1995 census (897 men and 911 women). Cronbach's alpha coefficients were 0.83 for men and 0.85 for women. Overall, the corrected item-total correlation coefficients were >0.20 for both genders. The GHQ-12 yielded a two-factor solution of psychological distress (items 2, 5, 6, 9, 10 and 11) and social dysfunction (items 1, 3, 4, 7 and 8), which jointly accounted for 49.1% of the total variance, for women. Item 12 on happiness was not discernable. For men, item 12 was separated from a social dysfunction factor and yielded the third factor with item 3 on social role, and the three factors jointly accounted for 57.6%. The results of the present study suggest that the GHQ-12 can be used as an internally reliable and homogeneous scale that produces mainly the factors of psychological distress and social dysfunction. Item 12 may be structurally different in the case of Japanese adults.

Adult↗
PubMed2005

SCN1A mutation analysis in myoclonic astatic epilepsy and severe idiopathic generalized epilepsy of infancy with generalized tonic-clonic seizures.

Severe myoclonic epilepsy in infancy (SMEI), severe idiopathic generalized epilepsy of infancy (SIGEI) with generalized tonic clonic seizures (GTCS), and myoclonic astatic epilepsy (MAE) may show semiological overlaps. In GEFS+ families, all three phenotypes were found associated with mutations in the SCN1A gene. We analyzed the SCN1A gene in 20 patients with non-familial myoclonic astatic epilepsy -- including 12 probands of the original cohort used by Doose et al. in 1970 to delineate MAE. In addition, 18 patients with sporadic SIGEI -- mostly without myoclonic-astatic seizures -- were analyzed. Novel SCN1A mutations were found in 3 individuals. A frame shift resulting in an early premature stop codon in a now 35-year-old woman with a borderline phenotype of MAE and SIGEI (L433fsX449) was identified. A splice site variant (IVS18 + 5 G --> C) and a missense mutation in the conserved pore region (40736 C --> A; R946 S) were detected each in a child with SIGEI. We conclude that, independent of precise syndromic delineation, myoclonic-astatic seizures are not predictive of SCN1A mutations in sporadic myoclonic epilepsies of infancy and early childhood.

Child↗
PubMed1969

The nature of general base-general acid catalysis in serine proteases.

The high reactivity of the serine residue at the active site of serine proteases is often attributed to the formation of a hydrogen bond between this serine and a histidine residue. In the case of the serine protease subtilisin, the catalytic serine residue can be specifically replaced by a cysteine residue and this modified enzyme is called thiol-subtilisin. By studying the D(2)O effect on acyl-enzyme formation with subtilisin and thiol-subtilisin, we present evidence that thiol-subtilisin but not subtilisin may contain a hydrogen bond. Based on the comparison of the catalytic activities of subtilisin and thiol-subtilisin, a rigid active site model for the serine proteases is proposed in which the histidine residue operates in a fixed steric position both as a general base and as a general acid, and this, rather than the formation of a hydrogen bond, accounts for the high nucleophilicity of the serine residue.

Binding Sites↗
PubMed2005

Prostate-specific antigen testing in general practice: a survey among 325 general practitioners in Denmark.

OBJECTIVES: Prostate-specific antigen (PSA) is a well-known and -utilized tumor marker for prostate cancer. Elevated PSA values are not specific for prostate cancer as they may be caused by other benign conditions. PSA testing is widely used by urologists and non-urologists. Interpretation of test results is difficult but important. Referral of patients for further work-up on suspicion of prostate diseases is mainly done by general practitioners (GPs). As the GP remains the gatekeeper between the patient and the urologist in terms of diagnosing prostate diseases, basic knowledge of PSA testing is crucial. The purpose of this study was to evaluate the basic use and knowledge of PSA testing and to give an estimate of the need for further education in PSA testing amongst GPs in our area. MATERIAL AND METHODS: A questionnaire regarding PSA testing and associated needs for education was mailed to all GPs in the Northern County of Denmark. Non-respondents were contacted by mail. RESULTS: Of the contacted GPs, 90% responded. Only 28% of GPs measured PSA in all males complaining of lower urinary tract symptoms (LUTS). Of patients seen as part of a general health check-up, PSA testing was done in 10%. The median PSA value for referral to urologists for further work-up was 5 ng/ml, but the decision was influenced by PSA value (79%), age (65%) and findings on digital rectal examination (DRE) (87%). Opportunistic screening for prostate cancer was done by 14% of GPs. Of the GPs who responded, 24% stated that they did not need any further education regarding PSA testing. CONCLUSIONS: The results of this study demonstrate that PSA testing is not standardized in our area. GPs do not test patients on the basis of recommendations provided by national or international societies. PSA testing is not used as a standard test in men with LUTS, and patients are not referred to urologists at a sufficiently low PSA level to improve the early diagnosis and work-up of patients with suspected prostate cancer. However, the decision of many GPs to refer patients to urologists for further work-up is influenced by the findings of a DRE, the age of the patient and the PSA value itself. Further education regarding PSA testing amongst GPs in our area would seem to be appropriate.

Adult↗
PubMed1999

Allergological examination in general practice and in the specialist field of allergology. A comparative study of the concordance between a group of general practitioners and the allergological specialised health care services to which they refer.

OBJECTIVE: To study the concordance between specially trained general practitioners (GPs) and specialist doctors working as consultants to GPs, with regard to diagnosis of allergic illnesses, evaluation of indications for hyposensitisation, and referrals from GPs to specialists. DESIGN: Thirty-four GPs and five specialists practising privately and eight allergologic outpatient clinics participated. The patients included had symptoms indicating allergologic examination. An identical diagnostic procedure was used by the GPs and by the specialists/outpatient clinics. SETTING: General practices, specialist practices, outpatient clinics. SUBJECTS: One-hundred and forty-eight patients. MAIN OUTCOME MEASURES: With regard to skin-prick test there was concordance between the GPs and the specialists in 82.5% of 1322 paired comparisons, in 74.0% with regard to anamnesis + skin-prick test, and in 66.5% with regard to the statement allergy. There was concordance with regard to indication for hyposensitisation in 88.3%, and for referral in 54.1%. There was symmetry concerning prick test and anamnesis + prick test, and asymmetry concerning the statement allergy, and indication for hyposensitisation and for referral. CONCLUSIONS: Specially trained GPs diagnosed specific allergy in concordance with specialists. There was asymmetry between GPs and specialists concerning the statement allergy, indication for hyposensitisation and for referral.

Allergy and Immunology↗
PubMed2003

Deprivation and systematic stroke prevention in general practice: an audit among general practitioners in the Rotterdam region, The Netherlands.

BACKGROUND: To investigate differences in quality of preventive care provided by general practitioners (GPs) to patients at risk of stroke living in deprived and non-deprived neighbourhoods in the Rotterdam region. METHODS: A 'deprivation score' was used to categorize neighbourhoods according to their deprivation status. Data on the process of patient care were collected by means of chart review and interviews with GPs. Cases of stroke (n=188) were retrospectively audited by an expert panel with guideline-based review criteria. To measure differences in quality of patient care between neighbourhoods, deprivation scores were related to scores for sub-optimal care. RESULTS: After adjustment for socio-demographic characteristics, patients in deprived neighbourhoods had an increased risk (OR 1.95 (95% CI: 0.98-3.90)) of having received sub-optimal preventive care if compared with patients in non-deprived neighbourhoods. This excess risk was limited to women (OR 3.57 (95% CI: 1.39-9.16) vs OR 1.01 (95% CI: 0.41-2.48) in men). Adjustment for socio-demographic characteristics and risk factor distribution did not change the OR for women to receive sub-optimal care significantly (OR 3.21 (95% CI: 1.24-8.31)). Sub-optimal care originated mainly from deficiencies in follow-up of treated hypertensive and diabetes patients and evaluation of patients' cardiovascular risk profile. Among treated hypertensive women in deprived neighbourhoods who received sub-optimal care, the mean number of deficiencies related to follow-up was almost double that of the corresponding group in non-deprived neighbourhoods. CONCLUSION: Quality of care to prevent stroke in general practice differs considerably between deprived and non-deprived neighbourhoods. Patients in deprived neighbourhoods, and women in particular, have almost twice the risk of receiving sub-optimal preventive care.

Adult↗
PubMed1995

Reducing systematic bias in studies of general practitioners: the use of a medical peer in the recruitment of general practitioners in research.

Reducing systematic bias in any group of study participants should be a priority of any researcher. This can be achieved by ensuring the sampling framework is adequate and by increasing response rates. Response rates in studies of general practitioners have to date tended to be low. Generalization of results to the wider population of GPs is therefore reduced. This paper systematically examines those factors which can reduce bias, recognising accurate identification of the target population, gaining good access to respondents, and maximising response rates as crucial factors. The importance of a medical peer in recruitment is examined. Applying these factors to a study situation, three different recruitment strategies were tested. As the strategy improved, there was an incremental improvement in the response rate (44%, 67%, 78%). These results indicate that by specifically addressing strategies which facilitate access to the target population, and increase the legitimacy and credibility of the study, significant improvements in response rates can be achieved.

Australia↗
PubMed2002

General practice-specific care categories: a method to examine the impact of morbidity on general practice workload.

BACKGROUND: Governments are increasing pressure on GPs to provide better services to their patients without giving consideration or due recognition to the impact of those initiatives on their already heavy workload. OBJECTIVE: This pilot study aimed to measure accurately the impact of case mix on general practice workload. METHOD: The general practice-specific care category (GP-SCC) model was developed and applied to a random sample of patients who attended a four-doctor suburban practice four or more times between July 1995 and June 1997. RESULTS: The random sample comprised 245 patients (126 males, 119 females) out of a total practice population of approximately 4000. The mean patient age was 42.7 years (CI 39.6-45.8; range: 0-95). The mean patient consulted 10.70 times (CI 9.62-11.77) and discussed 13.19 health problems (CI 11.74-14.63), which equated to 1.20 problems per consultation (CI 1.17-1.23). The ambulatory case mix concept allowed the development of the GP-SCC model--defined as GP-SCC 1, acute/self-limiting problems and preventive care; GP-SCC 2, primarily chronic health problems; GP-SCC 3, psychological problems in conjunction with up to two other problem categories; and GP-SCC 4, a combination of four or more problem categories. GP-SCC 1 comprised 31.1% of patients (CI 29.1-35.1), accounting for 25.6% of visits (CI 24.0-27.3) and 21.9% of all problems encountered (CI 20.5-23.3); GP-SCC 2 comprised 16.7% of patients (CI 10.6-19.6), accounting for 10.6% of visits (CI 9.5-11.9) and 9.9% of all problems encountered (CI 8.9-11.0); GP-SCC 3 comprised 7.1% of patients (CI 4.4-11.2), accounting for 7.8% of visits (CI 6.8-8.9) and 7.7% of all problems encountered (CI 6.8-8.7); and GP-SCC 4 comprised 42.0% of all patients (CI 35.8-48.2), accounting for 56.0% of all visits (CI 54.2-57.8) and 60.5% of all problems encountered (CI 58.8-62.2). CONCLUSIONS: The GP-SCC model, built on the ambulatory case mix concept, is a useful tool to analyse the morbidity of practice populations, and has a good predictive value in terms of a practice' workload.

Adult↗
PubMed1992

Perceptions of psychological problems in general practice: a comparison of general practitioners and psychiatrists.

All general practitioners and psychiatrists working in a single health district were sent a questionnaire on their perceptions of the prevalence of psychological problems among patients consulting in general practice. One hundred and twenty-one GPs (75%) and 10 (83%) psychiatrists responded. GPs and psychiatrists agreed that up to 20% of consulting patients were likely to be clinically depressed; they also agreed on the most appropriate management, although GPs tended to be more conservative than psychiatrists would advise on making use of hospital services. GPs, however, believed non-specific psychological problems to be significantly less common than did psychiatrists. This expectation may help explain the reported failure of GPs to diagnose all psychological problems identified by formal psychiatric instruments.

Adult↗
PubMed1996

Effect of debt on U.S. medical school graduates' preferences for family medicine, general internal medicine, and general pediatrics.

The authors assess the importance of educational debt in graduates' primary care specialty choices, and the variety of mechanisms through which debt may influence career decisions. Logistic regression models were used to identify significant predictors of the primary care specialty choices made by the 1991 and 1992 graduates of U.S. medical schools. These predictors were debt itself; other financial indicators; certain medical school characteristics; certain practice location plans; certain demographic factors; aspects of academic performance; and students' predisposition to a primary care specialty. Data for this study were gathered from a variety of sources at the Association of American Medical Colleges and from the Health Education Assistance Loans program. Both direct and indirect effects of debt were identified under specific conditions. The study revealed complex relationships between debt and the other predictors identified. For example, debt operated in relation to the levels of the graduates' expected incomes; debt from subsidized loan sources was significant for women who chose general internal medicine; debt was important in choices of family practice; and debt by itself was significant for those planning to practice in the West and who chose general internal medicine. Also, seemingly opposing effects of debt occurred. For example, in the family practice model used in this study, the threshold effect of debt was positive, while the linear effect of debt above the threshold was negative. Such vriations help explain the conflicting findings of some past research. These and other findings prompt the authors to state that when investigating the effects of debt, it is not fruitful to ask what the effect of the debt is on all three primary care fields as a group. It is more appropriate to ask several questions, such as: under what conditions does debt influence specialty plans? Among which groups of students does debt have an impact on specialty plans? Are all of the primary care specialties similarly affected by the issues surrounding debt? Does the effect of debt change over time? The authors conclude by indicating possible policy implications of their findings.

Career Choice↗
PubMed1991

Generalizing Long's inversion of the matrix form of Prentice's equation and the concept of generalized inverse dioptric power.

The concept of generalized inverse dioptric power is introduced. Its use is illustrated in solving Long's matrix generalization of Prentice's equation for the decentration required to produce a specified prismatic effect. The solution holds in all cases for which a solution exists, including for the pure cylinder, and the result gives all solutions when more than one exists.

Eyeglasses↗
PubMed2004

Generalizing discriminant analysis using the generalized singular value decomposition.

Discriminant analysis has been used for decades to extract features that preserve class separability. It is commonly defined as an optimization problem involving covariance matrices that represent the scatter within and between clusters. The requirement that one of these matrices be nonsingular limits its application to data sets with certain relative dimensions. We examine a number of optimization criteria, and extend their applicability by using the generalized singular value decomposition to circumvent the nonsingularity requirement. The result is a generalization of discriminant analysis that can be applied even when the sample size is smaller than the dimension of the sample data. We use classification results from the reduced representation to compare the effectiveness of this approach with some alternatives, and conclude with a discussion of their relative merits.

Algorithms↗