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PubMed2001

The General Medical Council's Performance Procedures: the development and implementation of tests of competence with examples from general practice.

OBJECTIVE: This paper describes the development of the tests of competence used as part of the General Medical Council's assessment of potentially seriously deficient doctors. It is illustrated by reference to tests of knowledge and clinical and practical skills created for general practice. SUBJECTS AND TESTS: A notional sample of 30 volunteers in 'good standing' in the specialty (reference group), 27 practitioners referred to the procedures and four practitioners not referred but who were the focus of concern over their performance. Tests were constructed using available guidelines and a specially convened working group in the specialty. METHODS: Standards were set using Angoff, modified contrasting group and global judgement methods, as appropriate. RESULTS: Tests performed highly reliably, showed evidence of construct validity, intercorrelated at appropriate levels and, at the standards employed, demonstrated good separation of reference and referred groups. Likelihood ratios for above and below standard performance based on competence were large for each test. Seven of 27 doctors referred were shown not to be deficient in both phases of the performance assessment.

Adult↗

PubMed2002

[The Dutch College of General Practitioners' 'Irritable bowel syndrome' standard; reaction from the field of general practice].

In the recently published Dutch College of General Practitioners' standard entitled 'Irritable bowel syndrome', questions for use in establishing this difficult syndrome are provided. Being reserved during examination and using moderation in choosing a treatment regime are the most important recommendations. The emphasis should be on explaining that this is usually a harmless syndrome. This guideline is very helpful to the general practitioner.

Colonic Diseases, Functional↗

PubMed2002

[The Dutch College of General Practitioners' practice guideline, "Vaginal bleeding"; reaction from a general practice perspective].

The most important changes in the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' are the passages about the progesterone-containing 'intra-uterine device' (IUD), the combination of progesterone and oestrogen by prescribing, for example, a sub-50-pill for the treatment of menorrhagia, and advising the patient to undergo a transvaginal ultrasound to determine the amount of build-up in the endometrium. Vacuum aspiration of the endometrium to establish the cause of menorrhagia is not mentioned. This first revised version can contribute to the quality of care in general practice.

Female↗

PubMed1976

The paediatric training required by the general practitioner. A report by a Joint Working Party of the British Paediatric Association and the Royal College of General Practitioners.

This report has been written because special programmes of training for general practice are being developed in many parts of the country and there are questions about the paediatric component of training which need to be discussed nationally.An important part of this report is devoted to listing educational objectives which should be attained in paediatrics by the general practitioner at the end of his training.

Education, Medical↗

PubMed2003

The general practitioner-patient consultation pattern as a tool for cancer diagnosis in general practice.

A case-control study design was used to examine consultation patterns during the three years leading up to the diagnosis of an internal malignancy, within the context of the registered patient list of a single large general practice at Winterton, North Lincolnshire. Using a combination of matching, consultation subclassification, and conditional logistic regression, account was taken of the major confounders affecting consultation rates. Generally, the odds of cancer rose in tandem with increases in the average time between new consultations. This trend was significant for all breast cancers (at the 5% level) and persisted after adjustment for occupation, smoking, and marital status (P = 0.03), as well as after the exclusion of patients identified by routine screening (P = 0.05).

Case-Control Studies↗

PubMed2003

[The Dutch College of General Practitioners' practice guideline "Dizziness"; reaction from a general practitioner's perspective].

The Dutch College of General Practitioners' practice guideline entitled 'Dizziness' concerns a complaint experienced by many people, yet it provides few scientific data to support the recommendations. The standard does, however, provide the general practitioner with some concrete advice: the diagnostic work-up should, in the first instance, aim to differentiate vertigo from other forms of dizziness, and medicinal treatment is not indicated as it has not been proven to be effective. However, when it comes to further diagnostic procedures and non-medicinal therapy, the standard tends to list options and give less direction.

Diagnosis, Differential↗

PubMed2003

Head lice diagnosed in general practice in the West Midlands between 1993 and 2000: a survey using the General Practice Research Database.

The potential of the General Practice Research Database (GPRD) for communicable disease surveillance was explored using head lice as an example. All diagnoses of head lice and prescriptions for parasiticidal agents from 1993 to 2000 in the West Midlands were analysed. Diagnoses reached a peak of 28.2 per 1,000 patient years at risk and total prescriptions reached a peak of 27.1 per 1,000 patient years at risk in 1997. Malathion and permethrin were prescribed most often. The proportion of further parasiticidal prescriptions issued within 30 days of the initial prescription increased to a peak of 11.5% of prescriptions in 1997. The ratio of the same:different further prescriptions changed during the study period, reaching a high of 5:1 in 2000. These trends are mirrored by the Royal College of General Practitioners (RCGP) Weekly Returns Service and Prescribing Analysis and Cost (PACT) data. Use of GPRD provides additional insights into patient data, particularly on prescribing, that would not be available from other sources.

Adolescent↗

PubMed2004

[The practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The second revision of the Dutch College of General Practitioners' practice guideline on hormonal contraception discusses the various methods of hormonal birth control and can help the general practitioner to inform the patient when choosing the most desirable method. A thorough anamnesis is necessary with regard to the increased risks for breast cancer, uterine cancer and cardiovascular diseases in women using hormonal contraception, especially in those who smoke. The guideline also discusses non-hormonal methods briefly.

Breast Neoplasms↗

PubMed2004

[The practice guideline 'Stable angina pectoris' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The Dutch College of General Practitioners' (Dutch acronym: NHG) practice guideline 'Stable angina pectoris' (second revision) provides clear guidelines for the diagnosis and treatment of patients who experience chest pains as a result of angina pectoris, especially if coronary artery disease is the underlying cause of the complaints. The practice guideline clearly indicates for which complaints the general practitioner should suspect angina pectoris and which information from the anamnesis, family history and risk factors can contribute to distinguishing between stable and unstable angina pectoris. However, the physical examination should not be omitted because this can provide important indications for coronary or pulmonary dysfunction. According to the practice guideline, the treatment policy is determined by the estimated risk of significant coronary artery disease. However, additional tests can be useful even in the case of a small risk, as these can reassure patients. The indications and contraindications for medicinal substances are clearly presented.

Angina Pectoris↗

PubMed2005

[The practice guideline 'Miscarriage' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline 'Miscarriage' has been reviewed for the second time in fifteen years. It provides the practitioner with distinct diagnostic tools for vaginal bleeding in the first sixteen weeks of pregnancy and a clear management algorithm. The management of miscarriage is based on a joint decision between the general practitioner and the woman concerned. A more reserved attitude towards the surgical termination of pregnancy is advised. The guideline sufficiently addresses the issue of informing the woman as to the expected amount of bleeding during a miscarriage and the relationship with fertility. However, the risk factors for heavy blood loss are not mentioned in the guideline. The psychological impact of early miscarriage on women is given adequate attention and is part of the counselling during the follow-up period. Finally, the medical treatment of threatened miscarriage seems to result in an earlier miscarriage with less loss of blood compared to expectant management. The guideline pays also attention to medical treatment. Future research will clarify whether medical treatment is feasible in general practice.

Abortion, Spontaneous↗

PubMed1992

[The general practitioner and screening for cancer of the breast. Study of a sample of 200 general practitioners in the Bas-Rhin].

A questionnaire survey of 200 doctors who were a sample of the general practitioners of the Bas-Rhin department was carried out. This was in order to ascertain what they knew about cancer of the breast and how they practised medically in this area, what were their doubts and what motivated them to screen for this kind of cancer? The questionnaire was found on the whole to acceptable. The enquiry showed that undoubtedly doctors were in favour of screening for cancer of the breast but were less enthusiastic carrying it out routinely. They also were unaware of ways in which such screening could be carried out (mammography being considered and examination which shows where the cancer was and not as a screening method). Furthermore, there was some confusion between screening and means of diagnosis. Results of this study show that it should be possible to outline the content and means of informing general practitioners about how to screen in order to enable them to participate in the Alsatian pilot campaign for screening for breast cancer.

Attitude of Health Personnel↗

PubMed2005

[The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The recommendations provided by the revised guideline 'Anxiety disorders' are well suited to every-day practice. The multidisciplinary approach reflects the increasing cooperation between primary and secondary care in the management of mental-health problems. The description of the various anxiety disorders and the questions that can be asked to elicit the symptoms will facilitate recognition. The indications for treatment with medication are clear: a limited number of antidepressants should be used. Although it is agreed that patient education is an important part of treatment, the guidelines could have described in more detail how this should be done. Cognitive-behavioural techniques may be used but this requires extra training; its effectiveness when used by general practitioners needs further study. This guideline will add to existing knowledge and improve the skills of general practitioners in dealing with anxiety.

Antidepressive Agents↗

PubMed1992

[Generalized arterial disease. Diagnostic assessment in general medical practice].

PROBLEM: Primary and secondary prophylactic measures can be effective only if they are global in nature. In this connection, occlusive arterial disease (OAD) must be considered to be a systemic disease, and the striking coincidence of peripheral, coronary and central occlusive sites must receive greater attention. STUDY: Examination of frequency of an additional peripheral or cerebral vascular diagnostic work-up in 40 nonselected patients with primary CHD in a general practice. RESULTS: From a random sample of a group of patients from a general practitioner's office with the primary diagnosis of coronary arterial disease (CAD), it can be seen that in only 30 percent of the patients was a search for other sites of occlusion (peripheral, central) undertaken, irrespective of the underlying disease. CONCLUSIONS: For various reasons, in these patients, case history and the findings at physical examination often failed to provide adequate sensitivity and specificity, so that screening for high-risk patients using non-invasive methods (e.g. ultrasound) would be desirable also in the doctor's office.

Aged↗

PubMed2006

[The practice guideline 'Otitis media with effusion' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The usefulness of tympanotomy tubes in children with otitis media with effusion who also have speech and language retardation is doubtful in view of the natural development. The second revision of the practice guideline 'Otitis media with effusion' from the Dutch College of General Practitioners is still not in complete agreement with this. The indications for performing an adenoidectomy are now more limited. Pneumatic otoscopy and tympanometry are diagnostic aids that may deserve a permanent place in the general practitioner's medical practice in the future.

Acoustic Impedance Tests↗

PubMed2007

[Palliative care in Seirei Mikatahara General Hospital Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital].

This paper illustrates a brief review of the development process of the palliative care team at the Seirei Mikatahara General Hospital. Palliative care team has been first instituted in 2002, and currently providing general support for cancer patients receiving chemotherapy not only for terminally ill patients. In future, we would start a regional palliative care program, including community palliative care team, to provide appropriate palliative care for all cancer population.

Hospice Care↗

PubMed1990

General practitioner minor surgery facilitated by a Fife District General Hospital. Evaluation of a pilot project.

Large waiting lists for elective surgical operations in Fife stimulated a pilot project to encourage general practitioners (GPs), to undertake more minor surgery operations. A three part evaluation of the work was designed which looked at medical and patient satisfaction aspects of the project; views of the Local Medical Committee (General Practice) and Division of Surgery were sought. All parts of the evaluation appeared satisfactory and health service managers have been provided with sufficient information to make decisions on the implementation of further minor surgical schemes in Fife.

Consumer Behavior↗

PubMed1979

[Generalized periarticular calcinosis. Generalized hydroxylapatite disease].

The complex of symptoms know as generalized periarticular calcinosis is a disease observed clinically as occurring in periods lasting only a few days, and with a mainly monoarticular arthritic or tenosynovitis character which may be localized in various joints. A primary chronic course of the disease is rare. Crucial for the diagnosis is the demonstration of multiple periarticular calcifications, which can be identified biochemically as hydroxyapatite. The calcification probably initiates the burst of inflammation, and for this reason the symptoms can be certainly classified pathogenically as a crystalline synovitis. Etiologically, the disease is probably due to both genetic and acquired metabolic anomalies. Modification of calcification cannot be undertaken in our present ignorance of the exact pathogenesis, and for this reason the therapy of generalized periarthritis must remain symptomatic. The effect of non-steroid antiphlogistics, corticosteroids and colchicin is, however, unsatisfactory.

Adolescent↗

PubMed1983

Hypertension screening in general practice. Report on behalf of the General Practitioner Hypertension Study Group.

In 1974 eight general practitioners decided to co-operate in a hypertension screening exercise in their practices. The reasons for the survey and the methodology are described and the results of screening over 28,000 patients are given. The cut-off point for normal diastolic blood pressure was 89 mmHg and 23,979 (85 per cent) patients were considered to be normosensitive on this criterion, 694 (2.5 per cent) patients were already known by their doctors to have hypertension; 991 (3.5 per cent) had an initial abnormal reading but subsequent readings were normal. The survey identified 2,018 patients (7.12 per cent) as being hypertensive and 575 (2 per cent) failed to complete the survey. Because of the ever-changing population in the practices, 100 per cent surveillance was not achieved. It is considered necessary to carry out continuous case finding for the presence of hypertensive patients in general practice.

Adolescent↗