Are generalists still needed in a specialised world? General practice enables doctors to maintain general medical skills.
Explore the source record for details and available documents.
SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The presence of a general practitioner (GP) at the hospital emergency ward is a first attempt to answer a society phenomenon, challenging the hospital manager, but related to a more complex and extensive problem. New habits, due to various reasons, eventually move an ever growing proportion of patients from the community GP towards the hospital. The relationships between the patient and the practitioner are collapsing down like those between family members especially in towns. How can we resolve such an evolution politically? To have the city GP inside the hospital as it is already the case in big US cities? or, to favor the central role of the community general practitioner in the medical management of the patients, but in opposition to the present course of events? The first solution would be more expensive than the second one.
The deontological rules defining the relations between the general practitioners and specialists about domestic emergencies are clearly exposed in the code edited by the National Medical Council of Belgium. Ethical particularities exist. During an emergency situation, the patient could lose his freedom as well as his autonomy and might become a technical subject rather than an ethical person. The ethical values are in opposition with a medical practice trying to be more and more efficient with as a corollary, the necessity to have a full and permanent access to personal medical data.
The general practioneer is frequently concerned by the follow-up of patients receiving immunosuppressive agents for auto-immune diseases or for the prevention of graft rejection. We here review the side effects of the most frequently used immunosuppressive drugs: glucocorticoids, azathioprine, cyclophophamide, cyclosporine and methotrexate. Important drug interactions are also mentioned. We also discuss the adult vaccine schedule for patients treated with immunosuppressive agents. Finally, the consequences of immunosuppressive drugs on fertility and pregnancy are developed.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND AND OBJECTIVES: The care of cancer patients has become increasingly complex and multidisciplinary while more responsibility for cancer care has been shifted to primary care physicians. We developed a medical student educational program to teachfuture primary care physicians about care of cancer patients. METHODS: The Multidisciplinary Oncology Clerkship was designed for fourth-year medical students planning to enter primary care residencies. The clerkship hasfive major components: ambulatory patient care, multidisciplinary conferences, skill stations, problem-based learning in small groups, and supervised objective structured clinical examinations. Learning during the clerkship was evaluated with knowledge tests before, immediately after, and 6 months after the clerkship. RESULTS: Twenty-four students participated in the first year of the clerkship. Program evaluation revealed that the students' scores on the knowledge test rose 40% between the pre-clerkship and post-clerkship tests. Retesting at 6 months demonstrated knowledge retention of 90%. CONCLUSIONS: Multidisciplinary cancer education, using the combination of problem-based learning, skill stations, clinical exposure, and standardized patients, increases the cancer-care knowledge of medical students dedicated to a career in primary care.
Explore the source record for details and available documents.
The haemoglobin disorders are frequent genetic diseases in tropical regions and in the mediterranean basin. They include thalassaemia and sickle cell disease. Because of important migrations of populations after the Second World War many big cities are confronted with the disease in West Europe nowadays. In Brussels where a neonatal screening has been organised in the majority of the maternity's, 45% of newborns have at least one parent originating from a region at risk for an haemoglobin disorder. One neonate among 2.000 is diagnosed with a major haemoglobinopathy at the screening. This rate is important and it appeared essential to evaluate the knowledge and need for complementary information among the doctors confronted with the disease. A survey was done in January 1999 and a questionnaire was sent to all gynaecologists, paediatricians and general practitioners in Brussels. The main results were a general self-evaluation of poor knowledge and a great need for complementary information. This survey was important to obtain adequate support of official health authorities in term of screening, prevention and financial aid to information campaigns. A consensus is needed among the different doctors for the best care possible of sick patients.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Glomerulonephritis is a common renal disorder, and a leading cause of end-stage renal disease. Glomerulonephritis can present in protean ways, with general features including proteinuria, hematuria, renal failure, and hypertension. Recent advances in our knowledge of glomerulonephritis have indicated that in many cases early therapeutic intervention can lead to improvement in renal function, long-term preservation of renal function, or slowing of the progression to end-stage renal failure. The goal of this review is to describe the method of evaluation of glomerulonephritis, stress the importance of general measures to preserve renal function or slow the rate of progression of disease, and finally to familiarize the reader with distinct categories of disease and their treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.