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PubMed1988

Satisfaction and job stress in general practice.

This paper investigates sources of job satisfaction and dissatisfaction in general practice and identifies pressures and difficulties experienced by general practitioners in their work. The study revealed widespread job satisfaction based on three separate (but independent) aspects of general practice: clinical, psychosocial or managerial. Despite this, significant pressures were experienced and, in common with previous studies over the last 20 years, this research found continuing problems affecting young general practitioners in particular. The main pressures currently experienced were uncertainty and insecurity about work, isolation, poor relationships with other doctors, disillusion with the role of the general practitioner, and an awareness of changing demands. These pressures were related to experience in general practice, amount of study leave and practice organization. Like previous studies, it also appears from this research that continuing education could play an important role in attenuating these difficulties. It is argued that the emphasis should be on developing support, confidence and better contacts between general practitioners, as well as teaching knowledge and skills.

Attitude of Health Personnel↗
PubMed1989

The spectrum of farming accidents seen in Irish general practice: a one-year survey.

A one-year prospective survey of farming accidents in three Irish counties recruited 37 general practitioners in a wide geographical sample. The response rate to the survey was 84%. There were 319 accident cases seen by the general practitioners in the survey period, and 175 (55%) of these were farmers. Children accounted for 52 (16%) of all accident cases. The majority of cases (256, 80%) were treated by the general practitioner, and the spectrum of injuries treated was very broad. Many injuries required extensive suturing and follow-up of soft-tissue injuries. General practitioner coroners were involved with five fatal farm accident cases. It is concluded that the Irish rural general practitioner is providing a significant trauma service to farm accident victims, and is a valuable source of information on these incidents. The general practitioner would be a local source of expertise in a health education campaign directed at increasing the awareness among the farming community on the extent of farm accident morbidity and mortality. Continuing education for rural general practitioners should be directed towards regular updates on trauma management.

Accidents, Occupational↗
PubMed1989

Factors affecting the level of interest and activity in primary care research among general practitioners.

This paper presents the results of a state-wide survey of general practitioners in Victoria, Australia. The survey assessed their level of interest in general practice research as well as factors influencing the decision to participate in research. The study was conducted during the formation of a general practice research network which was being linked to a new primary care research unit in the Department of Community Medicine at Monash University. Of the 3350 general practitioners surveyed 1116 responded. One third expressed a high degree of interest in general practice research. Previous research experience and barriers to general practice research were also studied. The areas in which the doctors felt most research was required were identified. The results are compared with another study of Canadian family physicians, which is the only study of a similar nature previously published. The implications of the results are discussed with reference to the future direction of research by general practitioners.

Choice Behavior↗
PubMed1989

General practitioners' opinions about their responsibility for medical tasks: comparison between England and The Netherlands.

A questionnaire survey compared a sample of 371 general practitioners in the Avon region of England with 74 general practitioners in the east of the Netherlands. A list of 14 medical tasks--six technical tasks and eight chronic disease management tasks--was presented and the doctors indicated whether each task was totally, often, sometimes, seldom or not at all the responsibility of the general practitioner. The results show that English general practitioners felt more responsibility for chronic problems than the Dutch doctors whereas Dutch general practitioners felt more responsibility for technical tasks than the English. Fewer general practitioners in both countries felt responsible for technical tasks than for chronic disease. Reasons for the differences in terms of the structure of general practice and training are discussed.

Adult↗
PubMed2002

Andropause: knowledge and perceptions among the general public and health care professionals.

BACKGROUND: Andropause, the natural age-related decline in testosterone in men, has been debated in the literature. The nonsexual benefits of testosterone replacement therapy (TRT) in male hypogonadism are well documented, but whether health care professionals (HCPs) and members of the general public are aware of these benefits is not known. This study assesses the knowledge and perceptions of andropause and TRT among HCPs and members of the general public. METHODS: Brief surveys were administered to HCPs and members of the general public who called a medical information telephone line. Trained clinical interviewers surveyed participants for experiences with andropause and TRT and knowledge about nonsexual effects of low testosterone in men. RESULTS: Of 443 general public callers, 377 (85%) agreed to participate in the survey. Of these participants, 77% had heard of andropause or male menopause, and 63% had taken TRT. Of 88 HCP callers, 57 (65%) participated. Of these participants, 65% were pharmacists, 80% had encountered patients with symptoms of low testosterone, and 50% reported that patients rarely or never initiated conversations about low testosterone. Among HCPs and the general public, respectively, 98% and 91% knew that low testosterone is treatable with medication, and 60% and 57% knew that it results in osteoporosis. Only 25% of HCPs and 14% of the general public knew that low testosterone does not cause loss of urinary control. CONCLUSIONS: HCPs and members of the general public are knowledgeable about some aspects of low testosterone and have misconceptions about others. Educational initiatives are needed.

Climacteric↗
PubMed2005

Quality of stroke prevention in general practice: relationship with practice organization.

OBJECTIVE: To investigate the relationship between elements of practice organization related to stroke prevention in general practice, and suboptimal preventive care preceding the occurrence of stroke. DESIGN: This study was conducted among 69 Dutch general practitioners in the Rotterdam region. Information on the implementation of elements of practice organization related to stroke prevention was collected by postal questionnaire. Data on the process of patient care were collected by means of chart review and interviews with general practitioners. Cases of stroke (n = 186) were retrospectively audited by an expert panel with guideline-based review criteria. Using logistic regression analysis we investigated the relationship between the probability of suboptimal care delivery and the presence of specific elements of practice organization related to stroke prevention (tailored information systems, formal delegation of preventive tasks, standardization of care). RESULTS: For some elements of practice organization significant relationships with the quality of stroke prevention were found. Suboptimal care was less common among general practitioners with a higher level of noting high risk patients in the patient records (odds ratio 0.30; 95% CI 0.13-0.69, P = 0.01), delegating follow-up visits to support staff (odds ratio 0.42; 95% CI 0.22-0.82, P = 0.01) and compliance with the hypertension guideline (odds ratio 0.57; 95% CI 0.41-0.78, P = <0.001). Except for practice type (general practitioners in health centres less often provided suboptimal care, P = 0.02), no significant relationships with general practitioner and practice characteristics were found. CONCLUSION: This study shows that general practitioners with a higher level of integrated organizational structures for stroke prevention (record keeping, formal delegation of preventive tasks, guideline compliance) are less likely to deliver suboptimal care.

Family Practice↗
PubMed1996

Implementation of a pre-hospital decision rule in general practice. Triage of patients with suspected myocardial infarction.

OBJECTIVE: To improve pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS. Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, for whom acute admission into hospital was requested, and in whom a pre-hospital electrocardiogram was recorded by the ambulance service. METHODS: The study consisted of two phases. In the first phase, a decision rule was developed based on clinical characteristics and electrocardiographic findings in 1005 patients with suspected acute cardiac pathology. In the second phase, the decision rule was prospectively validated. Symptoms were recorded by a standardized questionnaire by the general practitioner and a computerized electrocardiogram was made by the ambulance nurses at the patient's home. Three electrocardiographic outcomes were available: 'normal electrocardiogram', 'possible myocardial infarction' or 'extensive myocardial infarction'. By use of the predictive model, the general practitioner could decide if hospitalization was necessary or not. MAIN OUTCOME MEASUREMENTS: Identification of patients at low (stable angina, atypical chest pain, other pathology) and high (myocardial infarction, unstable angina) probability of acute cardiac pathology. RESULTS: Among 977 patients with a complete pre-hospital evaluation in the validation phase of the study, the decision rule recommended 'no hospitalization' in 227 patients (23%). The general practitioner followed this advice in 44% of these patients. Although seven of them developed a non-Q wave myocardial infarction, no complications occurred in patients not admitted. In addition, the general practitioner did not hospitalize 19 (2%) of 750 patients for whom the decision rule recommended admission. Pre-hospital triage by the general practitioner resulted in a 12% (118 of 977 patients) reduction of the number of patients admitted to the Coronary Care Units. CONCLUSIONS: Pre-hospital triage by the general practitioner was facilitated using a standardized questionnaire and pre-hospital electrocardiography, and resulted in a reduction in the number of patients admitted to the Coronary Care Unit, and proved to be safe.

Aged↗
PubMed1997

Differential sensitivities of mammalian neuronal and muscle nicotinic acetylcholine receptors to general anesthetics.

BACKGROUND: Nicotinic acetylcholine receptors (nAChRs) are members of a superfamily of fast neurotransmitter-gated receptor channels that includes the gamma-aminobutyric acidA (GABAA), glycine and serotonin type 3 (5-HT3) receptors. Most previous work on the interactions of general anesthetics with nAChRs has involved the muscle-type receptor. The authors investigate the effects of general anesthetics on defined mammalian neuronal and muscle nAChRs expressed in Xenopus oocytes. METHODS: Complementary deoxyribonucleic acid (cDNA) or messenger ribonucleic acid (mRNA) encoding for various neuronal or muscle nAChR subunits was injected into Xenopus oocytes, and the resulting ACh-activated currents were studied using the two-electrode voltage-clamp technique. The effects of halothane, isoflurane, sevoflurane, and propofol on the peak acetylcholine-induced currents were investigated, and concentration-response curves were constructed. RESULTS: The neuronal nAChRs were found to be much more sensitive to general anesthetics than were the muscle nAChRs, with IC50 concentrations being 10- to 35-fold less for the neuronal receptors. For the inhalational general anesthetics, the IC50 concentrations were considerably less than the free aqueous concentrations that cause general anesthesia in mammals. In addition, qualitative (dependence on acetylcholine concentration) and quantitative (steepness of concentration-response curves) differences in the anesthetic interactions between the neuronal and muscle nAChRs suggest that different mechanisms of inhibition may be involved. CONCLUSIONS: Although there is considerable uncertainty about the physiologic roles that neuronal nAChRs play in the central nervous system, their extraordinary sensitivity to general anesthetics, particularly the inhalational agents, suggests they may mediate some of the effects of general anesthetics at surgical, or even subanesthetic, concentrations.

Acetylcholine↗
PubMed1996

Non-pharmacological management of hypertension: results from interviews with 100 general practitioners.

OBJECTIVE: To describe the type and level of non-pharmacological management offered by general practitioners for essential hypertension. DESIGN: An open-ended interviewer-administered survey using a standard case of a 60-year-old man with essential hypertension. Seventy interviews were conducted face-to-face and 30 by telephone. SETTING: Auckland general practices. SUBJECTS: A random sample of 100 Auckland general practitioners. MAIN OUTCOME MEASURES: Aspects of the medical histories of patients, physical examination, laboratory testing and treatment relevant to non-pharmacological management. RESULTS: There was an 84% response rate. Most general practitioners reported offering non-pharmacological management at the first consultation before prescribing medication. However, few offered detailed programmes. Dietary therapy, restriction of alcohol consumption and exercise were suggested by most general practitioners. Restriction of sodium intake and behavioural therapy were less popular non-pharmacological interventions. The median number of visits of patients to a general practitioner before drugs were prescribed was five, which is in keeping with guidelines. The median number of days from the first visit to prescription of drug therapy was 42 (range 2-341). The clinical advice given by the majority of participants was consistent with current guidelines on the treatment of hypertension but the range of advice given was wide. CONCLUSIONS: The results suggest that general practitioners are aware of non-pharmacological interventions for the management of hypertension. They report making routine use of non-pharmacological therapies for blood pressure reduction and other health benefits early in the clinical process before considering pharmacological therapy. These non-pharmacological therapies are not delivered with well-defined and detailed programmes.

Alcohol Drinking↗
PubMed1999

Posttraumatic stress disorder after injury: impact on general health outcome and early risk assessment.

OBJECTIVE: To evaluate prospectively components of general health outcome after trauma and to report on the further validation of the Michigan Critical Events Perception Scale (MCEPS), an instrument that predicts increased risk for posttraumatic stress disorder (PTSD). METHODS: Adults without neurologic injury admitted to a Level I trauma center in 1997 were interviewed during hospitalization. Baseline data included demographics, injury mechanism, Injury Severity Score, the Short Form 36 (SF36), and the MCEPS, which measures peri-traumatic dissociation (the sense of depersonalization or derealization during an injury event). Surveys sent by mail and completed 6 months later included the SF36 and civilian Mississippi Scale for PTSD. RESULTS: A total of 140 patients were interviewed; the 70% (n = 100 patients) who completed the 6-month assessment form the study group. Injuries were categorized as 71% blunt, 13% penetrating, and 16% burn. Mean Injury Severity Score was 13.7+/-0.52. PTSD at 6 months occurred in 42% of the patients and was directly related to MCEPS dissociation (p = 0.001; odds ratio = 3.1; 95% confidence interval, 1.6, 5.9). A stepwise linear regression explains 40% of the variance in 6-month SF36 general health outcome (adjusted R2 = 0.402). The model controls for individual factors related to dissociation, PTSD, and general health outcome. Development of PTSD was independently and inversely related to general health outcome as measured by the SF36 at 6 months (p < 0.001, beta = -0.404). The R2 change of 0.132 for PTSD (vs. 0.082 for 6-month physical function) illustrates that PTSD contributes more to the patient's perceived general health at 6 months than the degree of physical function or injury severity. CONCLUSIONS: Within hours of injury, the MCEPS identifies patients who are three times more likely to develop PTSD. PTSD compromises self-reported general health outcome in injured adults independent of baseline status, Injury Severity Score, or degree of physical recovery. These data suggest that psychological morbidity is an important part of the patient's perceived general health.

Adult↗
PubMed1986

A comparison of the patients and practices of recent graduates of family practice and general internal medicine residency programs.

This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and 1,100 hospitalized patients. Family physicians and general internists were generally similar in demographic and practice characteristics, though family physicians were more likely to have entered office-based practice (90% versus 70%). Among office-based physicians, family physicians saw more patients per week in ambulatory settings (117.3 versus 74.6), whereas general internists had more patients in the hospital (6.45 versus 3.81) and provided more hospital consultations per week (2.74 versus 0.45). Family physicians practiced in smaller communities and were more likely to practice on Saturday mornings, to accept walk-in patients, and to schedule appointments for new patients within 1 week. Both specialties functioned as first-contact generalists for at least 95% of office encounters. Although pediatrics and obstetrics are practiced only by family physicians and general internists see proportionately more older patients, within specific age groups the patients of general internists and family physicians were similar in terms of their main health problems, functional status, and diagnoses.

Data Collection↗
PubMed1997

The prognosis of low back pain in general practice.

STUDY DESIGN: A prospective cohort study on low back pain in consecutive patients in general practice, in which potential prognostic indicators at baseline and at the 1-year follow-up examination were assessed by means of four weekly questionnaires. OBJECTIVES: To identify prognostic indicators of the duration of low back pain in general practice and the occurrence of a relapse. BACKGROUND: Little is known about the prognosis of low back pain in general practice. Different designs and different results of preceding studies make drawing conclusions about the prognostic indicators, in any, of the course of low back pain in general practice difficult. METHODS: For a period of 2 years, 15 general practitioners from Amsterdam and surrounding areas studied consecutive patients with chronic low back pain and those with a recent onset of low back pain. A large number of potential prognostic indicators were assessed at the initial visit. After the initial visit, each patient was monitored for a period of 12 months. The follow-up assessment was conducted with four weekly postal questionnaires. The associations among the potential prognostic indicators, the duration of the index episode, and the occurrence of a relapse were analyzed using multivariate Cox regression and logistic regression analysis, respectively. RESULTS: Of the 605 patients identified, 443 were included in the follow-up period of assessment; the questionnaires were completed by 269 patients. In general, patients with less severe low back pain participated less often or did not complete the follow-up study. Thirty-five percent of the population still experienced low back pain after 12 weeks, and 10% still experienced it after 1 year. Approximately three of every four patients whose index episode ended before the end of the follow-up period had one or more relapses within a year. The analysis resulted in a model with four variables predicting the duration of the low back pain, including "the duration of the low back pain preceding the initial visit," "receiving physical therapy," "pain intensity", and "history of back surgery." Daily functioning appeared to be the only variable that was significantly associated with the occurrence of a relapse. CONCLUSIONS: Only a few variables appear to be related to the clinical course of low back pain seen in general practice. In particular, the duration preceding the initial visit and, unexpectedly, receiving physical therapy were both associated with a longer duration of low back pain.

Adult↗
PubMed2001

Implementation barriers for general practice guidelines on low back pain a qualitative study.

STUDY DESIGN: Qualitative study design, using semi-structured interviews. OBJECTIVE: To explore factors that determine non-adherence to the guidelines for low back pain. SUMMARY OF BACKGROUND DATA: Guidelines for low back pain have been published in the past decade in various countries. In the Netherlands, general practitioners adhere to them to a fair extent, and it is unclear whether room for improvement remains. METHODS: Forty semistructured, in-depth interviews were conducted with twenty patients who consulted for low back pain, and with their general practitioners. The interviews were fully transcribed and analyzed qualitatively. RESULTS: Patients often had limited expectations of the consultation. They wanted to hear a diagnosis or expected to receive simple advice. The general practitioners said they were well informed about the guideline and mostly agreed with its content. Reasons for non-adherence were mainly related to patients' experiences in the past and general practitioners' interpretations of their preferences. General practitioners stated that they were inclined to give in to patients' demands, for example the request for radiographic films or a referral to a physical therapist. In general, patients and their general practitioners were satisfied with the chosen management. CONCLUSIONS: Improvement of the quality of back pain care may still be possible. Implementation strategies should aim at training physicians in communication skills, especially about subjects for debate, where patients' beliefs and experiences color their expectations.

Adult↗
PubMed2006

Two presentations of contact lens-induced papillary conjunctivitis (CLPC) in hydrogel lens wear: local and general.

PURPOSE: The purpose of this study was to confirm that two distinct clinical presentations of contact lens-induced papillary conjunctivitis (CLPC), local and general, occur in hydrogel lens wear. METHODS: Retrospective analyses of 124 CLPC events were identified. The classification of CLPC was based on location and extent of papillae. CLPC was classified as local if papillae were present in one to two areas of the tarsal conjunctiva and general if papillae occurred in three or more areas. The CLPC events were compared with an asymptomatic control group in prospective clinical trials conducted from 1993 until 2003 at two clinical sites, Australia and India. Two hundred sixteen subjects from Australia and 914 subjects from India wore either high Dk silicone hydrogel or low Dk hydrogel lenses on a 6-night (6N) or 30-night extended-wear (EW) schedule. The physiological responses of the ocular surface, including tarsal conjunctiva redness and roughness, number of papillae present, lens fit and performance, and subjective patient symptoms, were measured during each visit at each site. These variables listed were compared between local CLPC groups and asymptomatic controls and general CLPC groups and asymptomatic controls. RESULTS: Two types of CLPC in hydrogel lens wearers have been confirmed. Of the 124 CLPC events, there were 61 local and 63 general events. Local and general CLPC cases reported significantly greater frequency of symptoms compared with the asymptomatic controls, in particular itching, lens awareness, secretion, and blurred vision (p < 0.1). CONCLUSIONS: The classification of CLPC into two types, local and general, in hydrogel lens wear was confirmed based on presentations at both sites. This distribution of papillae between local and general CLPC may indicate separate etiologies involved in the pathogenesis of the condition.

Adolescent↗
PubMed2005

Generalized entropy arising from a distribution of q indices.

It is by now well known that the Boltzmann-Gibbs (BG) entropy can be usefully generalized using the non-extensive entropies, which have been applied to a wide range of phenomena. However, it seems that even more general entropies could be useful in order to describe other complex physical systems, a task which has already been undertaken in the literature. Following this approach, we introduce here a quite general entropy based on a distribution of q indices thus generalizing S(q). We establish some general mathematical properties for the new entropic functional and explore some examples. We also exhibit a procedure for finding, given any entropic functional, the q-indices distribution that produces it. Finally, on the road to establishing a quite general statistical mechanics, we briefly address possible generalized constraints under which the present entropy could be extremized, in order to produce canonical-ensemble-like stationary-state distributions for Hamiltonian systems.

Journal Article↗
PubMed1995

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

1. The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2. Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3. Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4. Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. (ABTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1997

Comparative evaluation of patient information leaflets by pharmacists, doctors and the general public.

This study was undertaken to compare and contrast the views of pharmacists, general practitioners (GPs) and the general public on the value or otherwise of pharmacy-generated patient information leaflets. All three groups perceived these leaflets to be useful and an aid to improving compliance. Concerning the information included in leaflets, GPs rated the inclusion of a section on side-effects as being the least important, whilst pharmacists and the general public rated information on the storage of medicines as being least important. Pharmacists' estimates on what percentage of patients actually read leaflets were significantly lower than estimates by the general public. General practitioners and pharmacists generally concurred on the types of patients for whom leaflets are considered unsuitable, although a significantly higher percentage of pharmacists than GPs identified unsuitable patients. There were reservations by the pharmacists concerning the cost-effectiveness of leaflet facilities and on the value of leaflets compared with verbal counselling. The general public expressed the view that a leaflet facility would affect their choice of pharmacy and that they would be prepared to wait an additional short time to receive such a leaflet. Almost all GPs thought that it was in the patient's best interest to receive an information leaflet.

Adolescent↗
PubMed2006

Factor instability of clinical teaching assessment scores among general internists and cardiologists.

CONTEXT: We are unaware of studies examining the stability of teaching assessment scores across different medical specialties. A recent study showed that clinical teaching assessments of general internists reduced to interpersonal, clinical teaching and efficiency domains. We sought to determine the factor stability of this 3-dimensional model among cardiologists and to compare domain-specific scores between general internists and cardiologists. METHODS: A total of 2000 general internal medicine and cardiology hospital teaching assessments carried out from January 2000 to March 2004 were analysed using principal factor analysis. Internal consistency and inter-rater reliability were calculated. Mean item scores were compared between general internists and cardiologists. RESULTS: The interpersonal and clinical teaching domains previously demonstrated among general internists collapsed into 1 domain among cardiologists, whereas the efficiency domain remained stable. Internal consistency of domains (Cronbach's alpha range 0.89-0.93) and inter-rater reliability of items (range 0.65-0.87) were good to excellent for both specialties. General internists scored significantly higher (P<0.05) than cardiologists on most items except for 4 items that more accurately assessed the cardiology teaching environment. CONCLUSIONS: We observed factor instability of clinical teaching assessment scores from the same instrument administered to general internists and cardiologists. This finding was attributed to salient differences between these specialties' educational environments and highlights the importance of validating assessments for the specific contexts in which they are to be used. Future research should determine whether interpersonal domain scores identify superior teachers and study the reasons why interpersonal and clinical teaching domains are unstable across different educational settings.

Cardiology↗