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[PMID]:29381721
[Au] Autor:von Babo M; Chmiel C; Müggler SA; Rakusa J; Schuppli C; Meier P; Fischler M; Urner M
[Ad] Endereço:Department of Internal Medicine, Waid City Hospital, Zurich, Switzerland.
[Ti] Título:Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.
[So] Source:PLoS One;13(1):e0191752, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. METHODS: In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. RESULTS: 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. CONCLUSION: This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.
[Mh] Termos MeSH primário: Transfusão de Sangue/utilização
Medicina Geral
Hospitais de Ensino/organização & administração
Padrões de Prática Médica
[Mh] Termos MeSH secundário: Estudos Transversais
Seres Humanos
Medicina Interna
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191752


  2 / 7238 MEDLINE  
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[PMID]:29489699
[Au] Autor:Qiu Y; Liu Y; Ren W; Ren J
[Ad] Endereço:Department of General Practice, the First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
[Ti] Título:Prostatic cyst in general practice: A case report and literature review.
[So] Source:Medicine (Baltimore);97(9):e9985, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Prostatic cyst is a rare disease of the prostate especially in general practice. As it is often asymptomatic, how to manage it is still unfamiliar with, general practitioners (GPs). PATIENT CONCERNS: The 24-year-old man presented with left back discomfort for 1 week without severe pain, dysuria, or fever. DIAGNOSES: Ultrasonography revealed the presence of a 14×14 mm cystic lesion. INTERVENTIONS: The patient was given the medicine and regular follow-up. OUTCOMES: Several days later, he recovered without lower back discomfort. LESSONS: Patients with prostatic cyst of small size and no symptom should be follow-up regularly. Although prostatic cyst of progressive symptoms, large size (2.5 cm or larger), or high serum prostate-specific antigen (PSA) should be timely referred to urological specialists.
[Mh] Termos MeSH primário: Cistos/complicações
Medicina Geral/métodos
Dor Lombar/etiologia
Doenças Prostáticas/complicações
[Mh] Termos MeSH secundário: Cistos/diagnóstico por imagem
Seres Humanos
Dor Lombar/diagnóstico por imagem
Masculino
Doenças Prostáticas/diagnóstico por imagem
Ultrassonografia
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009985


  3 / 7238 MEDLINE  
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[PMID]:27777243
[Au] Autor:Fleming A; Barry L; Byrne S; Prentice M
[Ad] Endereço:School of Pharmacy, University College Cork, Cork, Ireland.
[Ti] Título:Antimicrobial susceptibility of long term care facility and general practice urine samples in patients 65 years and older: an observational study.
[So] Source:Eur J Public Health;27(2):307-312, 2017 04 01.
[Is] ISSN:1464-360X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: Antimicrobial resistance in long-term care facilities (LTCFs) poses a risk to elderly residents. The aim of this observational study was to investigate recent patterns of antimicrobial susceptibility in urine samples submitted to the Microbiology Laboratory at Cork University Hospital (CUH) from LTCFs in the greater Cork region. The antimicrobial susceptibilities of LTCF and General Practitioner (GP) urine samples sent to CUH, for patients aged over 65 years of age, were compared. Methods: A retrospective analysis of the antimicrobial susceptibilities of urine samples submitted to the microbiology laboratory at CUH in quarter one of 2011-2014 was conducted. LTCF and GP urine sample susceptibilities, for patients over 65 years of age, were compared using Chi square statistics. Results: Overall, the LTCF urine samples were less susceptible than GP urine samples to the antimicrobials recommended in the national urinary tract infection guidelines; trimethoprim, nitrofurantoin, cephalexin, co-amoxiclav, ciprofloxacin and amoxicillin ( P < 0.001). Important trends in antimicrobial susceptibility over the time period were noted. A significant reduction in susceptibility to co-amoxiclav was found between Q1 2011 and Q1 2014 in both settings (GP P = 0.013, LTCF P = 0.005). This study provides important information which will contribute to the revision of antimicrobial prescribing guidelines in the future. Conclusion: This study highlights the need for continuous surveillance of antimicrobial susceptibility trends in LTCFs. Antimicrobial stewardship strategies are urgently required to address antimicrobial resistance and appropriate antimicrobial prescribing in the LTCF setting.
[Mh] Termos MeSH primário: Antibacterianos/urina
Farmacorresistência Bacteriana
Medicina Geral/estatística & dados numéricos
Instituição de Longa Permanência para Idosos/estatística & dados numéricos
Casas de Saúde/estatística & dados numéricos
Infecções Urinárias/urina
[Mh] Termos MeSH secundário: Idoso
Antibacterianos/uso terapêutico
Feminino
Seres Humanos
Irlanda
Assistência de Longa Duração
Masculino
Estudos Retrospectivos
Infecções Urinárias/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1093/eurpub/ckw138


  4 / 7238 MEDLINE  
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[PMID]:29231639
[Au] Autor:Hunnålvatn KH; Ivan D; Wisborg T
[Ti] Título:Emergency medicine in the general practice internship in Finnmark county.
[Ti] Título:Akuttmedisinsk turnusarbeid i Finnmark..
[So] Source:Tidsskr Nor Laegeforen;137(23-24), 2017 12 12.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:eng; nor
[Ab] Resumo:BACKGROUND: It is preferred that duty doctors in municipal health services participate in call-outs in emergency situations. The frequency of participation has previously been shown to vary. We wanted to examine the newly qualified doctors' expectations and experiences ­ both before and after the general practice internship ­ of emergency medicine and ambulance call-outs. MATERIAL AND METHOD: All 23 of the interns who were to undertake their general practice internship in Finnmark county in the period 2015­16 answered a questionnaire and participated in a focus group interview before the start of the internship. Twenty-one of the interns participated in the focus group interview after completing the internship. Each doctor took part in two interviews. We analysed the transcripts from the focus group interviews using the grounded theory method. RESULTS: The responses from the questionnaire before the general practice internship showed that the interns felt they needed more training in intravenous cannulation and in teamwork. Their expectations in connection with the challenges of call-outs are best characterised by the core category 'Can I do anything useful?' from the focus groups before the internship. After the internship, however, the core category 'It all went well in the end', was the best fit. Due to short transport times and their knowledge of certain patients, some of the doctors chose not to take part in call-outs. INTERPRETATION: During the general practice internship, the interns were initially anxious about whether they might be superfluous in call-outs, but eventually found their footing in the call-out role. The study shows that there is a need for more practice in certain practical procedures, and that doctors' non-technical skills need to be improved. This can be done through training in team leader roles before the general practice internship.
[Mh] Termos MeSH primário: Serviços Médicos de Emergência
Medicina Geral/educação
Internato e Residência
Papel do Médico/psicologia
[Mh] Termos MeSH secundário: Ambulâncias
Atitude do Pessoal de Saúde
Competência Clínica
Grupos Focais
Seres Humanos
Noruega
Equipe de Assistência ao Paciente
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.17.0160


  5 / 7238 MEDLINE  
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[PMID]:27778214
[Au] Autor:Card SE; Clark HD; Elizov M; Kassam N
[Ad] Endereço:Division of General Internal Medicine, University of Saskatchewan, Department of Internal Medicine, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada. sharon.card@usask.ca.
[Ti] Título:The Evolution of General Internal Medicine (GIM)in Canada: International Implications.
[So] Source:J Gen Intern Med;32(5):576-581, 2017 May.
[Is] ISSN:1525-1497
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.
[Mh] Termos MeSH primário: Medicina Geral/tendências
Medicina Interna/tendências
Internacionalidade
Médicos/tendências
[Mh] Termos MeSH secundário: Canadá
Competência Clínica/normas
Medicina Geral/métodos
Seres Humanos
Medicina Interna/métodos
Médicos/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s11606-016-3891-z


  6 / 7238 MEDLINE  
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[PMID]:29368472
[Au] Autor:Austin JL; Burdick H; Chouinard S; Coben J; Colenda C; King DE
[Ti] Título:The State Innovation Model (SIM) Plan: A Practical Guide for Practitioners.
[So] Source:W V Med J;112(5):12-5, 2016 Sep-Oct.
[Is] ISSN:0043-3284
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência à Saúde/legislação & jurisprudência
Medicina Geral
[Mh] Termos MeSH secundário: Orçamentos/legislação & jurisprudência
Assistência à Saúde/economia
Organização do Financiamento/legislação & jurisprudência
Medicina Geral/legislação & jurisprudência
Seres Humanos
Medicaid/economia
Medicaid/legislação & jurisprudência
Medicare/economia
Medicare/legislação & jurisprudência
Planejamento de Assistência ao Paciente/economia
Planejamento de Assistência ao Paciente/legislação & jurisprudência
Estados Unidos
West Virginia
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE


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[PMID]:29181944
[Au] Autor:Christiansen TW; Sandvik H
[Ti] Título:Fastlegeordningen forvitrer ­ hva nå?.
[So] Source:Tidsskr Nor Laegeforen;137(22), 2017 11 28.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:nor
[Mh] Termos MeSH primário: Medicina Geral/organização & administração
[Mh] Termos MeSH secundário: Medicina Geral/economia
Medicina Geral/normas
Política de Saúde
Seres Humanos
Noruega
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.17.0856


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[PMID]:29253440
[Au] Autor:Ellis DA; McQueenie R; McConnachie A; Wilson P; Williamson AE
[Ad] Endereço:Department of Psychology, Lancaster University, Lancaster, UK.
[Ti] Título:Demographic and practice factors predicting repeated non-attendance in primary care: a national retrospective cohort analysis.
[So] Source:Lancet Public Health;2(12):e551-e559, 2017 Dec.
[Is] ISSN:2468-2667
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Addressing the causes of low engagement in health care is a prerequisite for reducing health inequalities. People who miss multiple appointments are an under-researched group who might have substantial unmet health needs. Individual-level patterns of missed general practice appointments might thus provide a risk marker for vulnerability and poor health outcomes. We sought to ascertain the contributions of patient and practice factors to the likelihood of missing general practice appointments. METHODS: For this national retrospective cohort analysis, we extracted UK National Health Service general practice data that were routinely collected across Scotland between Sept 5, 2013, and Sept 5, 2016. We calculated the per-patient number of missed appointments from individual appointments and investigated the risk of missing a general practice appointment using a negative binomial model offset by number of appointments made. We then analysed the effect of patient-level factors (including age, sex, and socioeconomic status) and practice-level factors (including appointment availability and geographical location) on the risk of missing appointments. FINDINGS: The full dataset included information from 909 073 patients, of whom 550 083 were included in the analysis after processing. We observed that 104 461 (19·0%) patients missed more than two appointments in the 3 year study period. After controlling for the number of appointments made, patterns of non-attendance could be differentiated, with patients who were aged 16-30 years (relative risk ratio [RRR] 1·21, 95% CI 1·19-1·23) or older than 90 years (2·20, 2·09-2·29), and of low socioeconomic status (Scottish Index of Multiple Deprivation decile 1: RRR 2·27, 2·22-2·31) significantly more likely to miss multiple appointments. Men missed fewer appointments overall than women, but were somewhat more likely to miss appointments in the adjusted model (1·05, 1·04-1·06). Practice factors also substantially affected attendance patterns, with urban practices in affluent areas that typically have appointment waiting times of 2-3 days the most likely to have patients who serially miss appointments. The combination of both patient and practice factors to predict appointments missed gave a higher pseudo R value (0·66) than models using either group of factors separately (patients only R =0·54; practice only R =0·63). INTERPRETATION: The findings that both patient and practice characteristics contribute to non-attendance of general practice appointments raise important questions for both the management of patients who miss multiple appointments and the effectiveness of existing strategies that aim to increase attendance. Addressing these issues should lead to improvements in provision of services and public health. FUNDING: Scottish Government Chief Scientist Office and Data Sharing and Linkage Service of the Scottish Government.
[Mh] Termos MeSH primário: Agendamento de Consultas
Medicina Geral
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Atenção Primária à Saúde/utilização
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Meia-Idade
Estudos Retrospectivos
Escócia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


  9 / 7238 MEDLINE  
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[PMID]:28468576
[Au] Autor:Blattner K; Nixon G; Gutenstein M; Davey E
[Ad] Endereço:a Rawene Hospital, Hokianga Health , Rawene , New Zealand.
[Ti] Título:A targeted rural postgraduate education programme - linking rural doctors across New Zealand and into the Pacific.
[So] Source:Educ Prim Care;28(6):346-350, 2017 Nov.
[Is] ISSN:1475-990X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This article describes the University of Otago Rural Postgraduate medical programme, established in 2002 to provide a targeted rural education option for medical practitioners working in rural and remote areas of New Zealand. With both faculty and participants dispersed throughout New Zealand and the Cook Islands embedded in day to day rural clinical practice, this programme uniquely reflects the national and international clinical networks it has been developed to support. It now provides the academic component of two vocational training programmes: the New Zealand Rural Hospital Medicine Training Programme and The Cook Islands General Practice Training Programme. We describe the journey the Rural Postgraduate programme has taken over the last decade: the opportunities, learnings and challenges. The programme is continuing to expand and is creating a growing community of rural and remote practitioners throughout New Zealand and the Pacific.
[Mh] Termos MeSH primário: Educação de Pós-Graduação em Medicina/organização & administração
Medicina Geral/educação
Serviços de Saúde Rural/organização & administração
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Simulação por Computador
Comportamento Cooperativo
Educação a Distância/métodos
Seres Humanos
Nova Zelândia
Ilhas do Pacífico
Ensino/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1080/14739879.2017.1319253


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[PMID]:28468646
[Au] Autor:Galbraith K; Ward A; Heneghan C
[Ad] Endereço:Centre for Evidence-based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK. kevin.galbraith@kellogg.ox.ac.uk.
[Ti] Título:A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.
[So] Source:BMC Med Educ;17(1):78, 2017 May 03.
[Is] ISSN:1472-6920
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. METHODS: We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. RESULTS: A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. CONCLUSION: We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.
[Mh] Termos MeSH primário: Competência Clínica
Medicina Baseada em Evidências
Medicina Geral/educação
Aprendizagem Baseada em Problemas
[Mh] Termos MeSH secundário: Adulto
Técnica Delfos
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1186/s12909-017-0916-1



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