373 research outputs found
Predictors of patient-initiated reconsultation for lower respiratory tract infections in general practice.
No full textReconsultation for lower respiratory tract infection (LRTI) is common in general practice, but those who reconsult rarely have more significant illness warranting antibiotics. Knowledge of factors that predict patient-initiated reconsultation may allow clinicians to address specific issues during the initial consultation that could reduce reconsultations. Thirty-three per cent of a cohort of 431 LRTI patients in a randomised controlled trial reconsulted. Excluding 35 patients with GP-requested reconsultation left 28% (112/396) with a patient-initiated reconsultation during 28-day follow-up. Patient-reported dyspnoea and concerns that persisted after the initial consultation independently predicted patient-initiated reconsultation
Voluntary organizations supporting patients with cancer: A qualitative exploratory study into their experiences.
No full textPurpose: Both the incidence of cancer and cancer survival rates are increasing. Cancer patients can experience distress and have higher needs for psychosocial care. While voluntary organizations can support cancer patients’ needs, many patients have little awareness of them. We aimed to explore the experiences of cancer voluntary organizations in one region of the Netherlands, how familiar they are with each other’s efforts, and how eager they are to collaborate with each other. Methods: Thematic analysis of three one-to-one semi-structured interviews and two focus group discussions (FGDs) with members of seven cancer voluntary organizations. Results: The main themes identified were: (1) objectives of the participating cancer voluntary organizations, (2) patients’ and healthcare professionals’ familiarity with the existence of the voluntary organizations and their reach, (3) challenges recruiting volunteers, (4) messages to healthcare providers, and (5) eagerness to collaborate. Participants shared many tips and ideas during the FGDs, and demonstrated a wish to collaborate. Conclusions: The prime objective of cancer voluntary organizations is to decrease the impact of cancer on the personal life of patients and their loved ones. However, awareness of what they can offer is poor amongst both patients and their clinicians. Participants became keen to collaborate, which may result in both the sharing of ideas and expertise, and an increased use of these cancer support services
Praten en prikken bij luchtweginfecties: 3,5 jaar follow-up
No full textAchtergrond: We onderzochten het langetermijneffect van een eenmalig bezoek aan een huisarts die een CRP-sneltest gebruikte of een communicatietraining had gevolgd over het spreekuurbezoek en antibioticumvoorschriften van volwassen patiënten met een luchtweginfectie op de lange termijn. Methoden: We hebben patiënten na een factorieel, clustergerandomiseerd interventieonderzoek 3,5 jaar gevolgd. Van 379 patiënten (20 huisartspraktijken) die hun huisarts bezochten vanwege acute hoest, hadden we complete data (88% van het originele trial cohort). Primaire uitkomstmaten waren het aantal consulten voor luchtweginfecties per patiënt per jaar en het percentage antibioticavoorschriften uitgeschreven tijdens deze consulten. Resultaten: Het gemiddelde aantal consulten voor luchtweginfecties was 0,40 per patiënt per jaar in de CRP-groep in vergelijking met 0,56 per patiënt per jaar in de groep zonder CRP-sneltest (p = 0,12). Voor de communicatietrainingsgroep en de groep zonder communicatietraining waren dit respectievelijk 0,36 en 0,57 consulten per patiënt per jaar (p = 0,09). Tijdens follow-up werd in de CRP-groep 30,7% van de luchtweginfecties behandeld met antibiotica in vergelijking met 35,7% in de groep zonder CRP (p = 0,36). Voor de communicatietrainingsgroep in vergelijking met de groep zonder communicatietraining was dit respectievelijk 26,3% en 39,1% (p = 0,02), respectievelijk. Conclusie: Het gebruik van een CRP-sneltest of toepassing van verbeterde communicatieve vaardigheden door huisartsen zorgt er niet voor dat patiënten minder vaak of vaker het spreekuur bezoeken voor luchtweginfecties. De CRP-sneltest werd slechts sporadisch ingezet bij dezelfde patiënt en medicaliseert derhalve niet. Patiënten die werden gezien door een huisarts die de communicatietraining had gevolgd, kregen ook in de 3,5 jaar na de trial significant minder antibiotica voor luchtweginfecties
Parents' knowledge, attitudes, and practice in childhood fever: an internet-based survey
No full textBackground Fever in children is common and mostly caused by self-limiting infections. However, the number of (re) consultations in primary care is high, driven by lack of knowledge and fear among parents. These drivers have only been studied in parents when consulting with their sick child. Aim To study knowledge, attitudes, and practice in childhood fever in parents within the general population. Design and setting Internet-based survey of a sample of 1000 parents from the general population of the Netherlands. Method A 26-item cross-sectional survey was conducted of parents with one or more children aged 38 degrees C), 55.2% correctly stated that antibiotics are effective in treating bacterial infections and not viral infections, and 72.0% knew that not every child with a fever needs treatment with antibiotics or paracetamol. When asked to prioritise aspects of a GP's consultation, 53.6% considered physical examination as most important. Obtaining a prescription for antibiotics or antipyretics was considered least important. Conclusion Knowledge, attitudes, and practices concerning childhood fever varied among parents with young children. Parents generally expect thorough physical examination and information, but not a prescription for medication (antibiotics or antipyretics) when consulting with a feverish child. GPs must be aware of these expectations as these provide opportunities to enhance consultations in general and prescription strategies in particular
BMC Public Health
No full textBackgroundDespite it is costly, slow and non-reproducible process, physician review (PR) is a commonly used method to interpret verbal autopsy data. However, there is a growing interest to adapt a new automated and internally consistent method called InterVA. This study evaluated the level of agreement in determining causes of death between PR and the InterVA model.MethodsVerbal autopsy data for 434 cases collected between September 2009 and November 2012, were interpreted using both PR and the InterVA model. Cohen\u2019s kappa statistic (\u3ba) was used to compare the level of chance corrected case-by-case agreement in the diagnosis reached by the PR and InterVA model.ResultsBoth methods gave comparable cause specific mortality fractions of communicable diseases (36.6\ua0% by PR and 36.2\ua0% by the model), non-communicable diseases (31.1\ua0% by PR and 38.2\ua0% by the model) and accidents/injuries (12.9\ua0% by PR and 10.1\ua0% by the model). The level of case-by-case chance corrected concordance between the two methods was 0.33 (95\ua0% CI for \u3ba\u2009=\u20090.29\u20130.34). The highest and lowest agreements were seen for accidents/injuries and non-communicable diseases; with \u3ba\u2009=\u20090.75 and \u3ba\u2009=\u20090.37, respectively.ConclusionIf the InterVA were used in place of the existing PR process, the overall diagnosis would be fairly similar. The methods had better agreement in important public health diseases like; TB, perinatal causes, and pneumonia/sepsis; and lower in cardiovascular diseases and neoplasms. Therefore, both methods need to be validated against a gold-standard diagnosis of death.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2032-7) contains supplementary material, which is available to authorized users.5U22/PS022179_10/PS/NCHHSTP CDC HHS/United State
Glob Health Action
No full textBackgroundIn Ethiopia, most deaths take place at home and routine certification of cause of death by physicians is lacking. As a result, reliable cause of death (CoD) data are often not available. Recently, a computerized method for interpretation of verbal autopsy (VA) data, called InterVA, has been developed and used. It calculates the probability of a set of CoD given the presence of circumstances, signs, and symptoms reported during VA interviews. We applied the InterVA model to describe CoD in a rural population of Ethiopia.ObjectiveVA data for 436/599 (72.7%) deaths that occurred during 2010\u20132011 were included. InterVA-4 was used to interpret the VA data into probable cause of death. Cause-specific mortality fraction was used to describe frequency of occurrence of death from specific causes.ResultsInterVA-4 was able to give likely cause(s) of death for 401/436 of the cases (92.0%). Overall, 35.0% of the total deaths were attributed to communicable diseases, and 30.7% to chronic non-communicable diseases. Tuberculosis (12.5%) and acute respiratory tract infections (10.4%) were the most frequent causes followed by neoplasms (9.6%) and diseases of circulatory system (7.2%).ConclusionInterVA-4 can produce plausible estimates of the major public health problems that can guide public health interventions. We encourage further validation studies, in local settings, so that InterVA can be integrated into national health surveys.5U22/PS022179_10/PS/NCHHSTP CDC HHS/United StatesWellcome Trust/United Kingdo
Individualizing fracture risk prediction
No full textLow bone mineral density (BMD) and clinical factors (CRF) have been identified as factors associated with an increased relative risk of fractures. From this observation and for clinical decision making, the concept of prediction of the individual absolute risk of fractures has emerged. It refers to the individual's risk for fractures over a certain time period, e.g. the next 5 and 10 years. Two individualized fracture risk calculation tools that are increasingly used and are available on the web are the FRAX algorithm and the Garvan fracture risk calculator. These tools integrate BMD and CRFs for fracture risk calculation in the individual patient in daily practice. Although both tools include straightforward risk factors, such as age, sex, previous fractures, body weight and BMD, they differ in several aspects, such as the inclusion of other CRFs, fall risks and number of previous fractures. Both models still need to be validated in different populations before they can be generalized to other populations, since the background risk for fractures is population specific. Further studies will be needed to validate their contribution in selecting patients who will achieve fracture risk reduction with anti-osteoporosis therapy
COGITA network has constructed a glossary of diagnostic reasoning terms
No full textThe role of gut feelings in diagnostic reasoning is recognized by most GPs throughout Europe, and probably throughout the world. Studies on this topic have emerged from different countries but there is the risk that authors will use different terms for similar concepts. The European Expert Group on Cognitive and Interactive Processes in Diagnosis and Management in General Practice, COGITA for short, was founded in 2008 to conduct cross-border research in the area of non-analytical diagnostic reasoning. Academic GPs, PhD students, psychologists, linguists and students meet once a year to share their experiences, exchange results and initiate new studies on the topic. A milestone in their research is this publication of a short glossary of diagnostic reasoning terms relating to the gut feelings research topic. It was constructed by the COGITA group members following a literature review, which aimed to define salient terms used in their publications. They described the terms, cross-reviewed the wording and reached consensus within the group. Two sections were created: (1) a diagnostic reasoning section that describes concepts such as analytical and non-analytical reasoning, clinical mind lines, and intuition, and (2) a research methods section describing concepts such as linguistic validity and saturation. The glossary, including relevant literature, has been published on the website http://www.gutfeelingsingeneralpractice.eu. In the future, the glossary will be modified if necessary and completed by members of the COGITA group
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