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PubMed1986

Generalized anxiety and generalized anxiety disorder: description and reconceptualization.

One hundred eight patients complaining of anxiety were diagnosed using the Anxiety Disorders Interview Schedule and classified into the various anxiety disorder categories as well as major depression. Although patients with a primary diagnosis of generalized anxiety disorder were more chronic than were panic disorder patients, most patients in each category met the DSM-III criteria for generalized anxiety disorder with the exception of simple phobic patients. On the basis of these data, it would seem that generalized anxiety disorder is a residual category within the anxiety disorders, since generalized anxiety disorder symptoms are almost always present. But if one distinguishes anticipatory anxiety, which is often part of panic or phobic disorders, from generalized anxiety, an independent anxiety disorder category emerges. This category is characterized by apprehensive expectation or chronic worry focused on multiple life situations.

Adult↗

PubMed1979

Sharing in preschool children: Facilitation, stimulus generalization, response generalization, and maintenance.

Three approaches to facilitating verbal and physical sharing and of the generalizability and durability of the behaviors that were trained were investigated. During a free play period, groups of preschool children were taught to share verbally, to share physically, or to share verbally and physically; another group was not trained. Immediately following free play, the children were observed in a different setting. Follow-up was conducted 4 weeks after training ended. Physical sharing that was durable and generalizable resulted only when children were taught to share verbally. Increases in physical sharing produced by training children to share only physically were not durable and did not generalize. Training both verbal and physical sharing produced results with a magnitude slightly greater than teaching just verbal sharing. Despite a lack of special programming, some of the treatment effects generalized to another setting and were maintained during the Follow-up. There was response generalization of the effects of training verbal sharing to physical sharing but not vice versa. Problems with the concept of response class, a methodological suggestion for studying response generalization, and possibilities concerning why generalization and maintenance occurred without specific programming are discussed.

Journal Article↗

PubMed1995

A critical incident study of general practice trainees in their basic general practice term.

OBJECTIVE: To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. DESIGN: Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. SUBJECTS: Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. RESULTS: Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. CONCLUSION: The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Adult↗

PubMed1998

General hospital and personal use devices: proposed classification of liquid chemical sterilants and general purpose disinfectants--FDA. Proposed rule.

The Food and Drug Administration (FDA) is proposing to classify both liquid chemical sterilants intended for use as the terminal step in processing critical and semicritical medical devices prior to patient use, and general purpose disinfectants intended to process noncritical medical devices and equipment surfaces. Under the proposal, liquid chemical sterilants would be classified into class II (special controls) and general purpose disinfectants would be classified into class I (general controls). FDA also proposes to exempt general purpose disinfectants from the premarket notification requirements. The agency is publishing in this document the recommendations of the General Hospital and Personal Use Devices Panel (the Panel) regarding the classification of these devices. After considering public comments on the proposed classification, FDA will publish a final regulation classifying these devices. This action is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices.

Device Approval↗

PubMed2001

Patients in general practice in Denmark referred to physiotherapists: a description of patient characteristics based on general health status, diagnoses, and sociodemographic characteristics.

BACKGROUND AND PURPOSE: Both musculoskeletal illness and mental illness characterized by somatic symptoms are common in primary care, and it is hypothesized that many patients with musculoskeletal illness have relatively poor mental health. The purpose of this study was to describe the characteristics of patients in general practice in Denmark who are referred to physiotherapists with signs and symptoms of musculoskeletal illness. SUBJECTS AND METHODS: One hundred ninety-four general practitioners, representing 124 practices, participated in a survey of 2,042 consecutive patients with musculoskeletal illness. RESULTS: The diagnoses were generally poorly defined. Compared with the general population, patients with musculoskeletal illness had markedly poorer physical health and poorer mental health. Patients with poorly defined diagnoses did not differ from patients with well-defined diagnoses in terms of physical health, but they scored lower on the mental health component summary scale of the Danish version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CONCLUSION AND DISCUSSION: Of patients referred to physiotherapists by general practitioners in Denmark, the subgroup with poorly defined diagnoses had lower mental health scores than those with well-defined diagnoses, suggesting that a biopsychosocial approach to care may be appropriate for this group of patients.

Adult↗

PubMed2001

Randomized controlled trial of general practitioner tutor visit or mailing to encourage general practice-based education.

OBJECTIVES: Evaluation of a general practitioner tutor visit, or mailing, with regard to the amount of practice-based education occurring in general practices. DESIGN: An initial survey of all practices in the Mersey Deanery was undertaken. General practices which replied were randomly allocated to receive a GP tutor visit (n=38), to receive a mailing (n=38) or to a control group (n=36). Visits carried out by tutors covered a loosely agreed format. All practices were sent a follow-up survey identical to the original one at 6 months after the intervention. SETTING: General practices in the Mersey Deanery, north-west England. SUBJECTS: General practices which had replied to an initial survey. RESULTS: The amount of both specifically arranged and informal practice-based meetings increased in all groups. No changes were statistically significant. CONCLUSIONS: This study illustrates the difficulty of assessing educational interventions by randomized controlled trials. Such interventions are often expensive, complex and difficult to standardize. A substantial amount of practice-based education is taking place.

Education, Medical, Continuing↗

PubMed1992

Educating students with mild handicaps in general classrooms: essential teaching practices for general and special educators.

This study was designed to identify and validate essential teaching practices needed by both general and special educators to successfully educate students with mild handicaps in general classrooms. An interdisciplinary panel of 105 experts, evenly divided into university-based and field-based participants from 35 states, identified 96 of 125 practices in six categories as being essential for effective teaching of mainstreamed students with mild handicaps. Based on a two-round Delphi procedure, a substantial majority (82%) of these teaching practices were seen as being essential for both general and special educators across all six rated categories. Panel ratings were significantly higher for special educators than general educators on four of the six categories. No significant differences in ratings were found for university-based versus field-based panelists, or for field-based panelists who were professionals directly involved in elementary or secondary teaching roles versus administrators, supervisors, and consultants. Based on essential teaching practices validated in this study, implications for preservice teacher preparation and staff development programs for general and special educators are discussed.

Persons with Disabilities↗

PubMed2004

[The practice guideline 'Pregnancy and puerperium' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice medicine].

The first revision of the Dutch College of General Practitioners' practice guideline about pregnancy and puerperium does not significantly differ from the first edition. The guideline is extensive, is well-worth reading and supports daily practice. There is a greater emphasis on the importance of cooperation and differentiation in primary care (midwifes and general practitioners). During the last decade many general practitioners stopped doing home deliveries and have therefore lost their experience in obstetric care and pathology. The guideline describes the general practitioner's tasks as a preconception counsellor, a professional expert on illnesses during pregnancy and after the delivery, and as the doctor of the newborn baby. It will hopefully stimulate a revived interest of and involvement in pregnancy and post-partum care among general practitioners.

Family Practice↗

PubMedDate not supplied

[Health Search--Research Institute of the Italian Society of General Practice: the creation of a research database in general practice].

OBJECTIVE: To describe a database used in general practice by analysing the characteristics of the physicians providing the data and the completeness of the data recording on the basis of the indicators of interest (smoking habits, weight, height, and the prevalence of hypertension). DESIGN: Descriptive study and multiple linear regression analysis of the relationships between structural variables and outcomes. SETTING: General practitioners (GPs) belonging to the Italian Society of General Medicine (SIMG), and enrolled in Health Search (HS). POPULATION: Six hundred and ninety-five voluntarily enrolled GPs and their patients. PRINCIPAL OUTCOMES: Descriptive statistics (mean and median values, standard deviation, frequencies) concerning the general characteristics of the GPs, the ways in which they connect to the network and their use of the clinical data management software, and epidemiological measures concerning the prevalence of hypertension among their patients, and the recording of weight, height and tobacco smoking habits. RESULTS: The geographic distribution of the GPs is homogeneous: 317 in Northern Italy (12.52 physicians per 10(6) patients), 134 in Central Italy (12.30 physicians per 10(6) patients) and 244 in Southern Italy and the Islands (11.89 physicians per 10(6) patients). Five hundred and ninety-five (85.6%) are males; their mean age is 46.7 years (SD +/- 3.8); the mean number of patients per physician is 1128; 69% have at least one post-graduate specialisation; 49% practise alone; and they work for a mean of 30 hours per week (SD +/- 13). Five hundred and fifty-three GPs were actually connected to the network as of January 2003. The data relating to the years 2000-2001 show an increase in the number of connected physicians (34 in 2000 and 261 in 2001) and in the number of connections (a median of 12 in 2000 and 17 in 2001). The GPs contact more than 80% of their patients every year. The frequency of the recording of data concerning smoking habits, weight and height increases in proportion with the frequency of connections. The prevalence of hypertension among the patients included in the survey is 5.4%. Multiple regression analysis showed that the variability in the prevalence of hypertension was not influenced by the frequency of PC use but by the different structure of the age classes of the patients. CONCLUSIONS: This study of the variables relating to GPs, their clinical practices, and their use of computerised records (examined by means of the chosen indicators) shows that the regular and complete recording of the principal data of health interest is feasible insofar as it is not biased by the characteristics of the GPs, and advantageous. The construction of the database therefore represents a first step towards the initiation of routine research into general practice in Italy.

Biomedical Research↗

PubMed1989

[Diagnostic activity in general practice. 2. Frequency of examination of urinary glucose and blood pressure determination among patients in general practice].

In order to estimate how frequently examinations of urine for glucosuria and blood pressure measurements are performed in the primary health care sector to detect common incapacitating diseases such as diabetes and hypertension, the authors carried out a study in five general practices in Denmark for a period of five years. The study was retrospective because it is not possible to study one's own behaviour prospectively. Nearly 1,000 persons aged 30 years or more were involved. 9% of the group had no contact with the health care sector during the period. In 49%, the urine had been tested at least once for glucose; 58% where women were concerned but only 40% of the men. Men under the age of 55 years were significantly underrepresented. Examination of the urine was only undertaken in 51% of the persons aged 55-74 years. Twelve new cases of diabetes were discovered, nine of these were diagnosed in general practice. Hypertension had been diagnosed in 52 patients before the registration period. 60% of the remainder had blood pressure measurements on at least one occasion during the period. Men under 55 years were significantly underrepresented (42%). Sixty-four new cases of hypertension were discovered, 59 of these in general practice. Screening for common diseases such as these is primarily performed by general practitioner. Several other works from general practice where no special efforts were made to systematize screening for diabetes or hypertension did not reveal any better results. It is estimated that 25% of diabetic patients and 50% of hypertensive patients remain undiagnosed. The present rather random screening for these diseases is insufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire.

This study compares the characteristics of general practitioners and a pen and paper test in the detection of psychiatric disorder in primary care settings. A psychiatrist interviewed a stratified sample of 283 patients drawn from 590 consecutive new illnesses seen in 15 general practices. Research diagnoses could be made in between one-quarter and one-third of the consecutive new illnesses. Two different research diagnostic systems agreed quite well with one another about who should be regarded as a psychiatric 'case' - although agreement between them for individual diagnoses was less impressive. Research diagnoses of psychiatric illnesses could be made in approximately 30% of new episodes of illnesses seen. If the DSM-3 system was used as a criterion of 'caseness', the specificity of the general health questionnaire was 75.4%, and the sensitivity was 87.1%. The general practitioners had fewer false positives than the questionnaire, but they were much more likely to miss psychiatric cases. Use of the general health questionnaire could increase their sensitivity from about 50% to 95%.

Family Practice↗

PubMed1995

Care of schizophrenia in general practice: the general practitioner and the patient.

BACKGROUND: The transfer of patients with chronic schizophrenia from large mental hospitals into the community has had an impact on the role of the general practitioner in the effective delivery of primary care services to these patients. AIM: A study was undertaken to assess the care available in general practice for patients with schizophrenia, the attitudes of general practitioners and patients to the care provided and the factors influencing patients' use of services. METHOD: Eighty three patients with a diagnosis of schizophrenia and 26 doctors in 13 London practices registered on the VAMP research bank took part in a series of structured and semi-structured interviews. This was followed by a systematic examination of the patients' case notes. RESULTS: Only 14 patients (17%) had no active symptoms according to the present state examination interview and 52 (63%) were currently taking antipsychotic medication. Fifty three patients were in contact with a psychiatrist. Approximately one quarter of patients were visited by a community psychiatric nurse; in 18 of these 19 cases, the main reason for contact was reported to be for administration of medication by depot injection. In all but one case, patients seeing a community psychiatric nurse were also being seen by a psychiatrist. Sixteen doctors reported having had a consultation in the previous month with a patient's relative, friend or member of hostel staff. There were considerable differences between patients and their doctors in their attitudes to the use of services. Of the 26 general practitioners, 23 were enthusiastic about the possibility of introducing shared care records. Of the 54 patients in contact with a mental health professional, only 18 favoured the use of shared care records. Most of the doctors (19, 73%) reported they would welcome a psychiatric liaison service in their practice; 40% of 53 patients said they would not. Patients receiving antipsychotic drugs and patients registered with inner city practices attended their general practitioners more frequently than those not taking antipsychotic medication and those registered with suburban practices. Use of antipsychotic medication (adjusted odds ratio (OR) 8.2, 95% confidence interval (CI) 2.2 to 30.7, P < 0.01), male sex (OR 5.8, 95% CI 1.5 to 22.1, P < 0.01) and active symptoms on the present state examination (OR 4.1, 95% CI 1.0 to 17.5, P = 0.06) were all predictive of current contact with mental health professionals. CONCLUSION: Family doctors were closely involved with the care of patients with schizophrenia and their relatives and were eager for increased liaison with secondary care services. Although patients were more resistant than doctors to management innovations this may reflect lack of familiarity with changes in community services. Greater input is needed by mental health professionals, particularly community psychiatric nurses, and some consideration of the burden of care in inner city practices is necessary in health service planning.

Adult↗

PubMed1995

Management of angina pectoris in general practice: a questionnaire survey of general practitioners.

BACKGROUND: Little is known about the current management of angina pectoris in general practice. AIM: This survey set out to assess general practitioners' perceptions of current investigation and treatment for angina pectoris. METHOD: A postal questionnaire was sent to all 217 general practitioners listed with the Hampshire Family Health Services Authority who have access to a regional cardiac centre in Southampton. RESULTS: The response rate was 79% (171 of 217). The majority (80%) of general practitioners reported referring 10% or fewer of their patients with angina to a cardiologist at the regional centre, and 72% reported referring a quarter or fewer of their patients to a hospital physician. Most (77%) considered an exercise test useful for diagnosis of angina, but almost half (47%) were uncertain about its prognostic value. Most respondents (79%) were not confident of interpreting the results of an exercise test. The majority (79%) believed that there was scientific evidence to show that coronary angioplasty relieves symptoms and 21% were of the opinion that it prolongs survival. Ninety six per cent believed coronary artery bypass grafting relieves symptoms and 62% that it prolongs survival. CONCLUSION: General practitioners do not appear to refer the majority of patients with angina pectoris for hospital investigation, and express divergent and contradictory opinions about exercise testing and the scientific evidence for the benefits of coronary angioplasty and coronary artery bypass surgery. Easier access to cardiological investigation and population based data about the value of exercise testing and survival benefits from coronary intervention are required to optimize selection of patients in the community who are most likely to benefit from coronary revascularization.

Angina Pectoris↗

PubMed1994

Exploratory study of general practitioners' orientations to general practice and responses to change.

BACKGROUND: Research into general practitioners' responses to the changes in the health service has focused on the quantifiable dimensions of workload, stress, job satisfaction and mental health. AIM: This study set out to investigate general practitioners' practice orientations and responses to change. METHOD: The study was undertaken in 1992. 'Young principals' who had attended MSD Foundation regional courses were invited by letter to reflect on recent change in general practice and to give their views on morale and recruitment. RESULTS: Forty nine young principals responded (response rate 45%). Responses were found to cluster around four orientations to practice: collectivism, pragmatism, traditionalism, and alienation. These varied in terms of four underlying values: autonomy, individualism, external referent and optimism. CONCLUSION: General practitioners' responses to change are more complex than is currently understood and are influenced by orientation to practice. In a relatively homogeneous 'enthusiastic' subgroup of general practitioners there is striking variation in practice orientation.

Adult↗

PubMed1993

Do general practitioners and general psychiatrists want to look after drug misusers? Evaluation of a non-specialist treatment policy.

A new means of monitoring drug misuse which was developed in the north west of England, but is now widely used throughout the United Kingdom, is described and evaluated. Report forms which had been specially designed and ensured the anonymity of drug misusers were widely distributed among doctors and non-medical health workers who may have had contact with drug misusers. The forms were returned post-free to a centre where they were entered on a customized drug misuse database. There were 2127 reports from the north west of England (population 3.99 million) relating to 1792 individuals over a 15-month period. However, despite intensive promotion of the project among doctors, the number of reports from doctors remained virtually unchanged over the 15 months despite a 33% increase in the overall number of reports. When the reports from three health districts, selected so as to be representative of the region demographically (total population 658,500, population aged 15-44 years 292,200), were considered there was a substantial fall (70%) in reports from general practitioners which was considerably greater than the 2% fall in all reports. In a linked study all the psychiatrists, 30% of probation officers and a one in six sample of general practitioners from the three selected health districts were approached for interview at the beginning of the 15-month period and again a year later. This structured enquiry about caseloads, treatment, and attitudes also revealed a fall in the number of drug misusers attended by general practitioners and general psychiatrists and a reduction in the services provided for them by general practitioners.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Continuing education for general practice. 1. Experience, competence and the media of self-directed learning for established general practitioners.

The arrangements under which continuing education for general practice is provided and attendance by general practitioners is rewarded have now been in operation for three years. More recently, reaccreditation has emerged as a significant issue for the profession. For these reasons it appears timely to review the whole basis of ongoing learning by established general practitioners. In this the first of two papers, learning by established professionals is considered in relation to the educational development of the learner, the role of experience and the goals of competence and performance. It is concluded that self-directed learning based on experience should form the centre-piece of continuing education for general practice and that educational provision should adopt a complementary role in sustaining motivation to learn and by enabling learning from experience to be shared and enriched. A model of self-directed learning, connecting experience and competence through systematic application of three learning media, reading, reflection and audit, is proposed and related to appropriate educational participation by established general practitioners.

Clinical Competence↗

PubMed2004

Prospective multidisciplinary audit of obstetric general anaesthesia in a district general hospital.

In the 3 years leading up to March 2001, the general anaesthesia rate for emergency and elective caesarean sections at our hospital was higher than that recommended by the Royal College of Anaesthetists. There were also concerns regarding the quality of communication between surgeon and anaesthetist prior to emergency caesarean section. A multidisciplinary audit was undertaken on both the indications for obstetric general anaesthesia and quality of communication between staff members during the perioperative period between January and August 2002. The results of the audit highlighted potential serious shortfalls in communication and teamworking; however, there was insufficient information to assess the appropriateness of the indication for general anaesthesia. Following this audit recommendations were made to improve communication channels between the personnel on labour ward and this coincided with a reduction in the use of general anaesthesia.

Anesthesia, General↗

PubMed2003

[General anesthesia for disabled patients undergoing dental treatment in a general hospital].

BACKGROUND: General anesthesia for dental treatment in disabled patients may present particular problems, especially when it is done in a general hospital, compared with specialized dental hospitals. METHODS: We surveyed 24 patients who underwent dental treatment under general anesthesia in our institution during the last decade. RESULTS: Electrocardiography or chest x-ray photography was not obtained in 8 patients owing to lack of patients' cooperation. Slow induction with sevoflurane was selected in 5 patients, because intravenous cannulae could not be placed owing to their rejection. Nasotracheal intubation was performed in all patients, but no difficulty in intubation was documented. As postoperative complications, we observed convulsion in one patient and muscle rigidity in another, but no critical troubles related to circulatory or respiratory status. In patients who were treated for more than ten teeth, we observed differences in age, body weight, duration of anesthesia, maximum concentration of sevoflurane administered during anesthesia, and use of postoperative analgesics compared with the other patients. CONCLUSIONS: We found particular problems of anesthesia for disable patients undergoing dental treatment in a general hospital, and suggest that information on numbers of teeth to be treated is helpful.

Adolescent↗