History Repeating Itself? Concerns about [Genetic] Testing in Primary Care (Preprint)

2018 ◽  
Author(s):  
Cati Brown-Johnson ◽  
Megan Mahoney ◽  
Latha Palaniappan
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Genetic Testing ◽  
20Th Century ◽  
Primary Care Physicians ◽  
Daily Practice ◽  
Early 20Th Century ◽  
Blood Tests ◽  
Cholesterol Measurement

UNSTRUCTURED Primary care physicians report low confidence in their genetic testing knowledge. Practitioners in the early 20th century similarly reported hesitations towards now-routine chemistry-based blood tests, e.g. counts, glucose, and cholesterol measurement. Physicians in 2017 say the same things about genetic testing: it is hard to incorporate into daily practice, not consistently useful, less important than other priorities, and technically difficult. Technologies that are now commonplace in clinical practice were approached overcautiously at inception, similar to genetic testing today.

WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697085
Author(s):  
Trudy Bekkering ◽  
Bert Aertgeerts ◽  
Ton Kuijpers ◽  
Mieke Vermandere ◽  
Jako Burgers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Urinary Stones ◽  
Care Practice ◽  
Supporting Evidence ◽  
Supervised Exercise ◽  
Review Team ◽  
New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

Abstract 66: Current Attitudes and Practice Patterns of Using New and Emerging Therapies to Manage Patients with Atrial Fibrillation (AF): a National Assessment of Cardiologists and Primary Care Physicians

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Gregory D Salinas ◽  
Caroline O Robinson ◽  
Nancy Roepke ◽  
B. S Burton ◽  
Debi Susalka ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Stroke Risk ◽  
Case Vignette ◽  
Independent Evidence ◽  
Patient Chart ◽  
Emerging Therapies ◽  
Chart Audits

Introduction: Stroke prevention is a cornerstone in the management of patients with AF at higher risk for ischemic events. This study assessed physician barriers to management of AF patients, including gaps in clinical knowledge and application of tools and guidelines for reducing stroke risk. Awareness, perception, and confidence in adopting newer anticoagulants were investigated, particularly related to balancing risk with treatment goals, and knowledge sources sought by physicians. Methods: The data for this study, conducted from March 2011 to May 2011, were collected through the use of a nationally-distributed case vignette survey to cardiologists and primary care physicians (PCPs), as well as patient chart audits nested within the physician sample. Each component of this study was reviewed and approved by the Western Institutional Review Board (WIRB). Results: Surveys from 142 cardiologists and 250 PCPs, and 632 patient chart audits, were analyzed. Nearly half of cardiologists and more than 75% of PCPs surveyed identified uncertainty regarding stroke risk assessment and lack of awareness of tools to guide risk assessment as barriers to determining appropriate antithrombotic therapy. Case vignette assessment found that 44% of PCPs familiar with the CHADS2 risk assessment tool were unable to appropriately assign a risk score, and they were less likely than cardiologists (53% vs 85%) to use this tool in clinical practice. Consistent with their greater familiarity, 65% of cardiologists are very confident in using emerging anticoagulants, while only 40% of PCPs have comparable confidence. The most frequently sought and valued resources for information about emerging anticoagulants were clinical practice guidelines, journal articles, CME activities, and communication with physician peers. Conclusion: Knowledge gaps and clinical barriers exist among physicians for stroke risk assessment, anticoagulation management, and use of emerging therapies in patients with AF. Physicians seek independent evidence-based information when deciding how to incorporate new anticoagulants into practice. The data suggest that physicians value education on safety and efficacy of therapies as well as practical guidance on applying clinical data to practice.

scholarly journals Lifestyle Medicine Around the World: Lifestyle Medicine in Israel

2019 ◽  
Vol 14 (4) ◽  
pp. 377-381
Author(s):  
Lilach Malatskey ◽  
Igal Hekselman ◽  
Shani Afek
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Medical Profession ◽  
Daily Practice ◽  
Well Being ◽  
The United States ◽  
Noncommunicable Disease ◽  
Active Member ◽  
Health Providers ◽  
Lifestyle Medicine

In 2015, the Centers for Disease Control in the United States declared that 7 of 10 deaths per year are caused by chronic diseases; in Israel, the situation is consistent with this assessment. Healthy Israel 2020, an Israeli Ministry of Health initiative, places physicians at the forefront of health promotion and preventive medicine. In 2012, the Israeli Society of Lifestyle Medicine (ISLM) was established under the auspices of the Israel Association for Family Physicians. This decision was taken because we, the authors, wanted to promote change in the primary care services through the recruitment of key leaders for implementation of lifestyle medicine (LM), including improved attitudes, knowledge, motivation, and skills of primary care physicians and health providers. Today, the ISLM is an active member of the Israeli Medical Association, promoting educational activities, physician’s health, and well-being initiatives; developing tools for health-promoting clinics; and more. Our future plans are to incorporate LM as an integral part of daily practice in all sectors of the medical profession in Israel. This is challenging, but we see this as the only way to effectively combat the noncommunicable disease epidemic.

Screening and management of cardiovascular disease in Australian adults with HIV infection

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 495 ◽  
Author(s):  
Derek Chan ◽  
David Gracey ◽  
Michael Bailey ◽  
Deborah Richards ◽  
Brad Dalton
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Clinical Practice ◽  
Hiv Infection ◽  
Primary Care Physicians ◽  
Management Practices ◽  
Cvd Risk ◽  
Online Forms ◽  
Current Screening

Background Cardiovascular disease (CVD) is common in HIV infection. With no specific Australian guidelines for the screening and management of CVD in HIV-infected patients, best clinical practice is based on data from the general population. We evaluated adherence to these recommendations by primary care physicians who treat HIV-infected patients. Methods: Primary care physicians with a special interest in HIV infection were asked to complete details for at least 10 consecutive patient encounters using structured online forms. This included management practices pertaining to blood pressure (BP), blood glucose, electrocardiogram, lipid profile and CVD risk calculations. We assessed overall adherence to screening and follow-up recommendations as suggested by national and international guidelines. Results: Between May 2009 and March 2010, 43 physicians from 25 centres completed reporting for 530 HIV-infected patients, of whom 93% were male, 25% were aged 41–50 years and 83% were treated with antiretrovirals. Risk factors for CVD were common and included smoking (38%), hyperlipidaemia (16%) and hypertension (28%). In men aged >40 years and women aged >50 years without evidence of ischaemic heart disease, only 14% received a CVD risk assessment. Lipid and BP assessments were performed in 87% and 88% of patients, respectively. Conclusions: This Australian audit provides unique information on the characteristics and management of HIV and CVD in clinical practice. We have found a high burden of risk for CVD in HIV-infected Australians, but current screening and management practices in these patients fall short of contemporary guidelines.

Truth telling to cancer patients: Views of Myanmar primary care physicians

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17030-17030 ◽  
Author(s):  
S. Mon ◽  
A. Pe
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Primary Care Physicians ◽  
Daily Practice ◽  
Truth Telling ◽  
Full Disclosure ◽  
Doctor Patient Communication ◽  
Diagnosis And Prognosis ◽  
The Individual ◽  
Young Physicians

17030 Background: Due to cultural and social concern, non oncology physicians are still practicing nondisclosure in Myanmar. The views of Myanmar primary care physicians about truth telling to cancer patients were studied. Methods: A Questionnaire about revealing diagnosis and prognosis to cancer patients was prepared and given to 150 qualified Primary care physicians attending the oncology related lecture in CME course for General Practitioners in 2006, Yangon, Myanmar. Results: A total of 145 completed forms (96.66%) were returned. Age of primary care physicians range from 23 yrs to 52 yrs. 90 doctors (62.06%) were under age of 35 yrs (mean 29.94 yrs) and practicing experience ranged from 1 to 10 yrs. The remaining 55 (37.93%) were over 35 yrs of age (mean 44.52 yrs) with practicing duration of 10 to 28 yrs. The common cancer patients they have seen in daily practice were breast cancer (40%), lung cancer (28.96%), GI cancer (15.17%), cervical cancer (8.96%), ovarian cancer (3.4%), head and neck cancer ( 2.06%) and hematological malignancies (1.37%).A total of 73 doctors (50.34%) answered that they let the patient know they were suffering from a serious disease (not mentioning the word cancer) that needs further specialized treatment. Interestingly, 69.09% of physicians over 35 yrs of age agree with this approach, whereas only 38.88% of young physicians prefer it. Besides, 56.6% of senior primary care physicians prefer to reveal the diagnosis and prognosis to one or more family members first. Although all doctors are aware of the psychological distress on patients by painful truth telling, 58.8% of younger generation prefer to practice full disclosure to patients. Altogether, 105 physicians (72.41%) agree that disclosure of diagnosis and prognosis depends on education status of the individual patient. Conclusions: In this study, there were variations in physicians’ attitude and practice of truth telling. Full disclosure was preferred more by young physicians in Myanmar. Further studies on patients’ preference of telling the truth will help to better understand doctor-patient communication in Myanmar. No significant financial relationships to disclose.

scholarly journals British Heart Rhythm Society Clinical Practice Guidelines on the Management of Patients Developing QT Prolongation on Antipsychotic Medication

2019 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Pier D Lambiase ◽  
Joseph Paul de Bono ◽  
Richard J Schilling ◽  
Martin Lowe ◽  
Andrew Turley ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Primary Care Physicians ◽  
Heart Rhythm ◽  
Qt Prolongation

The British Heart Rhythm Society’s Clinical Practice Guidelines on the Management of Patients Developing QT Prolongation on Antipsychotic Medication are written for heart rhythm consultants, primary care physicians, specialist registrars, nurses and physiologists who may be requested to review ECGs or advise on cases where antipsychotic-induced QT prolongation is suspected or proven. The guidance is adapted from the latest Maudsley Prescribing Guidelines in Psychiatry, published in 2018.

scholarly journals Knowledge, Attitude and Practice of Primary Care Physicians in Dealing with Acute Stroke in Indonesia

2021 ◽  
Author(s):  
Putu Jaya Kusuma ◽  
Lilik Djuari ◽  
Abdulloh Machin ◽  
Asra Al Fauzi
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Thrombolytic Therapy ◽  
Acute Stroke ◽  
Primary Care Physicians ◽  
P Value ◽  
Stroke Management ◽  
Significant Difference ◽  
Level Of Knowledge ◽  
Stroke Knowledge

Objective: There are still many things that interfere with the practice of effective acute stroke management, with one of them being the failure of health workers providing appropriate management. Hence, this study was conducted to evaluate the level of knowledge, attitude and practices of primary care physicians (PCPs) in acute stroke management in Indonesia.Material and Methods: This cross-sectional face-to-face survey was conducted among all PCPs, from 63 primary health care centres; from October, 2019 to January, 2020 in Surabaya, Indonesia. A self-designed questionnaire, consisting of 25 questions, based on several guidelines, was used as the instrument of this survey.Results: In total, 134 PCPs participated. The majority of their level of knowledge obtained was in the moderate category (51.5%), while the majority of their attitude and practices towards stroke were in the good category (67.9% and 75.2%). Nearly 75.0% of PCPs also knew about thrombolytic therapy, but only <50.0% knew the ‘golden period’ of thrombolytic therapy. A significant correlation was found between PCPs knowledge-attitude (p-value<0.001), knowledge-practices (p-value=0.002) and attitude-practices (p-value<0.001). There was also a significant difference in the level of stroke knowledge between PCPs, with different clinical practice experience (p-value=0.015). Better stroke knowledge tended to be obtained by PCPs with younger clinical practice experience.Conclusion: The level of knowledge, attitude and practices of PCPs in acute stroke management in Indonesia is good, but should still be improved; especially knowledge about the use of thrombolytic therapy and its ‘golden period.’

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