scholarly journals Use of 3D Printing in Model Manufacturing for Minor Surgery Training of General Practitioners in Primary Care

2019 ◽  
Vol 9 (23) ◽  
pp. 5212 ◽  
Author(s):  
M.C. Luque ◽  
A. Calleja-Hortelano ◽  
P.E. Romero
Keyword(s):  
Primary Care ◽  
3D Printing ◽  
General Practitioners ◽  
Face Validity ◽  
Training Models ◽  
Surgery Training ◽  
Minor Surgery ◽  
The Cost ◽  
Spanish Health ◽  
Dermal Lesions

In order to increase the efficiency of the Spanish health system, minor surgery programs are currently carried out in primary care centers. This organizational change has led to the need to train many general practitioners (GPs) in this discipline on a practical level. Due to the cost of the existing minor surgery training models in the market, pig’s feet or chicken thighs are used to practice the removal of figured lesions and the suture of wounds. In the present work, the use of 3D printing is proposed, to manufacture models that reproduce in a realistic way the most common lesions in minor surgery practice, and that allow doctors to be trained in an adequate way. Four models with the most common dermal lesions have been designed and manufactured, and then evaluated by a panel of experts. Face validity was demonstrated with four items on a five-point Likert scale that was completed anonymously. The models have obtained the following results: aesthetic recreation, 4.6 ± 0.5; realism during anesthesia infiltration, 4.8 ± 0.4; realism during lesion removal, 2.8 ± 0.4; realism during surgical wound closure, 1.2 ± 0.4. The score in this last section could be improved if a more elastic skin-colored filament were found on the market.

scholarly journals Recommendations for clinical research in children presenting to primary care out-of-hours services

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101154
Author(s):  
Anouk Weghorst ◽  
Gea Holtman ◽  
Pien Ingrid Wolters ◽  
Heleen Russchen ◽  
Freek Fickweiler ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Informed Consent ◽  
General Practitioners ◽  
Selection Bias ◽  
Acute Gastroenteritis ◽  
Out Of Hours ◽  
Informed Consent Procedure ◽  
Consent Procedure ◽  
The Cost

Background: Research in primary care is essential, but recruiting children in this setting can be complex and may cause selection bias. Challenges surrounding informed consent, particularly in an acute clinical setting, can undermine feasibility. The off-protocol use of an intervention nearing implementation has become common in pragmatic randomized controlled trials (RCTs) set in primary care. Aim: To describe how the informed consent procedure affects study inclusion and to assess how off-protocol medication prescribing affects participant selection in a paediatric RCT. Design: A pragmatic RCT evaluating the cost-effectiveness of oral ondansetron in children diagnosed with acute gastroenteritis in primary care out-of-hours services and a parallel cohort study. Method: Consecutive children aged 6 months to 6 years attending primary care out-of-hours services with acute gastroenteritis were evaluated to assess the feasibility of obtaining informed consent, the off-protocol use of ondansetron, and other inclusion/exclusion criteria. Results: The RCTs feasibility was reduced by the informed consent procedure because 39.0% (325/834) of children were accompanied by only one parent. General practitioners prescribed ondansetron off-protocol to 34 children (4.1%), whereof 19 children were eligible for the RCT. RCT-eligible children included in the parallel cohort had fewer risk factors for dehydration than children in the RCT despite similar dehydration assessments by general practitioners. Conclusion: The informed consent procedure and off-protocol use of study medication affect the inclusion rate but had little effect on selection. A parallel cohort study alongside the RCT can help evaluate selection bias, and a pilot study can reveal potential barriers to inclusion.

The cost of cervical screening by general practitioners

1992 ◽  
Vol 156 (10) ◽  
pp. 740-740 ◽  
Author(s):  
J A Dickinson ◽  
H Britt ◽  
C Bridges‐Webb ◽  
S Neary
Keyword(s):  
General Practitioners ◽  
Cervical Screening ◽  
The Cost

scholarly journals Analysis of Annual Costs of Mobile Clinics in the Southern United States

2020 ◽  
Vol 11 ◽  
pp. 215013272098062
Author(s):  
Sharon Attipoe-Dorcoo ◽  
Rigoberto Delgado ◽  
Dejian Lai ◽  
Aditi Gupta ◽  
Stephen Linder
Keyword(s):  
Primary Care ◽  
Healthcare Services ◽  
Medicare Beneficiaries ◽  
Mobile Clinic ◽  
Efficient Manner ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
At Risk Populations ◽  
Mobile Clinics ◽  
The Cost

Introduction Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. Methods The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. Results Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. Conclusion The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

Estimating the cost of primary care training in ambulatory settings

2000 ◽  
Vol 9 (8) ◽  
pp. 715-726 ◽  
Author(s):  
Andrew J. Hogan ◽  
Luisa Franzini ◽  
James R. Boex
Keyword(s):  
Primary Care ◽  
Primary Care Training ◽  
Care Training ◽  
The Cost

scholarly journals What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

Dementia ◽  
2020 ◽  
pp. 147130122097771
Author(s):  
Conceição Balsinha ◽  
Steve Iliffe ◽  
Sónia Dias ◽  
Alexandre Freitas ◽  
Joana Grave ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Social Contexts ◽  
Dementia Care ◽  
Family Carers ◽  
Primary Care Teams ◽  
Qualitative Interview Study ◽  
Framework Approach ◽  
Advanced Stages ◽  
Patient Relationships

Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

2019 ◽  
pp. 136345931987410
Author(s):  
Julie Høgsgaard Andersen ◽  
Tine Tjørnhøj-Thomsen ◽  
Susanne Reventlow ◽  
Annette Sofie Davidsen
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young Adults ◽  
General Practitioners ◽  
Mental Health Problems ◽  
Psychosocial Problems ◽  
Health Problems ◽  
Care Work ◽  
Psychiatric Nurses ◽  
Provision Of Care

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

scholarly journals Attitudes to and experience of disease management programs in primary care—an exploratory survey of general practitioners in Germany

2021 ◽  
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Patient Care ◽  
General Practitioners ◽  
Linear Regression Analysis ◽  
Chronically Ill ◽  
Disease Management Programs ◽  
Federal States ◽  
Set Up ◽  
Chronically Ill Patients

Summary Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.

scholarly journals Foundation Piles—A New Feature for Concrete 3D Printers

Materials ◽  
2021 ◽  
Vol 14 (10) ◽  
pp. 2545
Author(s):  
Marcin Hoffmann ◽  
Krzysztof Żarkiewicz ◽  
Adam Zieliński ◽  
Szymon Skibicki ◽  
Łukasz Marchewka
Keyword(s):  
3D Printing ◽  
Rapid Development ◽  
Construction Materials ◽  
Shallow Foundation ◽  
Soil Reinforcement ◽  
3D Printer ◽  
Permanent Formwork ◽  
3D Printers ◽  
New Feature ◽  
The Cost

Foundation piles that are made by concrete 3D printers constitute a new alternative way of founding buildings constructed using incremental technology. We are currently observing very rapid development of incremental technology for the construction industry. The systems that are used for 3D printing with the application of construction materials make it possible to form permanent formwork for strip foundations, construct load-bearing walls and partition walls, and prefabricate elements, such as stairs, lintels, and ceilings. 3D printing systems do not offer soil reinforcement by making piles. The paper presents the possibility of making concrete foundation piles in laboratory conditions using a concrete 3D printer. The paper shows the tools and procedure for pile pumping. An experiment for measuring pile bearing capacity is described and an example of a pile deployment model under a foundation is described. The results of the tests and analytical calculations have shown that the displacement piles demonstrate less settlement when compared to the analysed shallow foundation. The authors indicate that it is possible to replace the shallow foundation with a series of piles combined with a printed wall without locally widening it. This type of foundation can be used for the foundation of low-rise buildings, such as detached houses. Estimated calculations have shown that the possibility of making foundation piles by a 3D printer will reduce the cost of making foundations by shortening the time of execution of works and reducing the consumption of construction materials.

scholarly journals Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania

2013 ◽  
Vol 14 (1) ◽  
Author(s):  
Lina Jaruseviciene ◽  
Ida Liseckiene ◽  
Leonas Valius ◽  
Ausrine Kontrimiene ◽  
Gediminas Jarusevicius ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners

scholarly journals Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033061
Author(s):  
Mark Lown ◽  
Christopher R Wilcox ◽  
Stephanie Hughes ◽  
Miriam Santer ◽  
George Lewith ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Qualitative Study ◽  
Decision Aids ◽  
Care Practice ◽  
Semistructured Interview ◽  
Interview Guide ◽  
Registration Number ◽  
The Cost ◽  
Inductive Thematic Analysis

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

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