General Practitioners' knowledge and use of genetic counselling in managing patients with genetic cardiac disease in non-specialised settings.
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ABSTRACT:
SUBMITTER: Marathe JA
PROVIDER: S-EPMC4567985 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundCOVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia.MethodsA cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020.ResultsOut of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload.ConclusionAccess to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks.
| S-EPMC7891055 | biostudies-literature
Project description:BACKGROUND: Médecins Sans Frontières (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes. METHODS: We analysed data from 18 mental health projects run by MSF in 2009 in eight countries. Outcome measures were client-rating scores (1-10 scale; 1 worst) for complaint severity and functioning and counsellor assessment. The effect of client and programme factors on outcomes was assessed by multiple regression analysis. Logistic regression was used to assess binary outcome variables. RESULTS: 48704 counselling sessions were held with 14963 individuals. Excluding women-focused projects, 66.8% of patients were women. Mean (SD) age was 33.3 (14.1) years. Anxiety-related complaints were the most common (35.0%), followed by family-related problems (15.7%), mood-related problems (14.1%) and physical complaints (13.7%). Only 2.0% presented with a serious mental health condition. 27.2% did not identify a traumatic precipitating event. 24.6% identified domestic discord or violence and 17.5% psychological violence as the precipitating event. 6244 (43.9%) had only one session. For 91% of 7837 who returned, the counsellor reported the problem had decreased or resolved. The mean (SD) complaint rating improved by 4.7 (2.4) points (p?<?0.001) and by 4.2 (2.3, p?<?0.001) for functional rating. Risk factors for poorer outcomes were few sessions, non-conflict setting (stable or societal violence settings), serious mental health condition, or attending a large, recently opened project. CONCLUSIONS: The majority of clients accessing counselling services present with anxiety related complaints. Attrition rates were high. Good outcomes were recorded among those who attended for more than one visit. Lessons learned included the importance of adaptation of approach in non-conflict contexts such as societal violence or post-conflict contexts. There is a need for further research to evaluate the intervention against a control group.
| S-EPMC3849884 | biostudies-other
Project description:BackgroundGeneralists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care.MethodsA qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically.ResultsThe ideal cooperation between GPs and ONs was as a "meeting of experts" with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs' competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly. While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients.ConclusionsThe complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.
| S-EPMC5842567 | biostudies-literature
Project description:OBJECTIVES:To synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions. METHODS:We conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta-ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings. RESULTS:Of the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A "line of argument" was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached. CONCLUSION:This systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.
| S-EPMC6099359 | biostudies-literature
Project description:BACKGROUND:The best management of hypertension in frail oldest-old (?80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. DESIGN/SETTING:Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. METHODS:GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries. RESULTS:Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used. CONCLUSION:Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.
| S-EPMC7351187 | biostudies-literature
Project description:The aim of this study was to explore the knowledge, attitudes and practices of established general practitioners (GPs) in relation to breastfeeding. 10 GPs in the Australian Nepean Blue Mountains Health District were interviewed and the interviews transcribed and analyzed thematically. Emergent themes from each interview were identified and then compared between and across the 10 interviews. Five themes emerged following the analysis: breastfeeding knowledge and training; attitudes towards breastfeeding; GPs' role in relation to breast feeding; GPs' practices; influence of male gender. All the GPs interviewed had positive attitudes towards breastfeeding, however they were often lacking in knowledge and conviction to be able to provide strong support to women during their breastfeeding journey. Some reported ambivalence in their encouragement of breastfeeding due to their desire to maintain a good relationship with women who chose not to feed this way. Nine of the GPs had little or no formal breastfeeding training and relied mainly on personal experience. Their clinics did not provide formal breastfeeding support including a written breastfeeding friendly policy and most GPs were not proactive in creating such an environment. We hope that the results from this study will assist in developing breastfeeding policies and professional education to support GPs in this role.
| S-EPMC5830034 | biostudies-other
Project description:BACKGROUND:In most Western countries, the referral letter forms the basis for establishing the priority of patients for specialised health care and for the coordination of care between the services. To be able to define the quality of referral letters, the potential impact of the quality on the organisation of care, and to improve the quality of the letters, we need a multidimensional definition of the ideal content. The study's aim was to explore what information is seen as most important and should be included in referral letters from primary care to specialised mental health care to facilitate prioritisation and planning of treatment and follow-up of the patients. METHODS:Based on purposive sampling, four mixed discussion groups, which included general practitioners, mental health nurses from primary health care, psychiatrists and psychologists from specialised mental health care, managers and patient representatives, were formed; they were asked to identify the information they considered important in a mental health referral letter. In line with the Delphi technique, the importance of the themes was later individually rated by the participants. The study was conducted within The Western Norway Regional Health Authority. RESULTS:The four groups identified 174 information themes. After excluding themes that were assessed as duplicates, replaceable or less important, 40 themes were suggested, organised in seven units. A set of check-off points of essential information is recommended as an introduction in the referral letter. CONCLUSION:Compared with general guidelines and guidelines for somatic care, the results of this study suggest that the referral letter to specialised mental health care should have a larger emphasis on the overall treatment plan, on the specific role of specialised health care in the continuum of care, and on patient involvement. Further research should evaluate the validity of these findings for other patient groups in need of integrated care and investigate how the quality of referral letters affects patient-related and organisational outcomes. TRIAL REGISTRATION: TRIAL REGISTRATION NUMBER:NCT01374035.
| S-EPMC3751904 | biostudies-literature
Project description:BackgroundPost-traumatic stress disorder (PTSD) is common, is associated with substantial morbidity, and is often not recognised in primary care.AimTo explore whether general practitioners (GPs) have significant gaps in their knowledge of PTSD.Design of studyA controlled study.SettingPrimary care in two Scottish regions.MethodA validated postal questionnaire consisting of clinical vignettes for PTSD, acute stress reaction, and depression was used to gather the data. The primary outcome measures were the proportion describing 'best practice' management of PTSD and the comparison of this with the control condition, the proportion describing 'best practice' management of depression. The secondary outcome measures were comparisons of PTSD and depression by recognition, drug treatment, and referral.ResultsTwo-thirds (67.5%) of GPs included PTSD in their differential diagnosis for the PTSD vignette, and 86.8% made a referral to secondary care for the PTSD case. A minority of GPs (42.9%) and only 54.1% of a comparison group of psychiatrists specified the drug treatment of choice for PTSD, a selective serotonin reuptake inhibitor. Only 28.3% of GPs had the knowledge to recognise PTSD and prescribe appropriately, compared with 89.8% for depression (P <0.001). Only 10.2% of GPs described best practice for PTSD, compared with 47.7% for depression (P <0.001).ConclusionLack of knowledge is among the reasons for less than ideal recognition and management of PTSD in primary care. Further research should aim to explore the implementation of PTSD guidelines in primary care.
| S-EPMC1324918 | biostudies-literature
Project description:Breast cancer is the most common malignancy in women in the Western world. Except for the high breast cancer risk in BRCA1 and BRCA2 mutation carriers as well as the risk for breast cancer in certain rare syndromes caused by mutations in TP53, STK11, PTEN, CDH1, NF1 or NBN, familial clustering of breast cancer remains largely unexplained. Despite significant efforts, BRCA3 could not be identified, but several reports have recently been published on genes involved in DNA repair and single nucleotide polymorphisms (SNPs) associated with an increased breast cancer risk. Although candidate gene approaches demonstrated moderately increased breast cancer risks for rare mutations in genes involved in DNA repair (ATM, CHEK2, BRIP1, PALB2 and RAD50), genome-wide association studies identified several SNPs as low-penetrance breast cancer susceptibility polymorphisms within genes as well as in chromosomal loci with no known genes (FGFR2, TOX3, LSP1, MAP3K1, TGFB1, 2q35 and 8q). Some of these low-penetrance breast cancer susceptibility polymorphisms also act as modifier genes in BRCA1/BRCA2 mutation carriers. This review not only outlines the recent key developments and potential clinical benefit for preventive management and therapy but also discusses the current limitations of genetic testing of variants associated with intermediate and low breast cancer risk.
| S-EPMC2947107 | biostudies-literature
Project description:BackgroundEarly diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity.MethodsData from 185?000 referrals and 29?000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time database (CaPPS) were analysed to ascertain standardised referral rate ratios, detection rate (DR) (=sensitivity) and conversion rate (CR) (=positive predictive value) for Practice 2WW referrals and Consultant Upgrade 2WW. Metrics were compared using Spearman's rank correlation co-efficients.ResultsThere was consistency in Practice and Consultant Upgrade 2WW referral rates over time, though not for annual DR (Spearman's ?<0.37) or CR (Spearman's ?<0.26). Practice 2WW referral rates correlated negatively with CR and positively with DR while correlations between DR and CR were restricted to single-year comparisons in Practice 2WW. In Consultant Upgrade, 2WW CR and DR were strongly correlated but only when the same cancers were included in both rates.ConclusionsResults suggest 'random case mix' explains previously reported associations between CR and DR with more 'hard to detect' cancers in some Practices than in others in a given year corresponding to lower DR and CR. Use of Practice and Consultant Upgrade 2WW referral metrics to gauge General Practice performance may be misleading.
| S-EPMC5572170 | biostudies-literature