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General Physicians (general + physician)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Screening for diabetic retinopathy by non-ophthalmologists: an effective public health tool

ACTA OPHTHALMOLOGICA, Issue 4 2003
Lalit Verma
Abstract. Purpose:, To investigate and report the reliability of detection and grading of diabetic retinopathy by direct ophthalmoscopy through a dilated pupil by general physicians (non-ophthalmologists) and optometrists who have undergone a short period of training. Methods:, A total of 400 eyes of 200 diabetes patients were examined by two non-ophthalmologists. Their observations were compared with an ophthalmologist's diagnoses for the same patients. Results:, The diagnoses made by the general physician (kappa = 0.8381, SE = 0.041) and the optometrist (kappa = 0.7186, SE = 0.051) showed good rates of agreement with the ophthalmologist's diagnoses. Conclusions:, The provision of appropriate screening protocols and follow-up parameters can enable primary care physicians and support personnel to reliably screen individuals for retinopathy in diabetes. This will reduce the workload of tertiary hospitals, and provide optimal services to the huge majority of the Indian population that has limited access to eye care services. [source]

Management of brain metastases

INTERNAL MEDICINE JOURNAL, Issue 5 2004
L. C. Lim
Abstract Solid tumour brain metastases are a frequent clinical dilemma for oncologists and general physicians. The sound management of brain metastases requires a multidisciplinary approach. In this review we discuss the diagnosis and management of brain metastases including the role of surgery, radiotherapy, and chemotherapy. The standard approaches of surgical excision and primary radiotherapy have evolved from randomised studies. However, controversies remain regarding post-surgery irradiation in the setting of a solitary metastasis and the role of palliative chemotherapy. (Intern Med J 2004; 34: 270,278) [source]

Intestinal tuberculosis mimicking fistulizing Crohn's disease

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 1 2007
Wai-Man Wong
Abstract A patient is reported with intestinal tuberculosis that mimicked fistulizing Crohn's disease endoscopically. He had complete resolution of symptoms after a full course of antituberculosis therapy. Gastroenterologists and general physicians should aware of the possibility of intestinal tuberculosis in areas with a high prevalence of tuberculosis infection. [source]

Epidemiology and clinical classification of onychomycosis

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2005
I Effendy
ABSTRACT Objectives, To review recent data , what is new in the epidemiology of onychomycoses? To identify the most relevant diagnostic criteria for effective therapy. Methods, The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease. Results, One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice. Furthermore, contrary to previous findings, 70.7% of participants did not practice sports. Lastly, these preliminary findings showed that treatment strategy depends largely on the type of treating physician, with GPs preferring monotherapy and dermatologists preferring combination therapy. Conclusions, A consensus was reached that treatment strategy should depend on the severity of nail involvement and the causative fungus. It is thus important to promote the importance of sampling. To simplify the choice of an appropriate treatment, onychomycosis may be divided into just two clinical groups: onychomycosis with and without nail matrix area involvement. However, the distinct clinical findings (number and type of affected nails, multimorbidity, drug interaction, etc.) in each individual case must be taken into account to ensure an appropriate treatment decision. [source]

Effectiveness of staged diabetes management on the quality of diabetes care in Mexico

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 6 2010
J Rodriguez-Saldana MD
Abstract The aim of this study was to investigate the effectiveness of staged diabetes management, a structured programme developed by the International Diabetes Center in Minneapolis, USA, on the quality of outpatient diabetes care at the primary level in Mexico. A prospective study was conducted in patients treated at outpatient diabetes clinics established in public health centres in 2001,2007 in Hidalgo, Mexico. Diabetes care was provided by multidisciplinary teams which included general physicians and nurses as a minimum. Organisational arrangements were made to reduce waiting times, avoid rotation of staff, and provide adequate time for baseline and follow-up visits. Process and outcomes indicators of quality of diabetes care included body mass index, blood pressure, fasting/casual blood glucose, lipoprotein measurement, haemoglobin A1c, and foot examination. Analysis of 4393 patients showed increases in the percentage of recorded process indicators of quality of diabetes care between baseline and the fifth visit: body mass index 85.5 vs 95.9%; blood pressure measurement 74.4 vs 95.6%; HbA1c 12.9 vs 17.7%; total cholesterol 18.3 vs 55.9%; and foot examination 19.1 vs 94.9%. Significant differences were noted by a decrease in fasting blood glucose (185.75±79.01 vs 162.89±72.53mg/dl, p<0.001), and a 3.6 percentage point decrease in HbA1c (12.05±4.47 vs 8.45±1.89%, p<0.001). These results suggest that it is possible to improve the quality of diabetes care at the primary level; this can be done through the implementation of a programme that integrates: changes in the structure and in the process of care, customised clinical guidelines, and a standardised system of information that enables measuring clinical results with very limited resources. Copyright © 2010 John Wiley & Sons. [source]

Can rational prescribing be improved by an outcome-based educational approach?

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 1 2010
A randomized trial completed in Iran
Abstract Introduction: An outcome-based education approach has been proposed to develop more effective continuing medical education (CME) programs. We have used this approach in developing an outcome-based educational intervention for general physicians working in primary care (GPs) and evaluated its effectiveness compared with a concurrent CME program in the field of rational prescribing. Methods: A cluster randomized controlled design was used. All 159 GPs working in 6 cities, in 2 regions in East Azerbaijan province in Iran, were invited to participate. The cities were matched and randomly divided into an intervention arm, for an outcome-based education on rational prescribing, and a control arm for a traditional CME program on the same topic. GPs' prescribing behavior was assessed 9 months before, and 3 months after the CME programs. Results: In total, 112 GPs participated. The GPs in the intervention arm significantly reduced the total number of prescribed drugs and the number of injections per prescription. The GPs in the intervention arm also increased their compliance with specific requirements for a correct prescription, such as explanation of specific time and manner of intake and precautions necessary when using drugs, with significant intervention effects of 13, 36, and 42 percentage units, respectively. Compared with the control arm, there was no significant improvement when prescribing antibiotics and anti-inflammatory agents. Discussion: Rational prescribing improved in some of the important outcome-based indicators, but several indicators were still suboptimal. The introduction of an outcome-based approach in CME seems promising when creating programs to improve GPs' prescribing behavior. [source]

Primary hyperparathyroidism: Referral patterns and outcomes of surgery

ANZ JOURNAL OF SURGERY, Issue 3 2002
Richard S. Flint
Background: Parathyroidectomy has long been established as an effective treatment for primary hyperparathyroidism (HPT). Methods: A 15-year retrospective audit was made by surgeons at North Shore Hospital, Auckland, of 33 patients with primary HPT who had parathyroidectomy. Results: There were 22 females and 11 males, ranging in age from 18 to 77 years (median 63 years). Initial diagnosis was predominantly by a general practitioner (72%), who invariably referred to a physician. Referral to surgery was made by general physicians (55%), endocrinologists (33%) and geriatricians (6%). Delay between diagnosis and referral for surgery ranged from 8 days to 10 years (median 7 months), and exceeded 2 years in 24% of patients. Twenty-eight (85%) were symptomatic: 13 (39%) had renal symptoms, 13 (39%) had bone disease, 10 (31%) had gastrointestinal complaints, seven (21%) had psychiatric illnesses and six (18%) had fatigue. The high incidence of symptoms was matched by high biochemical values (mean serum cal- cium level 2.97 mmol/L), and large parathyroid glands (mean weight 2001 mg). Twenty-nine patients (88%) had single adenomas, two (6%) had chief cell hyperplasia and two (6%) had carcinoma. Thirty-one (94%) were cured of their primary HPT. Conclusions: Parathyroidectomy is a safe and effective treatment for primary HPT but depends upon referral from non-surgical clinicians. A large proportion of patients have long delays before their surgery, and the group selected for surgery is referred with severe disease. [source]