JournalWatch September 2009
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at http://atoz.ebsco.com/titles.asp?id=6259
CLINICAL GUIDELINES
Title: Low back pain: individual needs must be considered
Authors: LONGWORTH, S.
Source: Guidelines in Practice 2009; 12(8): 11-14 (August)
Summary: The author reviews the NICE guideline on Low back pain, Early management of
persistent non-specific low back pain. The document covers the same clinical area as the
Low back pain evidence review, the first comprehensive evidence-based guideline from the
Royal College of General Practitioners (RCGP), published over a decade ago.
URL: http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgpstudents
http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgp
UrlNotes: Register for free access
Title: BTS/SIGN guideline on asthma management has been revised
Authors: PINNOCK, H.
Source: Guidelines in Practice 2009; 12(8): 26-34 (August)
Summary: The 2009 update of the BTS/SIGN guideline focuses attention on the
management of acute asthma with crucial recommendations about objective assessment
and recording of severity and recommends the use of oximetry in acute asthma is relevant
to all primary care clinicians. Practices should ensure that pregnant women with asthma are
routinely reviewed and reassured that their usual asthma treatments are safe during
pregnancy and lactation. The guideline includes information on the switch to CFC-free
inhaled steroids and updates the advice on the use of long-acting B2 agonists.
URL: http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgpstudents
http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgp
UrlNotes: Register for free access
Title: Newer agents are available for blood glucose control
Authors: GADSBY, R.
Source: Guidelines in Practice 2009; 12(8): 39-44 (August)
Summary: The revision of the glycaemic control section of NICE Clinical Guideline 66 on The
management of type 2 diabetes was published in May 2009 in two forms: as NICE Clinical
Guideline 87 (a partial update of the original guideline) and as a short clinical guideline on
Newer agents for blood glucose control in type 2 diabetes. These updates were developed
because several new glucose-lowering therapies have recently been approved that were not
covered in the previous guideline.
URL: http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgpstudents
http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgp
UrlNotes: Register for free access
DISEASES
ANGINA
Title: Five year prognosis in patients with angina identified in primary care: incident cohort
study
Authors: BUCKLEY, B. S. SIMPSON, C. R. MCLERNON, D. J. et al
Source: British Medical Journal 2009; 339(7718): 438-441 (22 August)
Summary: In this sample of people with incident angina from primary care, there were sex
differences in survival and age and sex differences in the provision of revascularisation after
a diagnosis. Acute myocardial infarction after a diagnosis of angina was strongly predictive
of mortality. To minimise adverse outcomes, optimal preventive treatments should be used
in patients with angina.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=165512515&plid=1487535&lang=en
UrlNotes: Full-text access available to all, 1994 to present. Online citation: BMJ
2009;339:b3058 [published 6 August 2009]
EATING DISORDERS
Title: General practitioner attitudes towards referral of eating-disordered patients: a vignette
study based on the theory of planned behaviour
Authors: GREEN, H. JOHNSTON, O. CABRINI, S. et al
Source: Mental Health in Family Medicine 2008; 5(4): 213-218 (December)
Summary: The study examined differences between GPs to determine their impact on
variations in intention to refer a hypothetical patient with disordered eating to specialist
eating disorder services and the impact of patient weight on intention to refer. It found that,
despite current guidance, patient weight did not influence GPs' decisions. Much of the
variance in actual referral behaviour may be explained by cognitive attitudes and subjective
norms. Interventions to reduce this variation should be focused on informing GPs about
actual norms, and best practice guidelines.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=1281859&lang=en
UrlNotes: Full-text access available via the A-Z Journals Portal, 2003 to present
ECZEMA
Title: Control of atopic eczema requires sufficient emollient use
Authors: BOGGIS, A.
Source: Guidelines in Practice 2009; 12(8): 15-23 (August)
Summary: In this article the authors taken into account the NICE and The Primary Care
Dermatology Society (PCDS) and British Association of Dermatologists (BAD)
recommendations and aimed to produce a streamlined process for managing atopic eczema
in children, which can be used regularly in the practice.
URL: http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgpstudents
http://www.eguidelines.co.uk/user/register/index_newsys.php?assocID=rcgp
UrlNotes: Register for free access
Title: Eczema: types, presentation, causes and management
Authors: WATKINS, J.
Source: Practice Nurse 2009; 38(4): 11-18 (September)
Summary: Eczema has a variety of causes and triggers that can be exogenous or
endogenous and affected areas are itchy and erythematous, with papules, vesicles or
blisters that may ooze. If the condition becomes chronic, the skin becomes dry, scaly and
possibly pigmented. The condition cannot necessarily be cured, but identifying the type of
eczema and applying appropriate treatment helps to prevent or improve it.
UrlNotes: No electronic access. Please e-mail to receive a print copy. library@rcgp.org.uk
DEPRESSION
Title: Brief interventions for depression in primary care: A systematic review [clinical review]
Authors: MCNAUGHTON, J. L.
Source: Canadian Family Physician 2009; 55(8): 789-796 (August)
Summary: The authors sought to assess existing, brief nonpharmacologic interventions that
are available for primary care physicians with minimal training in psychotherapy to use in
managing depression in adults. They found that Bibliotherapy, CBT-based websites, and
CBT-based computer programs might be effective in assisting primary care physicians who
have minimal training in psychotherapy in treating adult patients with depression. Health
care personnel contact with patients undergoing these interventions might result in
increased effectiveness.
URL: http://www.cfp.ca/archive/
UrlNotes: Full-text access available to all, 1967 to present
Title: Clinical diagnosis of depression in primary care: a meta-analysis
Authors: MITCHELL, A. J. VAZE, A. RAO, S.
Source: The Lancet 2009; 374(9690): 609-619 (August)
Summary: The authors undertook a meta-analysis of 118 studies that assessed the accuracy
of unassisted diagnoses of depression by GPs. 41 of these studies were included because
they had a robust outcome standard of a structured or semi-structured interview. GPs can
rule out depression in most people who are not depressed; however, the modest prevalence
of depression in primary care means that misidentifications outnumber missed cases.
Diagnosis could be improved by re-assessment of individuals who might have depression.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=1110136&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2005 to present
Title: Therapist-delivered internet psychotherapy for depression in primary care: a
randomised controlled trial
Authors: KESSLER, D. LEWIS, G. KAUR, S. et al
Source: The Lancet 2009; 374(9690): 628-634 (August)
Summary: Computerised programs have been developed to improve accessibility of CBT, but
whether these interventions are responsive to individual needs is unknown. The authors
investigated the effectiveness of CBT delivered online in real time by a therapist for patients
with depression in primary care. They concluded that CBT seems to be effective when
delivered online in real time by a therapist, with benefits maintained over 8 months.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=1110136&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2005 to present
DRUG ADDICTION TREATMENT
Title: Assessing IDU prevalence and health consequences (HCV, overdose and drug-related
mortality) in a primary care trust: implications for public health action
Authors: HICKMAN, M. HOPE, V. COLEMAN, B. et al
Source: Journal of Public Health 2009; 31(3): 372-382 (September)
Summary: The authors report on an exercise to estimate the prevalence of injecting drug
use (IDU) and associated harms in a single primary care trust. They found that locally
specific and useful intelligence on injecting and its health consequence can be generated to
inform local public health action, and may contribute information to validate national
prevalence estimates.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=306735&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 1996 to present
MEDICAL EDUCATION
Title: Career start: a model for five-year training?
Authors: GUTHRIE, V. SIMPSON, A. FRENCH, F. et al
Source: Education for Primary Care 2009; 20(4): 268-270 (July)
Summary: Five-year training programmes leading to qualification as a GP are a topic of
current debate. Many positive indicators have been identified around extended training, and
any negativity is usually about the capacity of general practice to support more trainees or
concerns about finance when budgets for health are already constrained. Concerns about
trainees' ability to meet the demands of the GP curriculum within three years have partially
fuelled this debate, and some constructive solutions and suggestions are emerging.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: How GPs learn
Authors: MACLEOD, S.
Source: Education for Primary Care 2009; 20(4): 271-277 (July)
Summary: This study aimed to review the current knowledge of GPs' learning behaviour and
to increase understanding of how learning needs are assessed and met at present. It was
intended that the outcomes of the research could inform appraiser training and improve
both appraisers' and education providers' ability to promote effective CME for GPs.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: 'Just a lovely luxury?' What can public health attachments add to postgraduate general
practice training?
Authors: WILLS, J. REYNOLDS, J. SWANWICK, T.
Source: Education for Primary Care 2009; 20(4): 278-284 (July)
Summary: Changing trends in the role of general practice and GPs, including a focus on
commissioning and practice population health needs, were reflected in the specialty training
curriculum published by the RCGP in 2007. In response the London Deanery established
training attachments to the public health departments of ten PCTs across London,
incorporated into three-year GP specialty training programmes. These were evaluated in
2008 by London South Bank University in order to assess the attachment's suitability for
addressing areas of the RCGP curriculum, and to explore perceptions of its value for GP
training and for future practice.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: Standardised patient assessments on consecutive days during high-stakes GP training
interviews: is there any evidence of candidates sharing information?
Authors: FRASER, A. CALVERT, M. WILKINSON, M. et al
Source: Education for Primary Care 2009; 20(4): 285-290 (July)
Summary: The aim of this study was to evaluate whether the results of standardised patient
assessments on consecutive days of the week using the same scenarios were equivalent.
We were concerned that candidates later in the week may receive information from their
colleagues and potentially gain an unfair advantage by discovering the content of the
exercise.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: Continuing professional development and revalidation: an analysis of general
practitioners' recorded learning
Authors: HOWARD, J. SPARROW, N. TURNBULL, C. J. et al
Source: Education for Primary Care 2009; 20(4): 298-303 (July)
Summary: This paper describes a retrospective analysis of the learning logs kept by 71 GPs
undertaking the interim Membership by Assessment of Performance (iMAP) programme,
considering quantity of recorded learning, evidence of reflection on outcome and spread of
content across the domains of the General Medical Council's Good Medical Practice (GMP).
The average GP iMAP candidate undertook 87 hours of CPD over the year; 16 undertook
less than 50 hours while 22 recorded more than 100 hours. The GPs averaged five different
types of CPD and 31 recorded outcomes across the year. Most GPs recorded outcomes in
each domain of GMP and those who logged more activities were also those more likely to
record a wider spread of learning across the curriculum. These results suggest that the
RCGP's proposed managed CPD scheme is feasible.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: Doctors in the movies: a user's guide to teaching about film and medicine [teaching
exchange]
Authors: MEMEL, D. RABY, P. THOMPSON, T.
Source: Education for Primary Care 2009; 20(4): 304-315 (July)
Summary: The last decade has seen the development of medical humanities teaching, both
in undergraduate and postgraduate medical education, often led by GPs. With medical
students, the teaching has been both in the core curriculum, and as optional student-
selected components (SSCs). The authors developed an SSC that has specifically looked at
the relationship between medicine and the cinema. They describe the aims and structure of
the course and the resources, both films and books, that were used to run it successfully.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: Simulating doctors: a report on a workshop training actors to simulate general
practitioner appraisees and general practitioner registrars
Authors: LYON-MARIS, J. BURROWS, P.
Source: Education for Primary Care 2009; 20(4): 309-313 (July)
Summary: Using actors to simulate patients is standard practice in undergraduate and
postgraduate medical education. It has also become a standard assessment tool in
postgraduate medical education as part of the new MRCGP clinical skills assessment. The
UKCEA conference (2006) in Brighton hosted a workshop demonstrating the use of actors
simulating GP specialty training registrars in difficulty, as a way of stretching trainers at
experienced GP trainers' courses.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
Title: 'An education workforce which works collaboratively'. Deriving best-evidence operating
principles for interprofessional learning in Tayside: a qualitative study
Authors: REID, R. ALLSTAFF, K. BRUCE, D.
Source: Journal of Interprofessional Care 2009; 23(5): 534-538 (September)
Summary: This study aimed to describe methods used in planning and delivering IPL within
PLT and how IPL is perceived by different groups of participants and organizers. Based on
these findings and current literature, the researchers then aimed to develop operating
principles for PL events.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=71234710&plid=105892&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 1997 to present
Title: A mixed-methods study of interprofessional learning of resuscitation skills
Authors: BRADLEY, P. COOPER, S. DUNCAN, F.
Source: Medical Education 2009; 43(9): 912-922 (September)
Summary: This study aimed to identify the effects of interprofessional resuscitation skills
teaching on medical and nursing students' attitudes, leadership, team-working and
performance skills. The authors found that an intervention based on common, relevant,
shared learning outcomes set in a realistic educational context can work with students who
have differing levels of previous IPE and skills training experience. Qualitatively, positive
attitudes outlast quantitative changes measured using the RIPLS.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=98941&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 1997 to present
Title: The use of reflection in medical education: AMEE Guide No. 44
Authors: SANDARS, J.
Source: Medical Teacher 2009; 31(8): 685-695 (August)
Summary: There are a variety of educational approaches in undergraduate, postgraduate
and continuing medical education that can be used to facilitate reflection, from text based
reflective journals and critical incident reports to the creative use of digital media and
storytelling. The choice of approach varies with the intended outcomes, but it should also be
determined by the user since everyone has a preferred style. Guided reflection, with
supportive challenge from a mentor or facilitator, is important so that underlying
assumptions can be challenged and new perspectives considered. Feedback can enhance
reflection and while there is little research evidence to suggest that reflection improves
quality of care, the process of care can be enhanced.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=165512515&plid=105922&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 1997 to present
Title: Practica continua: Connecting and combining simulation modalities for integrated
teaching, learning and assessment
Authors: ELLAWAY, R. H. KNEEBONE, R. LACHAPELLE, K. et al
Source: Medical Teacher 2009; 31(8):725 ? 731 (August)
Summary: Recent developments are enabling simulators and simulation environments to
progress beyond single intervention models towards integrated continua of simulation.
Moving to greater integration can improve contextualisation, better management of the
transition from individual simulation to clinical practice, and provide wider opportunities to
synthesise skills and approaches to practice. Simulation integration may involve
experiential, modelling, technical, narrative, and evaluation dimensions; it includes both
direct actions and activities, and technical and systems designs. The framework of 'practica
continua' proposed in this article links theoretical approaches and practical examples of
integrated uses of simulation in education.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=165512515&plid=105922&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 1997 to present
Title: The replacement of 'paper' cases by interactive online virtual patients in problem-
based learning
Authors: POULTON, T. CONRADI, E. KAVIA, S. et al
Source: Medical Teacher 2009; 31(8): 752-758 (August)
Summary: To counter the limitation that paper cases are linear and do not allow students to
explore the consequences of decisions, interactive online virtual patients (VPs) were
developed which allowed students to consider options as the cases unfold, and allow
students to explore the consequences of their actions. A comprehensive evaluation was
carried out, using questionnaires, and interviews.Both tutors and students believed that the
ability to explore options and consequences created a more engaging experience and
encouraged students to explore their learning. They regretted the loss of paper and neither
group could see any value in putting cases online without the options.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=165512515&plid=105922&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 1997 to present
Title: Practice nurse appraisal: evaluation report
Authors: MURIE, J. WILSON, A. CERINUS, M. et al
Source: Education for Primary Care 2009; 20(4): 291-297 (July)
Summary: As general practice nurses (GPNs) now perform many activities formerly
undertaken by general practitioners (GPs), the paperwork and process of the Scottish GP
appraisal scheme may be usefully replicated for GPN appraisal.
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=104481&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2001 to present
PRESCRIBING ERRORS
Title: Prescribing errors in general practice: A prospective study
Authors: SAYERS, Y. M. ARMSTRONG, P. HANLEY, K.
Source: European Journal of General Practice 2009; 15(2): 81-83
Summary: There is little published research on errors that occur in prescribing and this study
aimed to estimate the seriousness and level of prescribing errors. From a total of 3,948
prescriptions, 491 (12.4%) contained one or more errors. From a total of 8,686 drug items,
546 (6.2%) contained one or more errors. Of the errors the majority were minor (398,
72.9%), a smaller number (135, 24.7%) were major nuisance errors, and there were 13
(2.4%) potentially serious errors. The most common errors related to drug directions and
dosage.
URL: http://www.informaworld.com/smpp/title~content=t749989318~db=all
UrlNotes: Full-text access available to all, 1995 to present
QUALITY ASSURANCE IN HEALTH SERVICES
Title: The role of the clinical professions in the regulation of healthcare in England: walking
the tightrope
Authors: LELLIOT, P.
Source: Psychiatric Bulletin 2009; 33(9): 321-324 (September)
Summary: The Royal Colleges and other professional bodies could use their clinical expertise,
authority and influence with clinicians to improve the quality of regulation of healthcare
services. At present, their contribution to regulation in England is ad hoc and informal.
Better engagement could increase the impact that professional bodies have on patient care
and create a new role for them as arbiters of quality in the organisation and delivery of
care. The requirement for healthcare provider organisations to register with the Care Quality
Commission from April 2010 and the National Health Service Next Stage Review have
created an opportunity for closer collaboration. However, there are problems that must be
overcome. These include the ownership of information about the quality of care and the
uses to which this is put. It would be self-defeating if closer working with the regulator
undermined the trust that clinicians have in quality improvement work led by the
professional bodies.
URL: http://pb.rcpsych.org/contents-by-date.0.shtml
UrlNotes: Full-text access available to all, 1977 to present (embargo 1 year)
TELEMEDICINE
Title: Telemedicine for management of patients with COPD? [comment]
Authors: MCKINSTRY, B. PINNOCK, H. SHEIKH, A.
Source: The Lancet 2009; 374(9691): 672-673 (August)
URL:
http://atoz.ebsco.com/JournalHome.asp?id=6259&sid=56951651&plid=1110136&lang=en
UrlNotes: Full-text access available via A-Z Journals Portal, 2005 to present