Russian SARS-CoV-2 vaccine

Falls prevention education between older adults and healthcare providers during transition from hospital to community-living

Recent studies have shown only 17% of postmenopausal women in the UK receive prescriptions for hormone replacement therapy (HRT), with diabetic women being prescribed HRT 30% less often than non-diabetic women. Up to 80% of women experience menopausal symptoms, however, so it is expected that by using HRT many would gain benefit from symptom relief, in addition to benefiting from its effects in disease prophylaxis. We conducted a questionnaire survey of the attitudes to HRT prescribing of 178 local general practitioners (GPs) and 47 hospital doctors, working in diabetes and gynaecology. Responses were received from 98 (55%) GPs and 39 (83%) hospital doctors. One hundred and thirty-six (99%) would advise HRT for menopausal symptoms, with 133 (97%) advising HRT for a spontaneous premature menopause and 126 (92%) for a surgically induced menopause. One hundred and thirty-four (98%) would advise HRT for diabetic women with menopausal symptoms, with 122 (89%) indicating that HRT had no adverse effect on glycaemic control. For disease prophylaxis, all hospital doctors and 93 (95%) GPs would advise HRT for prevention of osteoporosis, although only 91 (93%) GPs would advise HRT to diabetic women for this indication. Thirty-three (85%) hospital doctors would advise HRT as prophylaxis against cardiovascular disease compared with 66 (67%) of GPs. For this indication in diabetic women, 32 (82%) hospital doctors and 67 (68%) GPs would advise HRT. Oral HRT was the most widely recommended preparation although GPs also frequently recommended patches. Topical gel, implants and other preparations were less commonly advised. Hospital doctors predominantly advised HRT for menopausal symptoms to be continued for between 1 and 5 years, although more GPs recommended HRT to be continued for longer than 5 years. The majority of doctors from both groups advised that HRT used for disease prophylaxis be continued for more than 5 years. More doctors than anticipated indicated they would recommend HRT, especially to diabetic women. Concerns among doctors about the side-effects of HRT and, in particular, the metabolic effects of HRT, do not appear to deter them from advising HRT. Willingness to prescribe a drug, however, is different from actually prescribing it and responses to questionnaires tend to be those regarded as being acceptable. Low patient demand for HRT due to fear or lack of awareness may also be contributing. Organizational change with the development of more menopause clinics may facilitate wider use of HRT.

Background and objective: Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs’ role assigned...

Communication and awareness about death: A study of a random sample of dying people

To develop a model for creating a joint general practice-hospital formulary, using the example of ulcer healing drugs. A joint formulary development group produced draft guidelines based on an earlier hospital formulary, which were sent to interested local general practitioners for consultation. Revised guidelines were then drawn up and forwarded to the health board's medicines committee for approval and distribution. Grampian Health Board. Nine members of joint formulary development group plus local general practitioners who were invited to comment on a list of 11 ulcer healing drugs. Degree of coincidence of drugs selected by hospital doctors and general practitioners. The ulcer healing drugs selected by the panel of general practitioners and by hospital doctors were highly coincident. The cost of one day's treatment with drugs varied considerably between hospital and general practice--for example, one drug cost 46p in hospital and 1 pounds in general practice and another cost 1.26 pounds in hospital and 1.01 pounds in general practice. Overall, six drugs cost more in hospital and five cost more in general practice. A joint formulary for use in hospitals and general practice in a health board can be devised fairly simply by consultation as virtually the same drugs are used in both types of practice. It should influence the health board's expenditure on drugs and affect the choice of drugs when a patient is discharged from hospital or is referred to any hospital in the region.

Opinions conflict on whether there is a place in the Health Service for general practitioner (community) hospitals in which the patients' treatment is mainly the responsibility of their family doctors. The authors therefore analysed a sample of the patients admitted in the course of a year to a group of two general district hospitals with a comparable sample of the patients admitted to a general practitioner hospital. The aim was to analyse the type of care provided in the general practitioner hospital, to assess whether it was appropriate for the type of cases treated, and to decide whether the patients would have been better off in the district general hospital (and vice versa). The main conclusions are that a district hospital is best for serious illnesses needing skilled decisions and assessments but that most of the work of these hospitals is not of this kind and a community hospital staffed by general practitioners offers many advantages to patients-provided the work being done is constantly under critical assessment. The authors plead for special refresher courses under the N.H.S. for general practitioners working in community hospitals.

BackgroundElectronic linkage of UK cohorts to routinely collected National Health Service (NHS) records provides virtually complete follow-up for cause-specific hospital admissions and deaths. The reliability of dementia diagnoses recorded in NHS hospital data is not well documented.MethodsFor a sample of Million Women Study participants in England we compared dementia recorded in routinely collected NHS hospital data (Hospital Episode Statistics: HES) with dementia recorded in two separate sources of primary care information: a primary care database [Clinical Practice Research Datalink (CPRD), n = 340] and a survey of study participants’ General Practitioners (GPs, n = 244).ResultsDementia recorded in HES fully agreed both with CPRD and with GP survey data for 85% of women; it did not agree for 1 and 4%, respectively. Agreement was uncertain for the remaining 14 and 11%, respectively; and among those classified as having uncertain agreement in CPRD, non-specific terms compatible with dementia, such as ‘memory loss’, were recorded in the CPRD database for 79% of the women. Agreement was significantly better (p < 0.05 for all comparisons) for women with HES diagnoses for Alzheimer’s disease (95 and 94% agreement with any dementia for CPRD and GP survey, respectively) and for vascular dementia (88 and 88%, respectively) than for women with a record only of dementia not otherwise specified (70 and 72%, respectively). Dementia in the same woman was first mentioned an average 1.6 (SD 2.6) years earlier in primary care (CPRD) than in hospital (HES) data. Age-specific rates for dementia based on the hospital admission data were lower than the rates based on the primary care data, but were similar if the delay in recording in HES was taken into account.ConclusionsDementia recorded in routinely collected NHS hospital admission data for women in England agrees well with primary care records of dementia assessed separately from two different sources, and is sufficiently reliable for epidemiological research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12982-016-0053-z) contains supplementary material, which is available to authorized users.

Before the advent of the National Health Service in 1948 most hospital doctors were in close contact with the primary care of, at least, a section of the community both by their continuing close contacts with general practitioners and as a result of often having spent some part of their careers as general practitioners. Since 1948 this awareness of the health aspirations of the community has weakened as a result of advances in the care of disease which have made the hospital doctor increasingly dependent on sophisticated facilities and, thus, focused his attention on hospital care rather than on the community. Hospital staff must re-establish their link with primary care and must perceive clearly the ways in which they contribute to the health of their community. They must be conscious of the proportion of available resources that are used in hospital and be prepared to regulate demands so that there is equality in the distribution of resources in the health field. Hospitals are not only expensive but have become extravagant; it is the responsibility of the hospital doctor to curb extravagance. If private practice is to continue, it must be integrated into the health service, not excluded from it. Finally, the patient must be recognized as a member of a family and of a community that is both curious and concerned about health. The hospital doctor must communicate with patience, understanding and clarity. In this relationship he also has a part to play in health education and prevention of disease. He must remove the mystery from his art and enter into useful discussions with government and community.

Perceptions and Competence in Evidence-Based Medicine: A Survey of the American Urological Association Membership

目前衛生著和中央健康保險局皆致力雄動本土化的雙向轉診，並期採用整合性健康照護模式以改變民眾就醫行為並節省醫療資源，因此現階段「家庭醫師整合性照護制度試辦計畫」中，民眾對雙向轉診的接受度，乃成為多方關注的焦點。本研究針對台灣中部某社區醫院三個社區醫療群之轉診民眾進行意見調查，回收有效問春98份，受訪者平均年齡53.0歲，轉診大多是向塞層診所醫師提出(86.7%)，民眾認為需要或非常需要轉診者有95.9%。轉診前「家庭醫師已和社區醫院連絡好」、「寫好轉診單」、和「為民眾預約掛號」的比例皆超過九成；轉診時「合作醫院有專人提供協助」者也有96.9%。此外，約三分之二受訪者認為透過雙向轉診，等候的時問比自行就醫短，看診醫師，診問護士和其他工作人員的服務品質也較好。另外有71.4%社區醫院醫師會向民眾肯定家庭醫師的轉介，但也有6.1%會批評塞層醫師處置不當。轉診前家庭醫師曾囑咐病人再回診所追蹤者有74.5%，轉診復社區醫院醫師請民眾回家庭醫師處者只有37.8%，而將民眾預約回醫院追蹤者有51.0%。受測者中有93.9%希望家庭醫師得知其轉診結果，希望回家庭醫師處看報告或拿藥的比例約有四分之三，病情穩定復順意回家庭醫師診所追蹤者有80.6%。「以復有其他健康問題會先諮詢家庭醫師」、「需至專科就診時會透過家庭醫師」、及「會將家庭醫師雄薦給親朋好友」的比例皆約九成以上。但有關轉診復下次應回塞層診所或在社區醫院就醫，44.9%的病患認為向家庭醫師決定，主張醫院醫師決定或自己決定者各有21.4%，認為不一定者有12.2%。47.0%的轉診民眾擔心診所「儀器設備不如大醫院」，而擔心轉診資料不充足或資料外洩者皆約10%以內。

Objective With increasing cancer incidence and survival rates, follow-up care becomes a major healthcare concern, placing increased demands on general practitioners (GPs). We explored GPs’ awareness of late effects (LEs) after cancer treatment. Their degree of involvement and attitudes towards follow-up care was studied separately for solid cancers and Hodgkin’s lymphoma (HL). Design and setting Mailed questionnaire study in Norwegian general practice. Subjects 185 responding GPs with responsibility for HL survivors, more than 10 years since diagnosis. Main outcome measures and results All GPs reported some awareness of LEs. Increasing awareness of LEs was associated with female sex, being a specialist, having experience from hospital-based cancer care and familiarity with official guidelines on LEs after treatment. The majority of GPs were involved in follow-up care, which increased with patients’ time since treatment and was associated with higher awareness of LEs. GPs with work experience in hospital-based cancer care were more likely to be engaged in HL follow-up. Most GPs were willing to provide follow-up care at some point after treatment. Older and more experienced GPs, and those satisfied with the collaboration with hospital specialists, were more likely to provide follow-up earlier. Conclusion GPs’ awareness of LEs and their willingness to provide follow-up care were related to familiarity with guidelines and experience. GPs more involved in follow-up care also had higher knowledge of LEs. Distribution of guidelines on LEs and follow-up care, and improving collaboration with hospital specialists, might increase GPs’ knowledge and willingness to become involved in follow-up care, especially early in their careers. GPs’ involvement and attitude towards follow-up of survivors of common solid cancers and HL, a rare malignant disease, were similar. KEY POINTS Norwegian general practitioners (GPs) are involved in survivorship care after cancer treatment. We investigated their awareness of late effects (LEs), their involvement and their attitude towards follow-up care of solid cancers and Hodgkin’s lymphoma. • GPs registered as specialists, aware of guidelines and with experience from hospital-based cancer care reported higher awareness of LEs. • GPs with higher awareness of LEs were more frequently involved in follow-up care. • GPs with longer experience in general practice were comfortable with follow-up care at an earlier stage after treatment. • Results were similar for follow-up care of survivors of solid cancers and Hodgkin’s lymphoma.

ABSTRACTBackgroundWe examined health professionals' views of a novel post‐discharge medication review model for high‐risk patients with 2 referral pathways – general practitioners (GPs) referring for home medicines reviews (HMRs) or hospital doctors referring for hospital‐initiated medication reviews (HIMRs).AimTo identify positive and negative aspects of the model, barriers and facilitators to implementation and to make recommendations for a post‐discharge home medication review program.Method23 semi‐structured interviews were conducted with key stakeholders – hospital doctors, GPs, accredited pharmacists, hospital pharmacists and community pharmacists. Data were analysed thematically based on a conceptual framework.ResultsThere was consensus that the availability of flexible pathways to post‐discharge home medication reviews was vital for patient care. Participants highlighted it was crucial that the patient's GP and community pharmacist are kept informed if the HIMR pathway was chosen. Barriers to implementation were time constraints experienced by health professionals to organise and conduct the review within 7 days post‐discharge and lack of awareness of the HMR process. Facilitators to implementation included existing positive working relationships and familiarity and support for the HMR process. Suggestions for future implementation included incorporating the liaison pharmacist role into the usual responsibilities of clinical pharmacists and educating medical interns about the model.ConclusionConsensus among medical and pharmacy stakeholders was that streamlined and flexible pathways to post‐discharge medication reviews would enhance quality use of medicines along the continuum of care.

Differences in attitudes, beliefs and knowledge of hospital health care workers and community doctors to vaccination of older people

To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues.

Propionic acidemia (PA) and methylmalonic acidemia (MMA) are organic acidurias that can present with metabolic acidosis and hyperammonemia, often leading to frequent hospital admission. While recent studies have provided guidelines for management and diagnosis of these conditions, there is a lack of research detailing the frequency and reasons for hospital admission in the first three years of life. As part of a quality improvement project, data were extracted from medical records of all patients with PA and MMA (born between 2000 and 2024) who were seen at Children's National Hospital (CNH) during their first three years of life, time of data pull, or up to point of liver transplant. We collected data on the number of individuals with PA or MMA in our patient population, the age at which they first presented, and the reason for their hospital admission. Our cohort included 11 individuals with MMA, all of whom had MMUT mutations, representing a total of 12 different variants. Additionally, 15 individuals with PA were reported. Of these, 2 individuals with PA did not undergo genetic testing, 5 had 7 separate variants in PCCA gene, and 8 had 10 different variants in PCCB gene. The mean number of hospitalizations for metabolic decompensation was 4.45±6.6 for the MMA cohort and 8.7±6.7 for the PA cohort, with no statistically significant difference between the groups. The MMA cohort experienced a total of 49 admissions, 16 (33%) of which occurred in the first year of life. In the PA cohort, there were 130 total admissions, with 56 (43%) occurring in the first year. The most frequent reason for admission in both groups was vomiting. Individuals with PA and MMA are frequently hospitalized (accounting for 5-6% of their first three years of life) which likely impacts development and overall health. Data such as those presented in this study are crucial for improving our understanding of disease progression in these rare conditions. This information can help guide future research, support the development of the clinical guidelines, and provide healthcare providers with valuable insights to better educate families on risks and expectations. Using these data, we have altered our counseling at the time of diagnosis to better prepare families for their child's course.