[ad_1]
The respiratory symptoms of children can last up to three weeks
Symptoms of respiratory tract infections in children, including runny nose, dry cough and sore throat, may seem endless. According to new research, 90% of children take 23 days to recover from the symptoms of respiratory tract infection. The researchers used a new online study plan to track 485 children from 331 families in Bristol, England, suffering from respiratory tract infections (n = 197 respiratory tract infections) without requiring their doctor to family. Overall, the median duration of symptoms was 9 days. For children three years old or younger, the median duration of symptoms was 11 days, compared with seven days for older children. Children whose parents reported lower respiratory symptoms (such as fat cough and wheezing) had a median symptom duration of 12 days, compared with 8 days for those with only upper respiratory symptoms (such as runny nose and sore throats). Among children with only upper respiratory symptoms, the most persistent symptom was nasal discharge, while the fastest symptom to resolve was earache. For children with at least one symptom of the lower respiratory tract, all symptoms persisted for three weeks; runny nose and oily cough were the most serious symptoms. One in 12 parents asked for help from their family doctor. The authors suggest that these findings could inform primary care practice, public health interventions and, ultimately, parents regarding the worrisome symptoms for which they should consult their primary care physician.
Respiratory Tract Infections in Children in the Community: Prospective Online Initial Cohort Study
Professor Alastair D. Hay et al.
Bristol University, Bristol, United Kingdom
The repeated inactivated vaccine against the flu does not have any negative effects
Inactivated inactivated influenza vaccine vaccination in children with pre-existing diseases has no negative impact on the long-term protection against respiratory diseases and may even strengthen it. A study in the Netherlands examined data from 4,183 children aged 6 months to 18 years with pre-existing conditions who had received the inactivated influenza vaccine at least once from 2004 to 2015. Adjusted estimates showed a higher probability. low respiratory illness in children vaccinated with the previously inactivated influenza vaccine compared to children immunized for the first time. These results suggest that there is residual protection against previously inactivated influenza vaccines. This is particularly relevant for children with pre-existing medical conditions who repeatedly receive inactivated influenza vaccines during childhood.
Impact of repeated influenza vaccination on respiratory diseases in children with pre-existing medical conditions
Marieke L. A. de Hoog, PhD, et al
University Medical Center Utrecht, Utrecht, The Netherlands
Exhaustion predicts a turnover among clinicians, not staff
Burnout is alarming for clinicians and primary care staff, but is it related to staff turnover? New research shows that burnout contributes to turnover among primary care clinicians, but not among staff. A study of 740 clinicians and primary care staff from two health systems compared the 2013-2014 survey data on burnout and employee engagement (the probability of recommend their clinic as workplace) to the 2016 worklist data. Fifty-three percent of clinicians and staff reported burnout, whereas only one-third (32% of clinicians and 35% of staff) reported feeling very involved in their work. In 2016, 30% of clinicians and 41% of staff were no longer working in primary care in the same health care system. Clinicians who reported burnout in 2013/14 were more likely to leave the health system by 2016, taking into account the clinical time and the length of time they worked in the system. . In the regression models, neither burnout nor employee engagement predicted staff turnover. The authors suggest that high turnover rates have important implications for patient care. Continuity of care, which is a fundamental principle of primary care, is difficult to maintain in environments where turnover of staff and clinicians is frequent. In addition, turnover is costly for health care organizations. While reducing burnout can help reduce turnover rates among clinicians, the authors urge health care organizations and policymakers concerned about primary care turnover to understand its multifactorial causes. and develop effective retention strategies for clinicians and staff.
Burnout and rotation of health care staff
Rachel Willard-Grace, MPH, et al
University of California, San Francisco, San Francisco, California
Physicians more satisfied when they can meet the social needs of patients
When primary care practices attempt to help patients meet social and economic needs, their efforts may present an unexpected benefit. According to a new study, primary care physicians who practice in a prepared environment to manage patients with social needs get much higher job satisfaction than other physicians. Of the 890 US physicians who responded to the 2015 Commonwealth Fund Health Policy International Survey, those who reported working in a firm that was able to manage the social needs of patients had significantly higher job satisfaction, were more satisfied with time spent with patients, and felt that the quality of medical care provided to patients had improved. Feeling that it was easy to coordinate patient care with social services or other community resources was also significantly badociated with greater job satisfaction, personal income satisfaction and relative, satisfaction with time spent with patients and perspectives on the quality of medical care of patients. . The authors call on health systems to include the satisfaction of clinicians, closely related to burnout and retention problems, in their calculations of the costs and benefits of addressing the social needs of patients.
Ability to practice to meet the social needs of patients, to the satisfaction of physicians and the perceived quality of care
Matthew S. Pantell, MD, MS et al.
University of California, San Francisco, San Francisco, California
Psychological therapies and progressive help for progressive reduction of antidepressants
When antidepressants are discontinued, the risk of relapse or recurrence is greatly reduced by combining cognitive-behavioral therapy with a gradual decrease in medication. An badysis of existing research found that at 2 years, the risk of relapse or recurrence was lower with more attenuated cognitive-behavioral therapy (15-25%) compared with the more attenuated clinical management (35- 80%). Relapse / recurrence rates were similar for cognitive awareness-based therapy with tapered antidepressants and maintenance. In two studies encouraging frontline clinicians to quit smoking with antidepressants, six and seven percent of patients discontinued treatment, compared to eight percent for usual care. Six studies on psychological or psychiatric treatments, as well as progressive reductions in smoking cessation rates between 40 and 95% Two studies showed a higher risk of symptoms of discontinuation of treatment and abrupt cessation of treatment. The authors note that cognitive-behavioral therapy appears to improve treatment discontinuation rates compared to the primary care clinician's management of the progressive reduction in management time; However, the access of patients to such therapy may be limited. They call for an exploration of psychologically-informed digital support to stop anti-depressants to supplement the care provided by primary care clinicians.
Managing the discontinuation of antidepressants: a systematic review
Professor Tony Kendrick, et al
University of Southampton, Southampton, United Kingdom
Computerized Adaptive Testing Can Screen for Depression and Anxiety in Primary Care
The computer adaptive test is a valuable tool for detecting major depressive disorder in primary care and offers a format well received by patients. New research has compared computerized computerized tests, which personalize badessments by asking questions that vary based on previous responses, with widely used paper-based screening tools (Patient Health Questionnaire-9, Patient Health Questionnaire-2, and Trouble # 1). 39; generalized anxiety-7), and semi-structured interview, which is generally considered the benchmark in psychiatric evaluation. The accuracy of the computer-based adaptive diagnostic test for major depressive disorder was similar to that of PHQ-9 and greater than that of PHQ-2. Compared to the interview, the accuracy of the computerized adaptive anxiety test inventory was similar to that of generalized anxiety disorder 7 to badess the severity of the disorder. anxiety. Participants preferred to use tablets (53%), compared to interviews (33%) and paper and pencil questionnaires (14%). The majority of participants (64%) indicated that the paper-and-pencil questionnaire was their least preferred screening method. The authors suggest that the widespread use of electronic health records in primary care offers new opportunities to use electronic tools for screening, while the theory of multidimensional response to items, used in tests adaptive computerized, can increase the effectiveness of evaluation of mental and physical health.
Validation of computer adaptive test for mental health in primary care
Neda Laiteerapong, MD, et al
University of Chicago, Chicago, Illinois
New family doctors feel better prepared but report narrower scope of practice
Recent graduates in family medicine residency feel better prepared than their predecessors to provide a variety of clinical procedures and services, but they have a narrower scope of activity. These findings are the result of a University of Washington survey of family medicine graduates in affiliated programs in five states, with a focus on two cohorts: those who had their residency between 2010 and 2013 (n = 408) and a previous cohort graduating between 1996 and 1999 (n = 293). The survey looked at 26 services and procedures that graduates could provide in their practice and the degree of preparation of these to provide these services. The researchers found that the proportion of graduates practicing almost all of the procedures and services listed in the previous cohort was comparable or significantly higher than in the previous cohort; only OB ultrasound and end-of-life care were more common among recent graduates. The trend of the results was reversed when one compared the graduates who felt more than adequately prepared for the practice; a larger proportion of those in the last cohort reported feeling prepared in most regions compared to former graduates. For example, 52% of the first cohort reported providing care in retirement homes, compared to 33% of the last cohort, but 59% of the last cohort felt more than adequately prepared to provide such care, compared to 27% former graduates. According to the authors, these results suggest that training has improved over the past decade, but that its field of activity is decreasing for reasons other than training. The changes are likely due to a variety of factors, including changes in clinical practice and differences in size and type of practice, including a trend towards larger, multispecialized groups in which family physicians are not forced (or allowed) to practice a wide range of functions. procedures. The authors argue that the declining scope of practice has a negative impact on the extent and richness of physician practice, as well as access and quality of patient care. According to the authors, family medicine educators may need to adapt their training to a new generation of practice realities and physician preferences.
Changes in the preparation and practice habits of new family physicians
Amanda K. H. Weidner, MPH, et al
Washington University, Seattle, Washington
Ultrasound is an increasingly important tool in family medicine / general practice
Family physicians and general practitioners perform ultrasounds under various conditions and with satisfactory accuracy. Based on an badysis of existing research, this is the first comprehensive systematic review of the use of ultrasound by family physicians and general practitioners. Ultrasound has been used for a variety of different conditions, most often focused on abdominal and obstetric ultrasound. The extent of the training programs ranged from 2 to 3.5 hours. Competence in certain types of focused ultrasound could be achieved with only a few hours of training. Focused point-of-care ultrasounds have been reported to have superior diagnostic accuracy and do less harm than more comprehensive ultrasound or screening tests. In studies evaluating quality, participants generally scanned with a satisfactory level of accuracy, the quality depending on the extent of the examination and the anatomical area to be digitized. Some targeted badyzes had higher levels of diagnostic accuracy, required less training and were badociated with less damage, while more in-depth reviews were badociated with lower quality tests and potential risks. The authors predict that point-of-care ultrasonography will be increasingly important for family physicians and general practitioners with respect to diagnosis, treatment choice, and referral. They note that the results of these studies can help inform curricula and future research on the use of point-of-care ultrasound in family medicine / general practice.
Ultrasound in a GP office at the point of service: systematic review
Camilla Aakjær Andersen, MD, et al
University of Aalborg, Aalborg East, Denmark
Could the integration of social and medical care aggravate health and increase health inequalities?
At a time when health care is increasingly focused on the relationship between the social and medical needs of patients, a new provocative essay proposes that this goal may have unintended consequences. In fact, the authors say, some of these efforts are likely to exacerbate health and exacerbate health inequities. Examples include attempts by the Centers for Medicare and Medicaid Services (CMS) to encourage states to explore working conditions as a condition of eligibility for Medicaid, building on the benefits work for health and the promotion of work. According to the authors, such efforts could reduce access to health care by discouraging Medicaid enrollment. Other examples include the increasing use of social data for commercial health care purposes, which could increase bias and exclusion related to insurance coverage; and new research on how social deprivation affects biological susceptibility to mental and physical illnesses, which could shift issues such as poverty from the social to the medical field. To solve these problems, the authors ask: "A new dialogue … on the opportunities and potential consequences of integrating information on the social situation of patients into a market-based health system" .
Integration of social and medical care: Could it worsen health and increase inequalities?
Laura M. Gottlieb, MD, MPH, et al
University of California, San Francisco, San Francisco, California
Integrate community organization into clinical practice
A family doctor reflects on his journey from community organizer to clinician in primary care. As a clinician, she remains inspired by community organizing – a model for driving social change and improving public health – but has struggled to integrate it into clinical practice. It proposes a model of how clinicians and practices can proactively engage with community-based organization groups and facilitate referrals to help patients engage directly in the transformation of community-based organizations. root causes of their health problems. This model distracts the patient's attention as an individual agent of change for the benefit of the community and offers important lessons to clinicians interested in health equity in the community.
When the "patient-centered" is not enough: a call to community-centered medicine
Juliana E. Morris, MD, EdM
University of California, San Francisco, San Francisco, California
The Past, Present, and Future of Primary Care Research
Two articles in this issue of Annals of Family Medicine explore the history of research in family medicine and primary care, while a third is considering its future.
Low- and middle-income countries set priorities for primary care research
In low- and middle-income countries, primary care research priorities include integration of care at the public / private interface, secondary care, community services, as well as models of care and treatment. funding to promote equitable access to care. These priorities were developed by a modified Delphi expert panel composed of three individuals and comprised of primary care practitioners and academics from low- and middle-income countries, sampled from global networks, at the university level. 39, help with online surveys. They generated an initial list of more than 1,000 research ideas, which the researchers synthesized into 36 organizational questions and 31 financial questions. The last four priority questions on the organization deal with primary / secondary care transitions, horizontal integration within a multidisciplinary team, integration of the public and private sectors, and the ways to support successful primary health care teams. The related financial issues deal with payment systems to increase access and availability of primary care, mechanisms to incentivize governments to invest in primary care, the ideal proportion of a budget devoted to health care. health and factors to improve the distribution of the workforce. Panellists developed country-specific research implementation plans for priority issues that will be presented to potential funders for research.
Primary Care Research Priorities in Low- and Middle-Income Countries
Professor Felicity Goodyear-Smith, et al
University of Auckland, Auckland, New Zealand
Primary care research publications have increased but remain a small proportion of the total
Since 1974, the number of primary care research publications has increased but still represents only a small proportion of the MEDLINE database publications. According to a bibliometric badysis of the results of research conducted in 21 countries between 1974 and 2017, the United States and the United Kingdom recorded the highest volume of primary care research publications, followed by Canada and the United States. 39; Australia. Publications from Southern, Eastern and Western countries have grown significantly. During the same period, the United Kingdom and Australia reported the largest share of primary care publications among all MEDLINE publications. However, compared to the total number of MEDLINE publications in 2017, primary care publications still accounted for only a small proportion of the total. The authors suggest that examining factors badociated with increased research results could help define priorities for primary care research.
Development of primary care research in North America, Europe and Australia from 1974 to 2017
Gladys Ibanez, MD, PhD, et al
INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
Early attitudes towards family medicine research reflected the countercultural roots of the specialty
Although family medicine research has experienced tremendous growth over the last five decades, research was not a priority when the specialty was created in 1969. A review of archival and secondary sources suggests that priority granted to research in the early years of family medicine was due to internal problems. and external factors, including the desire of family physicians to distinguish themselves from the dominant specialty environment; lack of clear identity for the new specialty; the non-laboratory nature of family medicine research; the use of information from other specialties; and a focus on establishing an academic presence. A strong culture of general knowledge is essential to ensure the future of family medicine and strengthen its ability to improve the health of individuals, families and communities, suggests the author.
Unfinished Business: The Role of Family Medicine Research
Robin S. Gotler, MA
Case Western Reserve University, Cleveland, Ohio
Innovations in primary care
Primary care innovations are brief one-page articles describing the innovations of the front lines of health care. In this problem:
- Developing the Use of Botulinum Toxin in Primary Care for Chronic Migraine – The Primary Care and Neurology Departments have partnered to train and accredit primary care clinicians to provide patients with botulinum toxin injections for the treatment of chronic migraine headaches.
- Research Partners and Practice Clinicians – A postdoctoral fellowship in family medicine places researchers alongside clinicians in a clinical setting, providing on-site research expertise to clinicians interested in turning clinical questions into research and research projects. 39, quality improvement.
###
Annals of Family Medicine is an indexed and peer-reviewed research journal that provides an interdisciplinary forum for new factual information affecting primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medicine organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Family Medicine Departments, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the College of Family Physicians of Canada. Annals is published six times a year and contains original research in the areas of clinical, biomedical, social and health services, as well as contributions on methodology and theory, selected journals, essays and editorials. The full editorial content and interactive discussion groups of each published article are freely available on the journal's website, http: // www.
Media contact:
Janelle Davis
Annals of Family Medicine
(800) 274-2237, ext. 6253
[email protected]
Follow us: Twitter: @annfammed
Facebook: Annals of family medicine
[ad_2]
Source link
