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Journal of Family Medicine and Primary... Apr 2024Dr. Prakash Chand (PC) Bhatla MBBS was one of the illustrious past presidents (1975-76) of Indian Medical Association (IMA). He was a General Practitioner by vocation...
Dr. Prakash Chand (PC) Bhatla MBBS was one of the illustrious past presidents (1975-76) of Indian Medical Association (IMA). He was a General Practitioner by vocation and a towering professional leader. He made an immense contribution to the discipline of Family Medicine - the academic discipline, medical specialty, and the knowledge domain of Family Physicians/Family Doctors within India as well as the global level. He was a brilliant human being and professional par excellence. He was probably one of the greatest leaders of the medical profession in India and a rightful successor to Dr BC Roy's legacy. As a rare achievement, he received the Dr BC Roy National Award from the President of India twice. He received this prestigious recognition award in 1977 for socio-medical relief in India and again in 1982 for the promotion of Specialty of General Practice. He founded IMA CGP (Indian Medical College of General Practitioners), and his foundational work led to the recognition of Family Medicine as a specialty in India. Due to his efforts, Family Medicine was included in the list of recognized specialties by the National Board of Examinations (NBE) as well by the Medical Council of India (MCI). His contribution to medicine at a global level is also remarkable. He is also considered one of the founding forefathers of WONCA - World Organization of Family Doctors. He was associated with the foundation process of WONCA from the beginning (1964). The International Liaison Committee organized the first World meeting of General Practice in Montreal (Canada) in 1964 and the second meeting in Salsburg in 1966. Dr Bhatla was the convenor of the Third World Conference on General Practice in New Delhi, India, in 1968. A global representative body of Family Medicine/General Practice was launched in 1972 in Melbourne, Australia. Due to contribution to WONCA, he was elected for the first ever WONCA fellowship, the most prestigious global Family Medicine award. He was contemporary to other world leaders of Family Medicine and Primary Care such as Ian McWhinney and Barbara Starfeild. He is rightfully recognized and remembered as Father of Family Medicine. Dr Bhatla's intellectual, professional, and administrative contribution laid down the sound background for the foundation of a Specialty body of Family Medicine in India called the Academy of Family Physicians of India. Life and work of Dr PC Bhatla continues to inspire family doctors, family physicians, general practitioners, and Family Medicine specialists across India, South Asia, and the World in the 21 century.
PubMed: 38827689
DOI: 10.4103/jfmpc.jfmpc_587_24 -
Physiotherapy Sep 2023Manual patient handling is the most frequently reported risk factor for work related musculoskeletal disorders in healthcare. Patient handling tasks are routinely... (Review)
Review
BACKGROUND
Manual patient handling is the most frequently reported risk factor for work related musculoskeletal disorders in healthcare. Patient handling tasks are routinely performed manually without assistive devices and can create awkward postures and high loads for nurses and allied health professionals (AHPs). However, AHPs, notably physiotherapists, also utilize therapeutic handling to facilitate patient movement during rehabilitation.
OBJECTIVES
To comprehensively map the literature surrounding manual patient handling (without assistive devices) by healthcare practitioners.
METHODS
AMED, CINAHL, MEDLINE, SPORTDiscus, and EMBASE databases were searched. Grey literature was sourced from Google Scholar, EThOS, Open Grey, Health and Safety Executive, National Institute for Occupational Safety and Health and Work Safe Australia. Literature published in English between 2002 and 2021 was included.
RESULTS
Forty-nine records were included: 36 primary research studies, 1 systematic review and 12 'other' including narrative and government reports. Primary research was predominantly observational cross-sectional (n = 21). The most common settings included laboratories (n = 13) and hospitals (n = 13). Seven research questions were identified, with patient handling practices (n = 13) the most common. Nurses formed the largest practitioner population (n = 13) and patients were often simulated (n = 12). Common outcomes included tasks performed (n = 13) and physical demands during patient handling (n = 13).
CONCLUSION AND IMPLICATIONS OF KEY FINDINGS
This comprehensive scoping review identified that most research was observational, investigating nurses in hospitals or laboratories. More research on manual patient handling by AHPs and investigation of the biomechanics involved in therapeutic handling is needed. Further qualitative research would allow for greater understanding of manual patient handling practices within healthcare. CONTRIBUTION OF THE PAPER.
Topics: United States; Humans; Moving and Lifting Patients; Cross-Sectional Studies; Lifting; Musculoskeletal Diseases; Delivery of Health Care
PubMed: 37393883
DOI: 10.1016/j.physio.2023.06.003 -
Heliyon Dec 2023Sustainable development (SD) is a concept that can be used to address complex challenges, including energy transitions. SD offers diverse strategies that provide useful...
Sustainable development (SD) is a concept that can be used to address complex challenges, including energy transitions. SD offers diverse strategies that provide useful direction in navigating tensions, trade-offs and synergies in energy transitions. The purpose of this research was to identify the challenges that energy practitioners are faced with in energy transitions and explore potential solutions. To achieve this purpose, we identified and explored the challenges faced by energy practitioners in Canada. Specifically, we conducted a survey of 34 energy practitioners from across Canada, as well as in-depth interviews with the Energy Futures Lab design team (which is a civil society initiative actively working on the energy transition in Canada). We identified the following challenges faced by energy practitioners in Canada: there is no simple, single solution for energy transitions; energy transitions have potentially conflicting considerations; energy systems have potentially conflicting goals; energy practitioners have different levels of trust and competencies in key actors; energy practitioners need to work across the political spectrum; and the costs and benefits of energy transitions are unevenly distributed. We discuss how the three strategies of SD (i.e., economic choice, political choice, social choice) could be applied to manage the intended and unintended tensions and trade-offs inherent in energy transitions. We conclude that the three SD strategies are not always equally valued by energy practitioners, but they have the potential to be useful in different energy transitions scenarios.
PubMed: 38076189
DOI: 10.1016/j.heliyon.2023.e22624 -
Frontiers in Psychology 2023In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer... (Review)
Review
In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer practitioners, co-working as equals alongside workers with professional backgrounds in Network Meetings. The conceptual underpinnings of the peer practitioner role have been drawn from the principles and relational approach of Intentional Peer Support. These have significant similarities with Open Dialogue, in terms of philosophical and theoretical orientations, with a particular focus on what happens in the "between" of a relational encounter. However, there are also significant differences in how practice principles are conceptualized, particularly around areas such as mutuality and self-disclosure. This article offers an analysis of this conceptual territory drawing on the relevant literature. This is then taken forward with the teasing out of specific practice principles that capture the unique contribution that peer practitioners can bring to Open Dialogue practice. These are derived through discussions that took place in an Action Learning Set for peer practitioners who have been involved in delivering Open Dialogue services in mainstream mental health service settings. This was part of a wider research study entitled The principles address how peer practitioners may be particularly well-placed to offer attunement, validation, connection and mutuality, and self-disclosure - and hence how they may be able to contribute an additional dimension to dialogical practice.
PubMed: 37663329
DOI: 10.3389/fpsyg.2023.1176839 -
Family Practice Dec 2023Older patients with multimorbidity are under-represented in experimental research.
BACKGROUND
Older patients with multimorbidity are under-represented in experimental research.
OBJECTIVE
To explore the barriers and facilitators to general practitioner (GP) and older patient recruitment and retention in a cluster randomized controlled trial (RCT).
METHOD
This descriptive study uses qualitative and quantitative data from a cluster RCT, designed to evaluate the effectiveness of a medicines optimization intervention. The SPPiRE cluster RCT enrolled 51 general practices and 404 patients aged ≥65 years and prescribed ≥15 medicines. Quantitative data were collected from all recruited practices and 32 additional practices who were enrolled, but unable to recruit sufficient participants. Qualitative data were collected from purposive samples of intervention GPs (18/26), patients (27/208), and researcher logs and analysed thematically using inductive coding.
RESULTS
Enrolment rates for practices and patients were 37% and 25%, respectively. Barriers to GP recruitment were lack of resources and to patient recruitment were difficulty understanding trial material and concern about medicines being taken away. GPs' primary motivation was perceived importance of the research question, whereas patients' primary motivation was trust in their GP. All general practices were retained. Thirty-five patients (8.6%) were lost to follow-up for primary outcomes, mainly because they had died and 45% did not return patient-reported outcome measures (PROMs).
CONCLUSION
Patient retention for the primary outcome was high, as it was collected directly from patient records. Patient completion of PROM data was poor, reflecting difficulty in understanding trial material. Recruiting older patients with multimorbidity to clinical trials is possible but requires significant resource and planning.
TRIAL REGISTRATION
ISRCTN Registry ISRCTN12752680.
Topics: Humans; General Practitioners; Multimorbidity; Randomized Controlled Trials as Topic; General Practice; Patient Selection
PubMed: 37014975
DOI: 10.1093/fampra/cmad039 -
Scandinavian Journal of Primary Health... Dec 2023
Topics: Humans; General Practitioners; Family Practice; Referral and Consultation; Patients
PubMed: 37640676
DOI: 10.1080/02813432.2023.2250398 -
Primary Health Care Research &... Sep 2023Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients... (Review)
Review
BACKGROUND
Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled.
METHODS
CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed.
RESULTS
In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down - exploring the chaos experienced by patients as they seek help; (2) negative cycle - highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle - validating patient-doctor relationships underpinned by clear communication can help break the negative cycle.
CONCLUSIONS
Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient-doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.
Topics: Humans; Fibromyalgia; Communication; Patients; Referral and Consultation; Primary Health Care
PubMed: 37750736
DOI: 10.1017/S1463423623000506 -
Australian Journal of General Practice Oct 2023Sleep disturbance is among the most prevalent presentations in Australian general practice. Insomnia, the most common sleep disorder, is associated with impaired...
BACKGROUND
Sleep disturbance is among the most prevalent presentations in Australian general practice. Insomnia, the most common sleep disorder, is associated with impaired daytime, social and occupational function, reduced quality of life and substantially increased risk of future depression. Guidelines from Australian and international general practice, sleep and medical societies strongly recommend cognitive behavioural therapy for insomnia (CBT-i) as the first-line treatment for chronic insomnia. This is because CBT-i targets the underlying causes of insomnia, results in sustained improvements and commonly improves comorbid conditions such as depression and pain.
OBJECTIVE
This article aims to provide an overview of evidence-based assessment, management and referral options for insomnia in Australian general practice.
DISCUSSION
Access to brief insomnia assessment and evidenced-based treatments are becoming increasingly available to Australian general practitioners. CBT-i can be delivered through self-guided online programs or by suitably trained general practitioners and psychologists.
Topics: Humans; Adult; Sleep Initiation and Maintenance Disorders; General Practitioners; Quality of Life; Australia; Sleep; Sleep Wake Disorders
PubMed: 37788691
DOI: 10.31128/AJGP-01-23-6678 -
Frontiers in Digital Health 2023A proposed Diagnostic AI System for Robot-Assisted Triage ("DAISY") is under development to support Emergency Department ("ED") triage following increasing reports of...
INTRODUCTION
A proposed Diagnostic AI System for Robot-Assisted Triage ("DAISY") is under development to support Emergency Department ("ED") triage following increasing reports of overcrowding and shortage of staff in ED care experienced within National Health Service, England ("NHS") but also globally. DAISY aims to reduce ED patient wait times and medical practitioner overload. The objective of this study was to explore NHS health practitioners' perspectives and attitudes towards the future use of AI-supported technologies in ED triage.
METHODS
Between July and August 2022 a qualitative-exploratory research study was conducted to collect and capture the perceptions and attitudes of nine NHS healthcare practitioners to better understand the challenges and benefits of a DAISY deployment. The study was based on a thematic analysis of semi-structured interviews. The study involved qualitative data analysis of the interviewees' responses. Audio-recordings were transcribed verbatim, and notes included into data documents. The transcripts were coded line-by-line, and data were organised into themes and sub-themes. Both inductive and deductive approaches to thematic analysis were used to analyse such data.
RESULTS
Based on a qualitative analysis of coded interviews with the practitioners, responses were categorised into broad main thematic-types, namely: trust; current practice; social, legal, ethical, and cultural concerns; and empathetic practice. Sub-themes were identified for each main theme. Further quantitative analyses explored the vocabulary and sentiments of the participants when talking generally about NHS ED practices compared to discussing DAISY. Limitations include a small sample size and the requirement that research participants imagine a prototype AI-supported system still under development. The expectation is that such a system would work alongside the practitioner. Findings can be generalisable to other healthcare AI-supported systems and to other domains.
DISCUSSION
This study highlights the benefits and challenges for an AI-supported triage healthcare solution. The study shows that most NHS ED practitioners interviewed were positive about such adoption. Benefits cited were a reduction in patient wait times in the ED, assistance in the streamlining of the triage process, support in calling for appropriate diagnostics and for further patient examination, and identification of those very unwell and requiring more immediate and urgent attention. Words used to describe the system were that DAISY is a "good idea", "help", helpful, "easier", "value", and "accurate". Our study demonstrates that trust in the system is a significant driver of use and a potential barrier to adoption. Participants emphasised social, legal, ethical, and cultural considerations and barriers to DAISY adoption and the importance of empathy and non-verbal cues in patient interactions. Findings demonstrate how DAISY might support and augment human medical performance in ED care, and provide an understanding of attitudinal barriers and considerations for the development and implementation of future triage AI-supported systems.
PubMed: 38125759
DOI: 10.3389/fdgth.2023.1297073