The ability to detect mental disorders varies greatly among general practitioners in primary health care. The aim of this study was to determine the factors underlying the differences between general practitioners in the ability to recognize mental disorders in Finnish patient populations. The group studied consisted of 1000 randomly selected adult patients of primary care facilities in the city of Turku. The Symptom Checklist (SCL-25) was used as the reference method in the identification of psychiatric cases. According to the SCL-25, one fourth of the sample had mental disorders. A good recognition ability was associated with postgraduate psychiatric training and qualification as a specialist in general practice. Surprisingly, Balint group training, which is a method intended to improve the ability of general practitioners to manage their patients' mental health problems, was associated rather with poor than good detection ability.
BACKGROUND: Educational outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health professional behaviour, especially prescribing. Results from previous studies have shown a varying effect. OBJECTIVE: The purpose of the study is to examine the effect of academic detailing as a method of implementing a clinical guideline in general practice. METHODS: A cluster randomized, controlled, blinded study was carried out of the effect of an academic detail visit compared with postal distribution of a guideline for prescribing asthma medication. Half the practices in a Danish county with 100 practices were visited once. The outcome measure was routinely collected data from all Danish pharmacies on the sales of asthma medication. Data were collected monthly for 2 years before to 1 year after the intervention. RESULTS: There was no effect on the pattern of prescription of asthma medicines following the visit, neither immediately nor long term. CONCLUSION: We found no effect of academic detailing as a single intervention.
The authors conducted a nine-item mail questionnaire of the 16 Canadian family medicine teaching programme directors to determine the accessibility and operation of palliative care education for their respective family medicine residents. All 16 faculties of medicine responded (100%). The survey revealed that while all universities offer elective time in palliative care only five out of 16 (31%) have a mandatory rotation. The median durations of the mandatory and elective rotations are limited to two and three-and-a-half weeks, respectively. The majority of the universities offer formal lectures in palliative care (12/16, 75%) and educational reading material (13/16, 81%), with the main format in 14/16 (87%) of the sites being case-based learning. The two most common sites for teaching to occur for the residents are the community/outpatient environment and an acute palliative care unit. Fifty-six per cent (9/16) of the universities have designated faculty positions for palliative medicine with a median number of two positions per site. Only one centre offers a specific palliative medicine examination during the rotation. Feedback from the residents regarding their respective palliative medicine programmes were positive overall. Findings from our survey indicate an ongoing need for improved education in palliative medicine at the postgraduate level.
To determine the diagnostic accuracy of physical examination by office based (general practice) paediatricians in the evaluation of heart murmurs.
Each of 30 office based paediatricians blindly examined a random sample of children with murmurs (43% of which were pathological). Sensitivity and specificity were calculated and were related to paediatricians' characteristics.
Mean (SD) sensitivity was 82 (24)% with a mean specificity of 72 (24)% in differentiating pathological from innocent murmurs, with further investigations requested for 54% of assessments. The addition of a referral strategy would have increased mean sensitivity to 87 (20)% and specificity to 98 (8)%. Diagnostic accuracy was not significantly related to the paediatricians' age, education or practice characteristics, but was related to referral practices and confidence in assessment.
Diagnostic accuracy of clinical assessment of heart murmurs by office based paediatricians is suboptimal, and educational strategies are needed to improve accuracy and reduce unnecessary referrals and misdiagnosis.
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Cites: Int J Cardiol. 1988 Apr;19(1):107-133372064
In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.