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Interactions of Valeriana officinalis L. and Passiflora incarnata L. in a patient treated with lorazepam
by José Ramón Vallejo Villalobos
Phytother Res. 2009 Dec;23(12):1795-6.
María Consuelo Carrasco Ramos, Vallejo Villalobos José Ramón, Manuel Pardo-de-Santayana, Diego Peral Pacheco, Miguel Ángel Martín Alvarado, Jacinto Altimiras i Roset.
There is an increasing interest in the health risks related to the use of herbal remedies. Although most consumers... more There is an increasing interest in the health risks related to the use of herbal remedies. Although most consumers think that phytomedicines are safe and without side effects, interactions between complementary alternative and conventional medicines are being described. The aim of this clinical case report is to highlight the importance of the safe use of herbal remedies by providing a clinical interaction study between pharmaceutical medicines and herbal medicinal products. The case of a patient self-medicated with Valeriana officinalis L. and Passiflora incarnata L. while he was on lorazepam treatment is described. Handshaking, dizziness, throbbing and muscular fatigue were reported within the 32 h before clinical diagnosis. The analysis of family medical history ruled out essential tremor, Parkinson's disease, Wilson's disease and other symptom-related pathologies. His medical history revealed a generalized anxiety disorder and medicinal plant consumption but no neurological disorder. Appropriate physical examination was carried out. An additive or synergistic effect is suspected to have produced these symptoms. The active principles of Valerian and passionflower might increase the inhibitory activity of benzodiazepines binding to the GABA receptors, causing severe secondary effects. Due to the increase in herbal product self-medication, the use of herbal remedies should be registered while taking the personal clinical history. Multidisciplinary teams should be created to raise studies on medicinal plants with impact on medical praxis.
Alternative medicine and AIDS: Towards a more effective communication concerning medicinal plants
by José Ramón Vallejo Villalobos
Medicinas alternativas y SIDA: hacia una comunicación más eficaz en torno a las plantas medicinales
José Ramón Vallejo, Diego Peral
Grupo de Investigación en Humanidades Médicas, Facultad de Medicina, Universidad de Extremadura, Badajoz, España.
Medicina clinica (impact factor: 1.23). 09/2011; DOI: 10.1016/j.medcli.2011.07.004
La nomenclatura popular de las plantas medicinales como objeto de Atención Primaria
by José Ramón Vallejo Villalobos
Autores: José Ramón Vallejo Villalobos, Diego Peral Pacheco y María Consuelo Carrasco Ramos.
Revista: Salud Rural. Vol. XXV; nº 7 (2008). Edita: JARPYO EDITORES, S.A. Madrid. ISSN: 0212-646.
Número de páginas: 9 (pp. 69-72).
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A conceptual model for capacity building in Australian primary health care research.
by Liz Farmer
Farmer EA, Weston KM:Australian Family Physician 2002, 31:1139-1142.
BACKGROUND Many general practitioners and primary health care practitioners lack research and evaluation skills. In... more
BACKGROUND Many general practitioners and primary health care practitioners lack research and evaluation skills. In response, the Australian Government has funded important capacity building initiatives.
AIM To propose a conceptual model to assist these initiatives.
MODEL Four groups of research involvement are suggested: nonparticipants; participating (as part of a research team); managing/training (either leading research, or in formal training to do so); and academic (with, or leading toward, a doctorate). We outline six guiding principles for research capacity building: 1) a whole system approach, 2) accommodating diversity, 3) reducing barriers to participation, 4) enabling collaboration, 5) mentoring, and 6) networking.
CONCLUSION This model forms a framework to help plan and evaluate research capacity building initiatives.
General practice research training: impact of the Australian Registrar Research Workshop on research skills, confidence, interest and involvement of participants, 2002–2006
by Liz Farmer
Karin Ried, Brett D Montgomery, Nigel P Stocks and Elizabeth A Farmer Family Practice 2008 25(2):119-126; doi:10.1093/fampra/cmn010
Background. An intensive 3-day training programme, the ‘Registrar Research Workshop’ (RRW), has aimed to build... more
Background. An intensive 3-day training programme, the ‘Registrar Research Workshop’ (RRW), has aimed to build research capacity among Australian general practice registrars since 1994.
Objectives. To investigate the impact of the RRW on participants' skills, confidence, interest in research and research activity.
Methods. Cross-sectional postal survey in 2006 of five groups of registrars who participated in the annual workshop in 2002–2006 (response rate: 64%; 77 of 121). Outcome measures included research experience and skills prior to and after the workshop; impact of the workshop on capacity, confidence, attitude and interest in research; and research involvement as measured by publications and grant funding.
Results. Self-reported research skills increased over time for the whole group (two-way analysis of variance: P = 0.047), most significantly for registrars with little or no research experience (P < 0.001) and research project participants (P = 0.003). The impact of the workshop on capacity, confidence and interest in research was rated highly (mean 3.5–4.0 ± 0.1 on a five-point scale). Two-thirds of the survey respondents had been research active, 34% presented their findings at conferences, 25% published in peer-reviewed journals and 31% received research funding. Eighty-four per cent of respondents indicated a high interest in undertaking research in the future. All survey respondents recommended the workshop to other registrars.
Conclusions. The RRW provides a useful model for effective research training for interested general practice trainees. Such training has the potential to increase knowledge of research methods, which might augment future research activity in general practice.
Building research capacity. An exploratory model of GPs' training needs and barriers to research involvement.
by Liz Farmer
Jones A, Burgess TA, Farmer EA, Fuller J, Stocks NP, Taylor JE, Waters RL. Aust Fam Physician. 2003 Nov;32(11):957-60.
AIMS: To determine general practitioners' research training needs, and the barriers to involvement in research.... more AIMS: To determine general practitioners' research training needs, and the barriers to involvement in research. METHOD: Semi-structured interviews with 11 GPs in rural and metropolitan South Australia, analysed using a grounded theory approach. RESULTS: General practitioners' perceptions about their research needs were limited by their own experience and focussed at an individual level. Overlapping needs and barriers emerged, categorised as: 'individual issues' (a lack of research training or experience, concepts and attitudes to research, and research interest) and 'systems issues' (funding arrangements for general practice, access to resources, opportunity for publication and the role of The Royal Australian College of General Practitioners [RACGP]). DISCUSSION: Our data provide an exploratory model that may assist in developing suitable strategies for research capacity building programs. General practitioners perceived both individual and systems solutions to building research capacity, including multifaceted interventions.
Bursaries, writing grants and fellowships: a strategy to develop research capacity in primary health care.
by Liz Farmer
Ried K, Farmer EA, Weston KM. BMC Fam Pract. 2007 Apr 5;8:19
BACKGROUND: General practitioners and other primary health care professionals are often the first point of contact for... more BACKGROUND: General practitioners and other primary health care professionals are often the first point of contact for patients requiring health care. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary health care professionals are trained in research or have research experience. With the aim of enhancing research skills and developing a research culture in primary health care, University Departments of General Practice and Rural Health have been supported since 2000 by the Australian Government funded 'Primary Health Care Research Evaluation and Development (PHCRED) Strategy'. A small grant funding scheme to support primary health care practitioners was implemented through the PHCRED program at Flinders University in South Australia between 2002 and 2005. The scheme incorporated academic mentors and three types of funding support: bursaries, writing grants and research fellowships. This article describes outcomes of the funding scheme and contributes to the debate surrounding the effectiveness of funding schemes as a means of building research capacity. METHODS: Funding recipients who had completed their research were invited to participate in a semi-structured 40-minute telephone interview. Feedback was sought on acquisition of research skills, publication outcomes, development of research capacity, confidence and interest in research, and perception of research. Data were also collected on demographics, research topics, and time needed to complete planned activities. RESULTS: The funding scheme supported 24 bursaries, 11 writing grants, and three research fellows. Nearly half (47%) of all grant recipients were allied health professionals, followed by general practitioners (21%). The majority (70%) were novice and early career researchers. Eighty-nine percent of the grant recipients were interviewed. Capacity, confidence, and level of research skills in ten core areas were generally considered to have improved as a result of the award. More than half (53%) had presented their research and 32% had published or submitted an article in a peer-reviewed journal. CONCLUSION: A small grant and mentoring scheme through a University Department can effectively enhance research skills, confidence, output, and interest in research of primary health care practitioners.
Setting directions for capacity building in primary health care: a survey of a research network
by Liz Farmer
Ried K, Farmer EA, Weston KM BMC Fam Pract. 2006 Feb 9;7:8.
Background
The South Australian Research Network 'SARNet' aims to build research capacity in primary... more
Background
The South Australian Research Network 'SARNet' aims to build research capacity in primary health care, as part of a national government-funded strategy to integrate research into clinical practice. Internationally, research networks have been a fundamental part of research culture change, and a variety of network models exist. The 'SARNet' model uses a whole system, multidisciplinary approach to capacity building and supports individuals and groups. We undertook a descriptive baseline survey in order to understand the background and needs of SARNet members and to tailor network activities towards those needs.
Methods
A questionnaire survey, assessing members' professional background, research experience, and interest in research development and training, was sent to all members who joined the network in its first year. The visual 'research spider' tool was used to ascertain members' experience in ten core research skills, as well as their interest in developing these skills. Individuals were asked to classify themselves into one of four categories of researchers, based on previous research experience. These self-assessment categories ranged from non-participant to academic.
Results
Network membership was diverse. Of the 89 survey participants, 55% were general practitioners or allied health professionals. Overall, most survey respondents indicated little to moderate experience in 7 out of the 10 skills depicted in the 'research spider'. In comparison, respondents were generally highly interested in developing their research skills in all areas. Respondents' research skills correlated significantly with their self-assessed category of research participation (Spearman rank correlation, r = 0.82, p < 0.0005). Correlations between research category and publication record (Gamma association, γ = 0.53, p < 0.0005) or funding record (Gamma association, γ = 0.62, p < 0.0005) supported the internal validity of the survey instrument.
Conclusion
Literature describing evaluation of the impact of networks is scarce. Our survey questionnaire could provide a useful instrument for evaluation of both networks and capacity building initiatives. The survey including the 'research spider' tool provided valuable information about members' needs and interest in strategies to develop their research skills. Initial needs analyses as well as on-going evaluation of network activities are important to include into the business plans of research networks, in order to ensure the network's effectiveness and support of its membership.
Performance management in primary healthcare services: evidence from a field study
Co-authored with Aldónio Ferreira published in Qualitative Research in Accounting and Management
Purpose – There is a growing interest in research focusing on performance management practices in the public sector,... more
Purpose – There is a growing interest in research focusing on performance management practices in the public sector, but research is still limited with regards to public primary healthcare services (PHSs), which play an important role in national healthcare systems. These organisations are frequently criticised for alleged poor performance management practices and misuse of resources, though such claims are not always substantiated. The purpose of this study is to examine performance management practices in public PHSs.
Design/methodology/approach – Three case studies of PHSs organisations were conducted resulting in interview material and archival data. Otley's performance management framework was used to examine the data.
Findings – It is found that the performance management systems of the studied PHSs were disjoint and lacked consistency and coherence. Lack of direction and motivational were key issues in PHSs. Furthermore, the observations indicate that vertical controls between PHSs and parent organisation were weak and accountability poor.
Research limitations/implications – Generalisability of findings and social desirability bias are the important limitations. A key research implication is that the conceptual framework adopted can be meaningfully used to generate insights into performance management issues in public sector healthcare organisations.
Practical implications – The study highlights the implications of the poor design and use of performance management systems and highlights areas for improvement in the organisations studied, and potentially across the sector.
Originality/value – This study is the first to draw upon Otley's performance management framework to examine performance management practices in PHSs and to demonstrate its usefulness in this context.
Accessing primary health care: a meta-ethnography of the experiences of British South Asian patients with diabetes, coronary heart disease or a mental health problem
by Rebecca Hays
Published in Chronic Illness, 2012.
Co-authored with Charlotte Garrett, Linda Gask, Andrea Cherrington, Christine Bundy, Chris Dickens, Waquas Waheed and Peter Coventry.
Multimorbidity in primary care: a systematic review of prospective cohort studies
by Frances Mair
Authors: France, Emma F1; Wyke, Sally2; Gunn, Jane M3; Mair, Frances S4; McLean, Gary4; Mercer, Stewart W4
Source: British Journal of General Practice, Volume 62, Number 597, April 2012 , pp. e297-e307(11)
Publisher: Royal College of General Practitioners
Abstract:
Background
Primary care increasingly deals with patients with multimorbidity, but relevant... more
Abstract:
Background
Primary care increasingly deals with patients with multimorbidity, but relevant evidence-based interventions are scarce. Knowledge about multimorbidity over time is required to inform the development of effective interventions.
Aim
This review identifies prospective cohort studies of multimorbidity in primary care to determine: their nature, scope and key findings; the methodologies used; and gaps in knowledge.
Design
Systematic review.
Method
Studies were identified by searching electronic databases, reviewing citations, and writing to authors. Searches were limited to adult populations with no restrictions on publication date or language. In total, 996 articles were identified and screened.
Results
Of the 996 articles, six detailing five completed prospective cohort studies were selected as appropriate. Three of the studies were undertaken in the US and two in The Netherlands; none was nationally representative. The main focus of the studies was: healthcare utilisation and/or costs (n = 3); patients' physical functioning (n = 1); and risk factors for developing multimorbidity (n = 1). The conditions that were included varied widely. The findings of these studies showed that multimorbidity increased healthcare costs (n = 2), inpatient admission (n = 1), death rates (n = 1), and service use (n = 3), and reduced physical functioning (n = 1). One study identified psychosocial risk factors for multimorbidity. No study used random sampling, sample sizes were relatively small (414-3745 patients at baseline), and study duration was relatively short (1-4 years). No study focused on prevalence, treatment use, patient safety, service models, cultural or socioeconomic factors, and patient experience, and no study collected qualitative data.
Conclusion
Few longitudinal studies based in primary care have investigated multimorbidity. Further large, long-term prospective studies are required to inform healthcare commissioning, planning, and delivery.
Practice size and quality attainment under the new GMS contract: a cross-sectional analysis
Authored by Yingying Wang, Catherine O'Donnell, Danny Mackay and Graham Watt and published in British Journal of General Practice
Background The Quality and Outcomes Framework (QOF) of the new General Medical Services contract, for the first time,... more Background The Quality and Outcomes Framework (QOF) of the new General Medical Services contract, for the first time, incentivises certain areas of general practice workload over others. The ability of practices to deliver high quality care may be related to the size of the practice itself. Aim: To explore the relationship between practice size and points attained in the QOF. Design of study: Cross-sectional analyses of routinely available data. Setting: Urban general practice in mainland Scotland. Method: QOF points and disease prevalence were obtained for all urban general practices in Scotland (n = 638) and linked to data on the practice, GP and patient population. The relationship between QOF point attainment, disease prevalence and practice size was examined using univariate statistical analyses. Results: Smaller practices were more likely to be located in areas of socioeconomic deprivation; had patients with poorer health; and were less likely to participate in voluntary practice-based quality schemes. Overall, smaller practices received fewer QOF points compared to larger practices (P = 0.003), due to lower point attainment in the organisational domain (P = 0.002). There were no differences across practice size in the other domains of the QOF, including clinical care. Smaller practices reported higher levels of chronic obstructive pulmonary disease (COPD) and mental health conditions and lower levels of asthma, epilepsy and hypothyroidism. There was no difference in the reported prevalence of hypertension or coronary heart disease (CHD) across practices, in contrast to CHD mortality for patients aged under 70 years, where the mortality rate was 40% greater for single-handed practices compared with large practices. Conclusions: Although smaller practices obtained fewer points than larger practices under the QOF, this was due to lower scores in the organisational domain of the contract rather than to lower scores for clinical care. Single-handed practices, in common with larger practices serving more deprived populations, reported lower than expected CHD prevalence in their practice populations. Our results suggest that smaller practices continue to provide clinical care of comparable quality to larger practices but that they may need increased resources or support, particularly in the organisational domain, to address unmet need or more demanding QOF criteria.
Impact of the 2004 GMS contract on practice nurses: a qualitative study
Authored by Wendy McGregor, Hussein Jabareen, Catherine O'Donnell, Stewart Mercer and Graham Watt and published in British Journal of General Practice
BackgroundThe new GMS contract has led to practice nurses playing an important role in the delivery of the Quality and... more BackgroundThe new GMS contract has led to practice nurses playing an important role in the delivery of the Quality and Outcomes Framework (QOF). AimThis study investigated how practice nurses perceive the changes in their work since the contract's inception. Design of study A qualitative approach, sampling practice nurses from practices in areas of high and low deprivation, with a range of QOF scores. Setting Glasgow, UK. MethodIndividual interviews were conducted, audiotaped, transcribed, and analysed using a thematic approach. Results Three themes emerged: roles and incentives, workload, and patient care. Practice nurses were positive about the development of their professional role since the introduction of the new GMS contract but had mixed views about whether their status had changed. Views on incentives (largely related to financial rewards) also varied, but most felt under-rewarded, irrespective of practice QOF achievement. All reported a substantial increase in workload, related to incentivised QOF domains with greater 'box ticking' and data entry, and less time to spend with patients. Although the structure created by the new contract was generally welcomed, many were unconvinced that it improved patient care and felt other important areas of care were neglected. Concern was also expressed about a negative effect of the QOF on holistic care, including ethical concerns and detrimental effects on the patient–nurse relationship, which were regarded as a core value. ConclusionsThe new GMS contract has given practice nurses increased responsibility. However, discontent about how financial gains are distributed and negative impacts on core values may lead to detrimental long-term effects on motivation and morale.
Practice postcode versus patient population: a comparison of data sources in England and Scotland
Authored by Gary McLean, Bruce Guthrie, Graham Watt, Mark Gabbay and Catherine O'Donnell and published in International Journal of Health Geographics
BACKGROUND:Health professionals, policy-makers and researchers need to be able to explore potential associations... more BACKGROUND:Health professionals, policy-makers and researchers need to be able to explore potential associations between prevalence rates and quality of care with a range of possible determinants including socio-economic deprivation and morbidity levels to determine the impact of commissioning and service delivery. In the UK, data in England are only available nationally at practice postcode level. In Scotland, such data are available based on an aggregate of the practices population's postcodes. The use of data assigned to the practice postcode may underestimate the association between ill health and income deprivation. Here, we report on the impact of using data assigned to the practice population by comparing analyses using English and Scottish data.RESULTS:Income deprivation based on data assigned to the practice postcode under-estimated deprivation compared to using income deprivation data assigned to the practice population for the five least deprived deciles, and over-estimated deprivation for the five most deprived deciles. The biggest differences were found for the most deprived decile. A similar trend was found for limiting long-term illness (LLTI). Differences between the QOF prevalence rates of the least and most deprived deciles using practice postcode data were similar (0.2% points or less) in England and Scotland for 8 out of 10 clinical domains. Using practice population assigned deprivation, differences in the prevalence rate between the least and most deprived deciles increase for all clinical domains. A similar trend was again found for LLTI. Using practice population assigned deprivation, differences for population achievement increase for all CHD quality indicators with the exception of beta-blockers (CHD10). With practice postcode assigned deprivation, significant differences between the least and most deprived deciles were found for 2 out 8 indicators, compared to 5 using practice population assigned deprivation. For LLTI differences between the lowest and most deprived deciles increased for all indicators when ill health assigned to the practice population was used.CONCLUSION:We have found, through comparing deprivation and ill health data assigned to either the practice postcode or the practice population postcode in Scotland, that analyses based on practice postcode assigned data under-estimated the relationship between deprivation and ill health for both prevalence and quality care. Given the importance of understanding the effect of deprivation and ill health on a range of determinants related to health care, policy makers should ensure that practice population data are available and used at national level in England and elsewhere where possible
Practice nurses' workload, career intentions and the impact of professional isolation: A cross-sectional survey
Authored by Catherine O'Donnell, Hussein Jabareen and Graham Watt and published in BMC Nursing
BACKGROUND:Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This... more BACKGROUND:Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This study aimed to describe that role, identify how professionally supported they felt and their career intentions. An additional aim was to explore whether they felt isolated and identify contributory factors.METHODS:A cross-sectional questionnaire survey in one large urban Scottish Health Board, targeted all practice nurses (n = 329). Domains included demographics, workload, training and professional support. Following univariate descriptive statistics, associations between categorical variables were tested using the chi-square test or chi-square test for trend; associations between dichotomous variables were tested using Fisher's Exact test. Variables significantly associated with isolation were entered into a binary logistic regression model using backwards elimination.RESULTS:There were 200 responses (61.0% response rate). Most respondents were aged 40 or over and were practice nurses for a median of 10 years. Commonest clinical activities were coronary heart disease management, cervical cytology, diabetes and the management of chronic obstructive pulmonary disease. Although most had a Personal Development Plan and a recent appraisal, 103 (52.3%) felt isolated at least sometimes; 30 (15.5%) intended leaving practice nursing within 5 years.Isolated nurses worked in practices with smaller list sizes (p = 0.024) and nursing teams (p = 0.003); were less likely to have someone they could discuss a clinical/professional (p = 0.002) or personal (p < 0.001) problem with; used their training and qualifications less (p < 0.001); had less productive appraisals (p < 0.001); and were less likely to intend staying in practice nursing (p = 0.009). Logistic regression analysis showed that nurses working alone or in teams of two were 6-fold and 3.5-fold more likely to feel isolated. Using qualifications and training to the full, having productive appraisals and planning to remain in practice nursing all mitigated against feeling isolated.CONCLUSIONS:A significant proportion of practice nurses reported feeling isolated, at least some of the time. They were more likely to be in small practices and more likely to be considering leaving practice nursing. Factors contributing to their isolation were generally located within the practice environment. Providing support to these nurses within their practice setting may help alleviate the feelings of isolation, and could reduce the number considering leaving practice nursing
"They think we're OK and we know we're not". A qualitative study of asylum seekers' access, knowledge and views to health care in the UK
Authored by Catherine O'Donnell, Maria Higgins, Rohan Chauhan and Kenneth Mullen and published in BMC Health Services Research
BackgroundThe provision of healthcare for asylum seekers is a global issue. Providing appropriate and culturally... more BackgroundThe provision of healthcare for asylum seekers is a global issue. Providing appropriate and culturally sensitive services requires us to understand the barriers facing asylum seekers and the facilitators that help them access health care. Here, we report on two linked studies exploring these issues, along with the health care needs and beliefs of asylum seekers living in the UK.MethodsTwo qualitative methods were employed: focus groups facilitated by members of the asylum seeking community and interviews, either one-to-one or in a group, conducted through an interpreter. Analysis was facilitated using the Framework method.ResultsMost asylum seekers were registered with a GP, facilitated for some by an Asylum Support nurse. Many experienced difficulty getting timely appointments with their doctor, especially for self-limiting symptoms that they felt could become more serious, especially in children. Most were positive about the health care they received, although some commented on the lack of continuity. However, there was surprise and disappointment at the length of waiting times both for hospital appointments and when attending accident and emergency departments. Most had attended a dentist, but usually only when there was a clinical need. The provision of interpreters in primary care was generally good, although there was a tension between interpreters translating verbatim and acting as patient advocates. Access to interpreters in other settings, e.g. in-patient hospital stays, was problematic. Barriers included the cost of over-the-counter medication, e.g. children's paracetamol; knowledge of out-of-hours medical care; and access to specialists in secondary care. Most respondents came from countries with no system of primary medical care, which impacted on their expectations of the UK system.ConclusionMost asylum seekers were positive about their experiences of health care. However, we have identified issues regarding their understanding of how the UK system works, in particular the role of general practitioners and referral to hospital specialists. The provision of an Asylum Support nurse was clearly a facilitator to accessing primary medical care. Initiatives to increase their awareness and understanding of the UK system would be beneficial. Interpreting services also need to be developed, in particular their role in secondary care and the development of the role of interpreter as patient advocate.