Training primary-care physicians to recognize, 
diagnose and manage depression: does it improve 
patient outcomes?

Background. We developed a comprehensive, 20-hour training programme for primary-care physicians, that sought to improve their ability to detect, diagnose and manage depression. We evaluated the effects of physician training on patient outcomes, using a pre-post design.Methods. In the pre-training phase of the study, we sampled 1834 consecutive patients of 17 primary-care physicians and evaluated 518 of these patients for the presence of depression. We measured outcomes of all patients with depression at 3 months and 1 year. The outcome measures were: severity of psychopathology; duration of depressive episode; and level of daily functioning. After the 17 physicians completed the training, we drew a new sample from their practices (498 of 1785 consecutive patients were evaluated for depression) and measured outcomes for the depressed patients.Results. We found an effect of the training on short-term outcome, particularly for patients with a recent-onset depression. At 3-month follow-up depressed patients whose physicians had received training had less severe psychopathology and patients with recent-onset depression also showed higher levels of daily functioning than patients of the same physicians prior to the training. The patients with a recent-onset depression that was recognized by trained physicians had shorter depressive episodes, but this was not statistically significant. At 1-year follow-up, all training effects had faded away.Conclusions. Training primary-care physicians to recognize, diagnose and manage depression can improve short-term patient outcomes, especially for patients with a recent onset of depression. Patients suffering from a recurrent or chronic depression may need more specific interventions, both for acute treatment and long-term management.

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P001: Do all toddler’s fractures need to be managed by orthopaedic surgeons?

CJEM ◽

10.1017/cem.2017.203 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S77-S78

Author(s):

J.S. Adamich ◽

M. Camp

Keyword(s):

Primary Care ◽

Emergency Room ◽

Radiation Exposure ◽

Healthcare System ◽

Patient Outcomes ◽

Primary Care Physicians ◽

Primary Care Providers ◽

Care Providers ◽

The Mean

Introduction: There is increasing evidence that emergency room physicians or primary care physicians can definitively manage many uncomplicated paediatric fractures without orthopaedic follow-up. This strategy leads to a reduction in radiation exposure and decreased costs to patient families and the healthcare system without impacting patient outcomes. The aim of this study was to determine whether patients who sustained a toddler’s fracture of the tibia required orthopaedic surgeon follow-up. Methods: A retrospective analysis including patients who presented to the Hospital for Sick Children (SickKids) for management of toddlers’ fractures between Jan 2009 and Dec 2014 was performed. Results: 186 patients (115 males, 72 females) with an average age of 2.00 (range 0.2-3.9) were included in the study. The mean number of clinic visits including initial consultation in the emergency department was 2.00 (±1.0). The mean number of radiology department appointments was 2.76 (±1.1) where patients received a mean number of 5.86 (±2.6) radiographs. Complications were minimal and no patient developed a non-union nor re-fractured. All patients achieved clinical and radiographic union. To date, no patient has returned to clinic or undergone surgery for concerns regarding leg length inequality or malalignment. Conclusion: Our series supports reduced clinical follow-up of patients with a toddler’s fracture of the tibia. If the diagnosis can be made on the initial radiographs, emergency room physicians or primary care providers can definitively manage these patients with appropriate immobilization that can be removed by the parents between 3-4 weeks after the injury. A fracture clinic follow-up is only necessary if the diagnosis cannot be made on the initial radiographs. Our toddler’s fracture pathway will reduce patient radiation exposure and reduce costs incurred by the healthcare system and patients’ families without jeopardizing patient outcomes.

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Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

BMC Medical Education ◽

10.1186/s12909-020-02459-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M.-C. Audétat ◽

S. Cairo Notari ◽

J. Sader ◽

C. Ritz ◽

T. Fassier ◽

...

Keyword(s):

Primary Care ◽

Clinical Reasoning ◽

Primary Care Physicians ◽

Video Sequence ◽

Structured Interview ◽

Ambulatory Setting ◽

Structured Interviews ◽

Stimulated Recall ◽

Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

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Comparative short-term and long-term outcomes between internal and external intestinal plication in the management of small bowel obstruction

BMC Surgery ◽

10.1186/s12893-021-01304-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Song Liu ◽

Qiongyuan Hu ◽

Lihua Shao ◽

Xiaofeng Lu ◽

Xiaofei Shen ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Gut Dysfunction ◽

Gut Function

Abstract Background Small bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO. Methods All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well. Results Nine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery. Conclusions This study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations.

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Presurgical fMRI Affecting the Extent of Resection and Outcome of the Supratentorial Gliomas; a Single-center Experience From a Developing Country

10.21203/rs.3.rs-528310/v1 ◽

2021 ◽

Author(s):

Abolghasem Mortazavi ◽

Mohammad Ali Suraki Azad ◽

Abbas Amirjamshidi ◽

Mohammad Shirani ◽

Seyed Ebrahim Ketabchi ◽

...

Keyword(s):

Tumor Grade ◽

Extent Of Resection ◽

Positive Outcome ◽

Short Term ◽

Glioma Surgery ◽

Term Outcome ◽

Eloquent Areas ◽

Single Center Experience ◽

Supratentorial Gliomas

Abstract BackgroundFunctional magnetic resonance imaging (fMRI) is one of the available non-invasive imaging to map the different brain areas, which has been used during the current years. In this study, we aimed to evaluate the effect of fMRI on decision-making, the extent of resection, and the outcome of the patients with supratentorial gliomas.MethodsThis prospective study conducted from 2014 through 2017 to investigate how presurgical fMRI can help the neurosurgeon during glioma surgery. Baseline demographic and clinical data were collected, and standard fMRI protocol was used for each patient.Results Forty-one patients with supratentorial gliomas met inclusion criteria, including 29 males and 12 females ranging in age from 21 to 72. Our results showed a significant association between eloquent areas tumor and the EOR. Eight out of 41 (19.5%) experienced higher EOR than what the neurosurgeon expected after adjusting the fMRI findings with the intraoperative situation. Among these patients, postoperative KPS and motor indices reflected dropped levels accompanied by an instant language index level in the short-term period, whereas all indices improved after long-term follow-up. There was a significant association between increasing EOR and all indices in the 1-year follow-up.ConclusionsIn conclusion, we postulate that preoperative fMRI should be considered preoperatively, especially in the eloquent areas gliomas disregarding tumor grade. Moreover, it can lead to a positive outcome in supratentorial gliomas via giving useful data about the relation of the tumor and vital centers of the brain, although it may result in an unfavorable short-term outcome.

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Investigating information-seeking behaviors of primary care physicians who care for older depressed patients and their family caregivers: a pilot study

Journal of the Canadian Health Libraries Association / Journal de l Association de bilbiothèques de la santé du Canada ◽

10.5596/c05-041 ◽

2005 ◽

Vol 26 (4) ◽

pp. 111 ◽

Cited By ~ 4

Author(s):

Mary Jo Dorsey ◽

Ellen Detlefsen

Keyword(s):

Primary Care ◽

Pilot Study ◽

Information Seeking ◽

Primary Care Physicians ◽

Care Physician ◽

Structured Interviews ◽

Depressed Patients ◽

Types Of Information ◽

Primary Care Practices ◽

Information Seeking Behaviors

Objective To describe preliminary findings from a study of information-seeking behaviors of primary care physicians who care for elderly and depressed patients, and the correlation between what is sought versus what is provided to the patient and (or) caregiver. Setting Physicians in two large ambulatory primary care practices throughout urban Pittsburgh, Pennsylvania, who take care of geriatric patients. Methods Structured interviews, with common questions, will be conducted with 12 primary care physicians to determine patterns of information-seeking behaviors. Environmental scans of physicians' offices for evidence of their existing information behaviors will complement the information obtained from the interviews. Results This pilot study provides an analysis of the resources primary care physicians use to seek information to provide to patients and caregivers. Analyses show types of information sought, time spent seeking information, and methods used to find information given to patients. Conclusions With mounting evidence of the Internet being used for patient self care, it is essential to understand if primary care physicians understand the scope and breadth of information readily available to their patients. The primary care physician needs to be aware of the types of information made available to their patients and the caregivers who are inclined to obtain information for the patient.

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Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

10.21203/rs.3.rs-278334/v1 ◽

2021 ◽

Author(s):

wenbin jiang ◽

Shuyun Jiang ◽

Yan Yu ◽

Qijia Zhan ◽

Min Wei ◽

...

Keyword(s):

Cerebral Palsy ◽

Lower Limbs ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Dorsal Rhizotomy ◽

Gait Parameters

Abstract Background Selective Dorsal Rhizotomy (SDR) guided by our modified protocol can decrease spasticity in certain muscles. This study aimed to investigate gait parameters changes in cerebral palsy (CP) with focal spasticity after SDR in short-term follow-up. Methods CP classified as Gross Motor Function Classification System (GMFCS) level Ⅰ and Ⅱ who underwent SDR were included. Changes of spasticity, gait parameters and gait deviation index (GDI) were retrospectively reviewed. Results This study contained 26 individuals with 44 affected and 8 intact lower limbs (4 monoplegia, 4 hemiplegia and 18 diplegia). Mean age was 5.7 ± 1.9 years-old and follow-up duration was 9.9 ± 6.6 months. After SDR, average spasticity of 108 target muscles decreased from 2.9 ± 0.8 to 1.8 ± 0.6 in Modified Ashworth Scale (MAS). Kinematic curves changed after the surgery in sagittal and transverse plane in affected sides, further investigation showed improvements in ankle and knee. No changes were found in temporal-spatial parameters except decrease in cadence in affected sides. GDI improved significantly in affected limbs. Conclusion In short-term follow up, the new-protocol-guiding SDR can lower focal spasticity, GA showed improvements in kinematic parameters and GDI. Longer follow-up duration is needed to clarify the long-term outcome.

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Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

Clinical & Investigative Medicine ◽

10.25011/cim.v43i2.33566 ◽

2020 ◽

Vol 43 (2) ◽

pp. E14-23

Author(s):

Sophie Marcoux, MD, PhD Marcoux ◽

Caroline Laverdière

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Primary Care Physicians ◽

Adult Survivors ◽

Likert Scale ◽

Care Transition ◽

Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

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Ligation of the aorta for a mycotic abdominal aortic aneurysm in an infant

SAGE Open Medical Case Reports ◽

10.1177/2050313x18761309 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1876130

Author(s):

Zahira Zouizra ◽

Soukaina Benbakh ◽

Gaël Biaou ◽

Drissi Boumzebra

Keyword(s):

Mycotic Aneurysm ◽

Aortic Aneurysms ◽

Infrarenal Aorta ◽

Limited Data ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Abdominal Aortic ◽

Risk Of Rupture

Mycotic aortic aneurysms are exceedingly uncommon in infants and they have a high risk of rupture. Their surgical management is extremely challenging. We report a case of a 22-month-old girl who presented with abdominal pain and fever revealing a ruptured mycotic aneurysm of the infrarenal aorta. The surgical treatment consisted of a ligature of the proximal and distal ends of the aneurysm. Postoperative course was significant for hypertension. A year and a half follow-up showed no other complications. Limited data are available concerning our chosen technique, but the reported cases showed a good short-term outcome.

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Screening and management of cardiovascular disease in Australian adults with HIV infection

Sexual Health ◽

10.1071/sh13009 ◽

2013 ◽

Vol 10 (6) ◽

pp. 495 ◽

Cited By ~ 7

Author(s):

Derek Chan ◽

David Gracey ◽

Michael Bailey ◽

Deborah Richards ◽

Brad Dalton

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Clinical Practice ◽

Hiv Infection ◽

Primary Care Physicians ◽

Management Practices ◽

Cvd Risk ◽

Online Forms ◽

Current Screening

Background Cardiovascular disease (CVD) is common in HIV infection. With no specific Australian guidelines for the screening and management of CVD in HIV-infected patients, best clinical practice is based on data from the general population. We evaluated adherence to these recommendations by primary care physicians who treat HIV-infected patients. Methods: Primary care physicians with a special interest in HIV infection were asked to complete details for at least 10 consecutive patient encounters using structured online forms. This included management practices pertaining to blood pressure (BP), blood glucose, electrocardiogram, lipid profile and CVD risk calculations. We assessed overall adherence to screening and follow-up recommendations as suggested by national and international guidelines. Results: Between May 2009 and March 2010, 43 physicians from 25 centres completed reporting for 530 HIV-infected patients, of whom 93% were male, 25% were aged 41–50 years and 83% were treated with antiretrovirals. Risk factors for CVD were common and included smoking (38%), hyperlipidaemia (16%) and hypertension (28%). In men aged >40 years and women aged >50 years without evidence of ischaemic heart disease, only 14% received a CVD risk assessment. Lipid and BP assessments were performed in 87% and 88% of patients, respectively. Conclusions: This Australian audit provides unique information on the characteristics and management of HIV and CVD in clinical practice. We have found a high burden of risk for CVD in HIV-infected Australians, but current screening and management practices in these patients fall short of contemporary guidelines.

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