scholarly journals Coxibs: recent controversies

2005 ◽  
Vol 4 (10) ◽  
pp. 270-272
Author(s):  
Pauline Bourne ◽  
Marwan Bukhari ◽  
Andrew Vickers
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Secondary Care

The recent public and press interest in the cyclo-oxygenase type 2 inhibitors (Coxibs) has led to discussions between primary care trusts, pharmacists in both primary and secondary care, and clinicians. Two years ago the Journal reported on the gastrointestinal (GI) safety of this new and potentially promising class of drugs, but more recent evidence has suggested a cardiovascular (CV) risk. With one manufacturer voluntarily withdrawing its product from the market, another issuing statements in defence of its product, and the Committee on Safety of Medicines weighing in with its own advice, it was felt that a meeting of interested parties was appropriate. The Journal asked Pauline Bourne, Pharmacist, Marwan Bukhari, Consultant Rheumatologist, and Andrew Vickers, Consultant in Pain Management, for their views.

scholarly journals Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care

2018 ◽  
Vol 68 (669) ◽  
pp. e260-e267 ◽  
Author(s):  
Brian McMillan ◽  
Katherine Easton ◽  
Elizabeth Goyder ◽  
Brigitte Delaney ◽  
Priya Madhuvrata ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Secondary Care ◽  
Future Research ◽  
Increased Risk ◽  
Risk Of Progression

BackgroundDespite the seven-fold increased risk of type 2 diabetes mellitus (T2DM) among females previously diagnosed with gestational diabetes (GD), annual rates of follow-up in primary care are low. There is a need to consider how to reduce the incidence of progression to T2DM among this high-risk group.AimTo examine the views of females diagnosed with GD to ascertain how to improve primary care support postnatally, and the potential role of technology in reducing the risk of progression to T2DM.Design and settingA qualitative study of a purposive sample of 27 postnatal females leaving secondary care with a recent diagnosis of GD.MethodSemi-structured interviews were conducted with 27 females, who had been previously diagnosed with GD, at around 6–12 weeks postnatally. Interviews were audiotaped, transcribed, and analysed thematically.ResultsFacilitators and barriers to engaging in a healthy postnatal lifestyle were identified, the most dominant being competing demands on time. Although females were generally satisfied with the secondary care they received antenatally, they felt abandoned postnatally and were uncertain what to expect from their GP in terms of follow-up and support. Females felt postnatal care could be improved by greater clarity regarding this, and enhanced by peer support, multidisciplinary input, and subsidised facilities. Technology was seen as a potential adjunct by providing information, enabling flexible and personalised self-management, and facilitating social support.ConclusionA more tailored approach for females previously diagnosed with GD may help reduce the risk of progression to T2DM. A need for future research to test the efficacy of using technology as an adjunct to current care was identified.

Type 2 diabetes and COPD: treatment in the right healthcare setting? An observational study.

2020 ◽  
Author(s):  
Rimke P Willink ◽  
Rimke C Vos ◽  
Ingrid Looijmans-van den Akker ◽  
Huberta E Hart
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Medical Records ◽  
Secondary Care ◽  
Healthcare Setting ◽  
Health Condition ◽  
Treatment Allocation ◽  
Copd Patients ◽  
The Right

Abstract Background Type 2 diabetes (T2DM) and COPD are chronic conditions, for which patients need lifelong healthcare. The aim of the study is to examine in which healthcare setting patients with T2DM and COPD receive care, and if they are allocated to the correct setting.Method T2DM and COPD patients from five primary care centres were included. Data concerning treatment setting, patient- and clinical characteristics were extracted from electronic medical records. The profile of patients treated in primary care was compared with that of those treated in secondary care. For patients treated in secondary care we evaluated whether treatment allocation was according to guidelines and if back-referral to primary care could take place.Results Of the T2DM and COPD patients 7.6% and 29.6% were treated in secondary care of which 72.7% and 31.4% according to the guideline. T2DM patients treated in primary care were older (63 versus 57 years, p = 0.001), had a shorter diabetes duration (8 versus 11 years, p < 0.001) and lower HbA1c (53.0 versus 63.5 mmmol/l, p < 0.001) than those treated in secondary care. Those with COPD treated in primary care used less inhalation medication (75.2 versus 90.1%, p < 0.001) and had better spirometry results (67.39 versus 57.53 FEV1%pred, p < 0.001).Conclusion The majority of the patients with T2DM and COPD were treated in primary care correctly. Patients treated in primary care on average had a better health condition compared to those in secondary care. The majority of the T2DM patients and the minority of COPD patients were treated correctly in secondary care.

scholarly journals Type 2 diabetes and COPD: treatment in the right healthcare setting? An observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
R. P. Willink ◽  
Rimke C. Vos ◽  
I. Looijmans-van den Akker ◽  
Huberta E. Hart
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Secondary Care ◽  
Healthcare Setting ◽  
Health Condition ◽  
Correct Treatment ◽  
Copd Patients ◽  
The Right ◽  
Primary Care Practices

Abstract Background Type 2 diabetes (T2DM) and COPD are chronic medical conditions, for which patients need lifelong healthcare. The aim of this study is to examine in which healthcare setting patients with T2DM and COPD receive their care, and if this is the correct healthcare setting according to guidelines. Method T2DM and COPD patients from five primary care practices were included. Data concerning healthcare setting and patient- and clinical characteristics were extracted from the electronic medical records. Patient profiles treated in primary care were compared with the profiles of those treated in secondary care. In patients treated in secondary care we evaluated whether treatment allocation was according to the guidelines and if back-referral to primary care should take place. Results Of the T2DM and COPD patients 7.6% and 29.6% respectively, were treated in secondary care, and 72.7% respectively 31.4% of these were according to the guideline. T2DM patients treated in primary care were older (63 versus 57 years, p < 0.01, had a shorter diabetes duration (8 versus 11 years, p < 0.01) and lower HbA1c (53.0 versus 63.5 mmol/l, p < 0.01) than those treated in secondary care. Those with COPD treated in primary care used less inhalation medication (75.2 versus 90.1%, p < 0.01) and had better spirometry results (67.39 versus 57.53 FEV1%pred, p < 0.01). Conclusion The majority of the patients with T2DM and COPD were correctly treated in primary care and on average patients with a better health condition were treated in primary care.. Also, those who were treated in secondary care were most of the time treated in the correct treatment setting according to the guidelines.

Abstract # P-1: Use of Type 2 Diabetes Screening Guidelines in Primary Care: Concordance Between Physician Survey and Medical Records

2016 ◽  
Vol 22 ◽  
pp. 14
Author(s):  
Michelle Mocarski ◽  
Sandhya Mehta ◽  
Karin Gillespie ◽  
Tami Wisniewski ◽  
K.M. Venkat Narayan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Medical Records ◽  
Physician Survey ◽  
Diabetes Screening ◽  
Screening Guidelines

Effect and acceptability of AKI education using peer review audit in primary care

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696977
Author(s):  
Mufaza Asrar ◽  
Joanna McKinnell ◽  
Nitin Kolhe ◽  
Lynn Woods ◽  
Sally Bassett ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Secondary Care ◽  
Group Discussion ◽  
Risk Groups ◽  
Risk Identification ◽  
Care Staff ◽  
Small Group Teaching ◽  
Post Intervention ◽  
Early Management

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.

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