Innovations in primary health care

This review is devoted to a number of important innovations and their role in modern medical practice of a family practitioner. We have discussed benefits, restrictions and controversies related to their use. We have also reviewed the evidence base on the practical implementation of these innovations. This review is devoted to a number of important innovations and their role in modern medical practice of a family practitioner. We have discussed benefits, restrictions and controversies related to their use. We have also reviewed the evidence base on the practical implementation of these innovations.

Clinical Geriatrics as a Team Sport: Fostering Interprofessional Experiences in the Community

Team-based care is necessary to provide better healthcare outcomes for the complex needs of older adults. Shared clinical learning experiences prepare practitioners to work in collaborative partnership to achieve optimal outcomes. To promote collaborative partnership, we established interprofessional community based clinical experiences with older adults at home, in assisted living and in skilled nursing facilities. One nurse practitioner faculty member was paired with 2 students for each clinical experience day. Initially these were face-to-face encounters, however, with the onset of COVID-19, all high-risk encounters were converted to a virtual modality. The clinical encounters focused on the Age Friendly Model (4M). Post clinical discussions and recommendations focused on interprofessional treatment plans. A REDCap(TM) survey was completed by all student participants for program evaluation. Of the 14 surveys sent, 11 were completed; 10 (77%) females; 3 (23%) males; 7 (50%) family practitioner students; 7 (50%) adult-gerontology nurse practitioner students. Four had previous home health experience (14%), and 10 had none (86%). 4M Likert scale (1-5) means were “what matters” = 4.27, medications = 4.18, mentation = 4.09, and mobility = 4.09. Students found the overall experience valuable (mean = 4.27). Of 11 students, 3 (27%) were involved telehealth experiences. Students found real community based clinical experiences to be very enlightening, offering a different perspective, and altering their appreciation for the everyday life of the older adult. Future plans include adding social work and physical therapy students to these clinical experiences to enhance interprofessional education.

Comparison of COVID-19 outcomes among shielded and non-shielded populations

Many western countries used shielding (extended self-isolation) of people presumed to be at high-risk from COVID-19 to protect them and reduce healthcare demand. To investigate the effectiveness of this strategy, we linked family practitioner, prescribing, laboratory, hospital and death records and compared COVID-19 outcomes among shielded and non-shielded individuals in the West of Scotland. Of the 1.3 million population, 27,747 (2.03%) were advised to shield, and 353,085 (26.85%) were classified a priori as moderate risk. COVID-19 testing was more common in the shielded (7.01%) and moderate risk (2.03%) groups, than low risk (0.73%). Referent to low-risk, the shielded group had higher confirmed infections (RR 8.45, 95% 7.44–9.59), case-fatality (RR 5.62, 95% CI 4.47–7.07) and population mortality (RR 57.56, 95% 44.06–75.19). The moderate-risk had intermediate confirmed infections (RR 4.11, 95% CI 3.82–4.42) and population mortality (RR 25.41, 95% CI 20.36–31.71) but, due to their higher prevalence, made the largest contribution to deaths (PAF 75.30%). Age ≥ 70 years accounted for 49.55% of deaths. In conclusion, in spite of the shielding strategy, high risk individuals were at increased risk of death. Furthermore, to be effective as a population strategy, shielding criteria would have needed to be widely expanded to include other criteria, such as the elderly.

15. Challenging Governmental Decisions: The Process

This chapter examines the legal procedures an applicant must follow when challenging a government decision and explores how court decisions in this nominally very technical area of administrative law can have profound implications for the meaning in practical terms of such broad constitutional principles as the rule of law and the sovereignty of Parliament. The chapter begins by examining the historical duality with English administrative law of the mechanism through which citizens might question the lawfulness of government action. The chapter then continues to cover the case of Barnard v National Dock Labour Board; the Order 53 reforms; the case of O’Reilly v Mackman (1982); the post-O’Reilly case law; the case of Roy v Kensington and Chelsea and Westminster Family Practitioner Committee; and public law principle as a defence in criminal proceedings.

IoT Based Remote Health Monitoring and Alert System

Since they are isolated in their later years, most people are still forgotten and powerless in medical crises. To deal with this, we've devised a potential Remote Health Monitoring and Warning System (RHMAS). Heart attacks in the elderly are linked with complications such as body temperature changes, elevated blood pressure, profuse sweating, and an abnormal cardiac rhythm, among others. Our approach is to include sophisticated sensors capable of detecting and tracking these signs in order to warn family members, kin, family practitioner, and health care in the event of an emergency. Since most gadgets for this reason are wired, a wireless interface does not obstruct the user's movement. The suggested device includes a Photo-Plethysmography (PPG) dependent pulse sensor to identify arrhythmia, a temperature sensor to continuously track their body temperature, a pressure sensor to sense blood pressure ranges, and a heartbeat sensor. If the controlled data deviates from the nominal body state, an ESP 8266 module can give a message to the next of kin. If the tracked data hits emergency thresholds, health providers can send a message to her kin as well as a buzzer to a consent user.

ANTIBIOTIC THERAPY IN ACUTE EXACERBATION OF COPD:AN OPTIMAL WAY TO SUCCESS

Currently, chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. Acute exacerbation of the disease is associated with fast clinical deterioration, increased respiratory tract inflammation and lung function disorders. Acute exacerbation of COPD dramatically worsens patient�s prognosis and serves as an important indicator of therapy effectiveness. Family practitioner should recognize this condition and correctly chose proper antibiotic. Diagnosis of COPD exacerbation is based on clinical manifestations of the disease. Depending on presence of primary or secondary symptoms COPD exacerbations are divided into several types. Antibiotic therapy appears to be more beneficial in patients with type 2 or 3 exacerbation. Sputum purulence is considered an obligatory symptom. As a rule, in complicated course of acute exacerbation of COPD protected aminopenicillins or 3rd generation cephalosporins are the firsline antibiotics. In most cases of COPD exacerbation antibiotics are prescribed orally. If first-line antibacterial therapy fails, the respiratory fluoroquinolones (levofloxacin of moxifloxacin) are prescribed. The author, using her own experience with levofloxacin, gives an example of proper choice of antibiotic if such a situation. Successful experience of management of acute exacerbation of COPD may be useful for general practitioners, physicians, pulmonologists. Key words: chronic obstructive pulmonary disease, exacerbation, antibiotic therapy, levofloxacin.

The role of family practitioner in the diagnosis, treatment and surveillance of patients with psychiatric pathology

Psychiatric pathology is one of the emerging problems of contemporary medicine. In a society in a continuous development, there is a need for the evolution and updating of knowledge, including in the medical field. As depression, anxiety, burnout syndrome and other psychiatric disorders become more common, the addressability of these cases in the family medicine practice becomes a topic that requires a careful approach. Thus, this article aims to address the chal­lenges in the management of the psychiatric patient en­coun­tered in the family doctor’s office. Due to the fact that patients with mental illness are often stigmatized, it is necessary to educate the general population, but also the medical staff, so that these patients benefit from an early diagnosis, appropriate treatment and dynamic supervision. In conclusion, the central role in the health care system belongs to the family doctor, who is the one who benefits from an overview of the patient, which integrates somatic, psychiatric and social aspects.

The assessment of maternal deaths between 2015 and 2020 in Elazığ, Turkey

Objective: To determine the maternal deaths and the factors affecting them in our city. Methods: The maternal deaths occurred in our city between January 2015 and June 2020 were reviewed retrospectively. The review was conducted by checking “Maternal Death Registry Forms” of the Provincial Directorate of Health. In cases where additional data related with the cause of death were required, the relatives of the cases, associated family practitioner, The Council of Forensic Medicine or local authorities were contacted. The data of the cases including age, gravida, parity, abortion, delivery type, week of gestation during delivery, period of death and maternal deaths due to direct, indirect and incidental causes were recorded. Based on total live births and maternal deaths within 6.5 years, maternal mortality rate was found as the maternal death number per 100,000 live births. Descriptive statistics were used for the statistical analysis of the data. Results: A total of 46.618 live births occurred between 2015 and 2020 in Elazığ. The number of maternal deaths due to direct and indirect causes is 7, and maternal mortality rate was found 15.01/100,000. Hypertensive diseases during pregnancy (n=3, 42.8%), pulmonary embolism (n=1, 14.3%) and cerebral thrombosis (n=1, 14.3%) were among the natural causes of maternal deaths. Indirect cause for maternal death was cardiac diseases (n=2, 28.6%). When they were categorized according to the Three Delays Model, there were 3 death cases in the first delay model and 2 death cases in the third delay model, but there was no maternal death in the second delay model. Conclusion: Maternal death is an significant public health issue which develops due to the generally preventable causes and maintains its importance. The factors contributing to death should be paid attention in order to decrease maternal death rates.

Comparison of COVID-19 outcomes among shielded and non-shielded populations: A general population cohort study of 1.3 million

Many western countries used shielding (extended self-isolation) of people presumed to be at high-risk from COVID-19 to protect them and reduce healthcare demand. To investigate the effectiveness of this strategy, we linked family practitioner, prescribing, laboratory, hospital and death records and compared COVID-19 outcomes among shielded and non-shielded individuals in the West of Scotland. Of the 1.3 million population, 27,747 (2.03%) were advised to shield, and 353,085 (26.85%) were classified a priori as moderate risk. COVID-19 testing was more common in the shielded (7.01%) and moderate risk (2.03%) groups, than low risk (0.73%). Referent to low-risk, the shielded group had higher confirmed infections (RR 8.45, 95% 7.44-9.59), case-fatality (RR 5.62, 95% CI 4.47-7.07) and population mortality (RR 57.56, 95% 44.06-75.19). The moderate-risk had intermediate confirmed infections (RR 4.11, 95% CI 3.82-4.42) and population mortality (RR 25.41, 95% CI 20.36-31.71) but, due to their higher prevalence, made the largest contribution to deaths (PAF 75.30%). Age ≥70 years accounted for 49.55% of deaths. In conclusion, shielding has not been effective at preventing deaths in individuals at high risk. Also, to be effective as a population strategy, shielding criteria would need to be widely expanded to include other criteria, such as the elderly.