Семейная медицина и первичная медицинская помощь

[Наталья П.]

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Summary of recommendations for clinical preventive services.
American Academy of Family Physicians

[Наталья П.]

Журнал "Оценка медицинских технологий"
Health Technol Assess. 2007 Mar;11(10):1-184.

Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only.

Isaacs AJ, Critchley JA, See Tai S, Buckingham K, Westley D, Harridge SD, Smith C, Gottlieb JM.

EXERT Project, School of Health and Social Sciences, Middlesex University, London, UK.

OBJECTIVES: To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme, an instructor-led walking programme and advice-only in patients referred for exercise by their GPs.
DESIGN: A single-centre, parallel-group, randomised controlled trial, consisting of three arms, with the primary comparison at 6 months.
SETTING: Assessments were carried out at Copthall Leisure Centre in Barnet, an outer London borough, and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough.
PARTICIPANTS: Participants were aged between 40 and 74 years, not currently physically active and with at least one cardiovascular risk factor.
INTERVENTIONS: The 943 patients who agreed to participate in the trial were assessed in cohorts and randomised to one of the following three arms: a 10-week programme of supervised exercise classes, two to three times a week in a local leisure centre; a 10-week instructor-led walking programme, two to three times a week; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities. After 6 months the control group were rerandomised to one of the other trial arms. Assessments took place before randomisation, at 10 weeks (in a random 50% subsample of participants), 6 months and 1 year in the leisure centre and walking arms. The control participants were similarly assessed up to 6 months and then reassessed at the same intervals as those initially randomised to the leisure centre and walking groups.
MAIN OUTCOME MEASURES: The primary outcome measures were changes in self-reported exercise behaviour, blood pressure, total cholesterol and lipid subfractions. Secondary outcomes included changes in anthropometry, cardiorespiratory fitness, flexibility, strength and power, self-reported lifestyle behaviour, general and psychological health status, quality of life and health service usage. The costs of providing and making use of the service were quantified for economic evaluation.
RESULTS: There was a net increase in the proportion of participants achieving at least 150 minutes per week of at least moderate activity in the sport/leisure and walking categories in all three study groups: at 6 months, the net increases were 13.8% in the leisure centre group, 11.1% in the walking group and 7.5% in the advice-only group. There were significant reductions in systolic and diastolic blood pressure in all groups at each assessment point compared with baseline. There were also significant and sustained improvements in cardiorespiratory fitness and leg extensor power, and small reductions in total and low-density lipoprotein cholesterol in all groups, but there were no consistent differences between the groups for any parameter over time. All three groups showed improvement in anxiety and mental well-being scores 6 months after the beginning of the trial. Leisure centre and walking groups maintained this improvement at 1 year. There were no differences between groups. Costs to the participants amounted to pound100 for the leisure centre scheme and pound84 for the walking scheme, while provider costs were pound186 and pound92, respectively. Changes in overall Short Form 36 scores were small and advice only appeared the most cost-effective intervention.
CONCLUSIONS: The results of this trial suggest that referral for tailored advice, supported by written materials, including details of locally available facilities, supplemented by detailed assessments may be effective in increasing physical activity. The inclusion of supervised exercise classes or walks as a formal component of the scheme may not be more effective than the provision of information about their availability. On cost-effectiveness grounds, assessment and advice alone from an exercise specialist may be appropriate to initiate action in the first instance. Subsidised schemes may be best concentrated on patients at higher absolute risk, or with specific conditions for which particular programmes may be beneficial. Walking appears to be as effective as leisure centre classes and is cheaper. Efforts should be directed towards maintenance of increased activity, with proven measures such as telephone support. Further research should include an updated meta-analysis of published exercise interventions using the standardised mean difference approach.

[Наталья П.]

Best practice in primary care pathology

Best practice in primary care pathology: review 1.
Smellie WS, Wilson D, McNulty CA, Galloway MJ, Spickett GA, Finnigan DI, Bareford DA, Greig MA, Richards J.

Best practice in primary care pathology: review 2.
Smellie WS, Forth JO, McNulty CA, Hirschowitz L, Lilic D, Gosling R, Bareford D, Logan E, Kerr KG, Spickett GP, Hoffman J, Galloway A, Bloxham CA.

Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK. [Ссылки доступны только зарегистрированным пользователям ]

This second best practice review examines five series of common primary care questions in laboratory medicine: (1) laboratory testing for allergy, (2) diagnosis and monitoring of menopause, (3) the use of urine cytology, (4) the usefulness of the erythrocyte sedimentation rate, and (5) the investigation of possible urinary tract infection. The review is presented in a question-answer format. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.

PMID: 16443724 [PubMed - indexed for MEDLINE]

Best Practice in Primary Care Pathology: review 3.
Smellie WS.

Bishop Auckland Hospital, United Kingdom.

This third best practice review examines four series of common primary care questions in laboratory medicine: (i) 'minor' blood platelet count and haemoglobin abnormalities, (ii) diagnosis and monitoring of iron deficiency anaemia , (iii) secondary hyperlipidaemia and hypertriglyceridaemia and (iv) HbA1c and microalbumin use in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

PMID: 16714394 [PubMed - as supplied by publisher]

Best practice in primary care pathology: review 3.
Smellie WS, Forth J, Bareford D, Twomey P, Galloway MJ, Logan EC, Smart SR, Reynolds TM, Waine C.

Department of Chemical Pathology, Bishop Auckland General Hospital, Bishop Auckland County, Durham, UK. [Ссылки доступны только зарегистрированным пользователям ]

This best practice review examines four series of common primary care questions in laboratory medicine: (i) "minor" blood platelet count and haemoglobin abnormalities; (ii) diagnosis and monitoring of anaemia caused by iron deficiency; (iii) secondary hyperlipidaemia and hypertriglyceridaemia; and (iv) glycated haemoglobin and microalbumin use in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards, but form a guide to be set in the clinical context. Most of the recommendations are based on consensus rather than evidence. They will be updated periodically to take account of new information.

PMID: 16873560 [PubMed - indexed for MEDLINE]



Department of Pathology, Bishop Auckland Hospital, General Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK. [Ссылки доступны только зарегистрированным пользователям ]

This first best practice review examines four series of common primary care questions in laboratory medicine, namely: (i) measurement and monitoring of cholesterol and of liver and muscle enzymes in patients in the context of lipid lowering drugs, (ii) diagnosis and monitoring of vitamin B12/folate deficiency, (iii) investigation and monitoring of paraprotein bands in blood, and (iv) management of Helicobacter pylori infection. The review is presented in a question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.

PMID: 16189144 [PubMed - indexed for MEDLINE]

J Clin Pathol. 2006 Sep;59(9):893-902. Epub 2006 May 19.
Links
Erratum in:
J Clin Pathol. 2006 Oct;59(10):1116.
Best practice in primary care pathology: review 4.
Smellie WS, Forth J, Sundar S, Kalu E, McNulty CA, Sherriff E, Watson ID, Croucher C, Reynolds TM, Carey PJ.

Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK. [Ссылки доступны только зарегистрированным пользователям ]

This fourth best practice review examines four series of common primary care questions in laboratory medicine are examined in this review: (1) safety monitoring for three common drugs; (2) use of prostate-specific antigen; (3) investigation of vaginal discharge; and (4) investigation of subfertility. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of the guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most of them are consensus based rather than evidence based. They will be updated periodically to take account of new information.

PMID: 16714397 [PubMed - indexed for MEDLINE]

[Наталья П.]

Best practice in primary care pathology: review 5.
Smellie WS, Forth J, Ryder S, Galloway MJ, Wood AC, Watson ID.

Department of Chemical Pathology, Bishop Auckland General Hospital, Durham, UK. [Ссылки доступны только зарегистрированным пользователям ]

This fifth best practice review examines three series of common primary care questions in laboratory medicine: (1) minor liver function test abnormalities; (2) laboratory monitoring of patients receiving lithium; and (3) investigation of possible venous thromboembolism. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus-based rather than evidence-based. They will be updated periodically to take account of new information.

PMID: 16644875 [PubMed - indexed for MEDLINE]

Best practice in primary care pathology: review 6.
Smellie WS, Forth J, Coleman JJ, Irvine W, Dore PC, Handley G, Williams DG, Galloway PJ, Kerr KG, Herriot R, Spickett GP, Reynolds TM.

Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK. [Ссылки доступны только зарегистрированным пользователям ]

This sixth best practice review examines four series of common primary care questions in laboratory medicine: (1) laboratory monitoring in hypertension and heart failure abnormalities; (2) markers of inflammatory joint disease; (3) laboratory investigation of chronic diarrhoea; and (4) mumps and chickenpox. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.

PMID: 16822875 [PubMed - indexed for MEDLINE]

Best practice in primary care pathology: review 7.
Smellie WS, Forth J, Smart SR, Galloway MJ, Irving W, Bareford D, Collinson PO, Kerr KG, Summerfield G, Carey PJ, Minhas R.

Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK.

This seventh best-practice review examines four series of common primary care questions in laboratory medicine: (1) blood count abnormalities 2; (2) cardiac troponins; (3) high-density lipoprotein cholesterol; and (4) viral diseases 2. The review is presented in a question-answer format, with authorship attributed for each question series. The recommendations are a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. The recommendations are not standards, but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.

PMID: 17046843 [PubMed - in process]

Best Practice in Primary Care Pathology: Review 8.
Smellie WS.

County Durham and Darlington Acute Hospitals NHS Trust, United Kingdom.

This eighth best practice review examines four series of common primary care questions in laboratory medicine: (i) sodium abnormalities, (ii) faecal occult blood testing, (iii) warfarin management and (iv) sputum cytology in diagnosis of bronchopulmonary malignancy. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

PMID: 17172476 [PubMed - as supplied by publisher]

Best Practice in Primary Care Pathology: Review 9.
Smellie WS.

County Durham and Darlington Acute Hospitals Trust, United Kingdom.

This ninth best practice review examines two series of common primary care questions in laboratory medicine: (i) potassium abnormalities, (ii) skin ulcer microbiology. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

PMID: 17259298 [PubMed - as supplied by publisher]

Best practice in primary care pathology: review 10.
Smellie WS.

Bishop Auckland Hospital, United Kingdom.

This tenth best practice review examines three series of common primary care questions in laboratory medicine: (i) antenatal testing in pregnant women, (ii) estimated glomerular filtration rate calculation (iii) safety testing for methotrexate and (iv) blood glucose measurement in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

PMID: 17496187 [PubMed - as supplied by publisher]

[Наталья П.]

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the Family Practice Notebook
This notebook is intended to aid primary care providers in their pursuit of optimal care, well-informed patients, and healthy families.
This site is derived from a "peripheral brain" collection of medical notes, and is divided over 4316 topics within 616 chapters and 31 subspecialty books.

Например - ведение ринита
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Causes
See Rhinitis Causes

History
Duration of symptoms <1 week
Viral Rhinitis
Allergic Rhinitis Exacerbation
Chronic symptoms that follow pattern of triggers
Seasonal or Perennial Allergic Rhinitis
Other causes
Drug-Induced Rhinitis
Exercise-induced rhinitis
Gustatory Rhinitis or other food reactions
Vasomotor Rhinitis
Irritant Rhinitis
Unilateral Rhinorrhea
Choanal Atresia
Nasal Foreign Body (especially in young children)
Nasal Neoplasm
Cerebrospinal rhinorrhea
Underlying medical conditions
Hypothyroidism
Rheumatoid conditions (e.g. SLE, Sjogren's Syndrome)
Gastroesophageal Reflux

Examination
Eyes
Allergic Shiners
Allergic Conjunctivitis
Ears
Eustachian Tube Dysfunction (chronic congestion)
Nose
Nose breathing difficult (chronic congestion)
Deviated septum
Nasal Polyps
Purulent nasal drainage (Acute Sinusitis)
Mouth
Tonsil hypertrophy (non-Allergic Rhinitis)
Neck
Cervical Lymphadenopathy (Infectious Rhinitis)
Respiratory
Wheezing (Asthma and Atopic Triad)
Skin
Eczema (Atopic Triad)

Diagnostics
Eosinophils on nasal drainage evaluation
Suggests Allergic Rhinitis or Eosinophilia Syndrome
Allergy evaluation
Skin Testing for allergy
RadioAllergoSorbent Test (RAST)

Differential Diagnosis
Allergic Rhinitis
Sneezing and Pruritus with seasonal variation
Pale, boggy nasal mucosa
Family History of Allergic Rhinitis or atopy
Allergan exposure or positive Allergy Testing
Non-Allergic Rhinitis
See Rhinitis Causes
Perennial symptoms
Post-nasal drainage
Erythematous nasal mucosa
Irritant exposure and negative Allergy Testing

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]

Journal Watch is the primary care physician´s first source for the latest research and guidelines that affect patient care.


University of Oxford
Department of Primary Health Care
Обзор журналов
[Ссылки доступны только зарегистрированным пользователям ]

[Наталья П.]

The Cochrane Primary Care field is producing 2 minimalistic (<200 words) structured summaries of Cochrane reviews every two weeks and sending them out by email. If you would like to see some examples called P.E.A.R.L.S (Practical Evidence About Real Life Situations) go to [Ссылки доступны только зарегистрированным пользователям ] and click on P.E.A.R.L.S



If you wish to Subscribe to P.E.A.R.L.S go to (there is no cost)

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[Наталья П.]

Formed in 1971, Family Health International (FHI) is among the largest and most established nonprofit organizations active in international public health with a mission to improve lives worldwide through research, education, and services in family health.
[Ссылки доступны только зарегистрированным пользователям ]

FHI's Focus on Youth
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Worldwide, young women and men suffer a disproportionate share of unplanned pregnancies, sexually transmitted infections (STIs), including HIV, and other serious reproductive health problems. Family Health International (FHI) works with partner organizations worldwide to address persistent challenges that influence the health conditions and quality of services available to youth.

[Наталья П.]

[Ссылки доступны только зарегистрированным пользователям ]
Clinical Knowledge Summaries

practical, reliable, evidence-based, a central resource for the National Library for Health.

A source of clinical knowledge for the NHS about the common conditions managed in primary and first contact care.

Practical and reliable, it helps healthcare professionals confidently make evidence-based decisions about the healthcare of their patients and provides the know-how to safely put these decisions into action.

[Наталья П.]

Будущее направление развития общей врачебной практики – Дорожная карта
(The Future Direction of General Practice - A roadmap) (2007) (на англ.яз)

Автор:
Королевский колледж врачей общей практики, Лондон (Великобритания)

Опубликованный в октябре 2007 г., доклад под названием “Будущее направление развития общей врачебной практики – Дорожная карта” дает представление о медицинском обслуживании пациентов в системе первичной помощи 21-го века. Показано, что первичная помощь способна использовать значимые клинические достижения и обращаться к решению вопросов неравенства в здравоохранении и доступа к медицинскому обслуживанию.

Имеется в режиме online в формате [84 стр.]

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[Наталья П.]

10 наиболее популярных среди семейных врачей статей, которые они просматривали на сайте Medscape в 2007 году
(доступ на Medscape требует бесплатной регистрации)



1 Applying New NIH Guidelines for Pediatric Asthma: An Infant Who Has Failed Previous Asthma Therapy
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2 AAP Recommends Autism Screening for All Infants
[Ссылки доступны только зарегистрированным пользователям ]

3 Guidelines Updated for Adult Immunization Schedule
[Ссылки доступны только зарегистрированным пользователям ]

4 Zinc and Its Uses
[Ссылки доступны только зарегистрированным пользователям ]

5 Hormone Therapy Safer in Younger Women? A Best Evidence Review
[Ссылки доступны только зарегистрированным пользователям ]

6 Raising High-Density Lipoprotein Cholesterol: What Are We Learning From the Torcetrapib Experience?
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7 Examining the Ears, Nose, and Oral Cavity in the Older Patient
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8 AHA Updates Recommendations for Antibiotic Prophylaxis for Dental Procedures
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9 Primary Care Practice for Acute Otitis Media May Differ From Guidelines
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10 Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: AHRQ Executive Summary
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[Наталья П.]

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CDC Travelers' Health site
Информация для путешественников и медицинских работников для принятия решения о вакцинации, лекарственных препаратах и других мер, необходимых для предотвращеня заболеваний и повреждений во время международных путешествий.
Можно выбрать страну.