Late-life depression : issues for the general practitioner

Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo-pituitary-adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD

Documentary sources for the history of the Maltese general practitioner

The history of the Maltese General Practitioner (GP) remains to be written. Such history will enhance the identity of the family doctor and prove indispensable to characterise the Maltese context of practice. To list some of the resources available for the study of the history of the Maltese GP and use it to provide an overview of relevant material for the pre-seventeenth- century period. Over the past ten years, note was made of the material and literature encountered that could be of relevance to Maltese medical history in general and that of the Maltese GP in particular. Further information was obtained by consulting the references and other information provided by these works. These sources were categorized. As a case study, information on community medical services preceding 1600 AD was collected to come up with an account that goes beyond a strictly chronological overview, giving particular attention to other details such as training, remuneration, political involvement as well as gender and social issues. Evidence has been presented for fifteenth century community health services in Gozo and Mdina. In the following century, such service spread to a number of villages in Malta, financed by institutions or private individuals.peer-reviewe

General practitioner understanding of abbreviations used in hospital discharge letters

Determines the incidence of abbreviation use in electronic hospital discharge letters (eDLs) and general practitioner understanding of abbreviations used in eDLs. Abstract Objectives: To determine the incidence of abbreviation use in electronic hospital discharge letters (eDLs) and general practitioner understanding of abbreviations used in eDLs. Design, setting and participants: Retrospective audit of abbreviation use in 200 sequential eDLs was conducted at Nepean Hospital, Sydney, a tertiary referral centre, from 18 December to 31 December 2012. The 15 most commonly used abbreviations and five clinically important abbreviations were identified from the audit. A survey questionnaire using these abbreviations in context was then mailed to 240 GPs in the area covered by the Nepean Blue Mountains Local Health District to determine their understanding of these abbreviations. Main outcome measures: Number of abbreviations and frequency of their use in eDLs, and GPs’ understanding of abbreviations used in the survey. Results: 321 abbreviations were identified in the eDL audit; 48.6% were used only once. Fifty five per cent of GPs (132) responded to the survey. No individual abbreviation was correctly interpreted by all GPs. Six abbreviations were misinterpreted by more than a quarter of GPs. These were SNT (soft non-tender), TTE (transthoracic echocardiogram), EST (exercise stress test), NKDA (no known drug allergies), CTPA (computed tomography pulmonary angiogram), ORIF (open reduction and internal fixation). These abbreviations were interpreted incorrectly by 47.0% (62), 33.3% (44), 33.3% (44) 32.6% (43), 31.1% (41) and 28.0% (37) of GPs, respectively. Conclusion: Abbreviations used in hospital eDLs are not well understood by the GPs who receive them. This has potential to adversely affect patient care in the transition from hospital to community care

Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands

Outlines efforts to enhance primary care quality and access, including postgraduate training for family physicians, general practitioner accreditation, greater use of nurse practitioners, and after-hours care; their outcomes; and insights for U.S. reform

California Physician Facts and Figures

Examines trends in the state's supply of primary care physicians, including demographics, specialties, and education and training; acceptance of new patients by coverage type; family and general practitioner compensation; and medical group enrollment

Content Analysis of General Practitioner Requested Lumbar Spine X-ray Reports

Aims and Background X-rays of patients with low back pain rarely show serious pathology but frequently reveal incidental age-related changes and always expose people to radiation. Patients who have X-rays are more satisfied but report worse pain and disability. Psychological factors such as illness beliefs,catastrophizing and fear avoidance have been shown to be predictors of chronicity/disability. Authorities suggest that the way X-ray information is transmitted and interpreted by patients may influence outcome, therefore this study was designed to determine the words used by radiologists to describe lumbar spine Xrays. Methods: 120 consecutive X-ray reports for patients referred by primary care physicians were anonymised. A formal summative content analysis was undertaken. The coded words were grouped into categories according to their perceived meaning, and the process was refined until there were only three mutually exclusive categories. Results: Half the sample was aged 60 years or younger. Three categories were identified: anatomical, pathological and descriptive. In the pathological category, 33% of words described normal appearances, 47% described age-related changes and 20% described other features. In only 2% of cases were pathological words used to describe conditions as being "normal for age". Overall, 89 (74%) of the 120 reports contained at least one phrase containing words indicating the presence of degenerative changes. Conclusions: Almost three-quarters of lumbar spine X-ray reports use pathological words such as 'degenerative changes' to describe age-related changes but rarely describe them as being "normal for age"

Geometric Time and Causal Time in Relativistic Lagrangian Mechanics

In this article, we argue that two distinct types of time should be taken into account in relativistic physics: a geometric time, which emanates from the structure of spacetime and its metrics, and a causal time, indicating the flow from the past to the future. A particularity of causal times is that its values have no intrinsic meaning, as their evolution alone is meaningful. In the context of relativistic Lagrangian mechanics, causal times corresponds to admissible parameterizations of paths, and we show that in order for a langragian to not depend on any particular causal time (as its values have no intrinsic meaning), it has to be homogeneous in its velocity argument. We illustrate this property with the example of a free particle in a potential. Then, using a geometric Lagrangian (i.e. a parameterization independent Lagrangian which is also manifestly covariant), we introduce the notion of ageodesicity of a path which measures to what extent a path is far from being a geodesic, and show how the notion can be used in the twin paradox to differentiate the paths followed by the two twins