Views of patients about sickle cell disease management in primary care: a questionnaire-based pilot study.

OBJECTIVES: To determine how patients with sickle cell disease (SCD) perceive the quality of care that they receive from their primary healthcare providers. DESIGN: A questionnaire-based pilot study was used to elicit the views of patients about the quality of care they have been receiving from their primary healthcare providers and what they thought was the role of primary care in SCD management. SETTING: Sickle Cell Society and Sickle Cell and Thalassaemia Centre, in the London Borough of Brent. PARTICIPANTS: One hundred questionnaires were distributed to potential participants with SCD between November 2010 and July 2011 of which 40 participants responded. MAIN OUTCOME MEASURES: Analysis of 40 patient questionnaires collected over a nine-month period. RESULTS: Most patients are generally not satisfied with the quality of care that they are receiving from their primary healthcare providers for SCD. Most do not make use of general practitioner (GP) services for management of their SCD. Collecting prescriptions was the reason most cited for visiting the GP. CONCLUSION: GPs could help improve the day-to-day management of patients with SCD. This could be facilitated by local quality improvement schemes in areas with high disease prevalence. The results of the survey have been used to help develop a GP education intervention and a local enhanced service to support primary healthcare clinicians with SCDs ongoing management

Patients' views on improving sickle cell disease management in primary care: focus group discussion.

OBJECTIVES: To assess sickle cell disease (SCD) patient and carer perspectives on the primary care services related to SCD that they receive from their general practitioner (GP). DESIGN: A focus group discussion was used to elicit the views of patients about the quality of care they receive from their primary health-care providers and what they thought was the role of primary care in SCD management. The focus group discussion was video recorded. The recording was then examined by the project team and recurring themes were identified. A comparison was made with notes made by two scribes also present at the discussion. SETTING: Sickle Cell Society in Brent, UK. PARTICIPANTS: Ten participants with SCD or caring for someone with SCD from Northwest London, UK. MAIN OUTCOME MEASURES: Patients perceptions about the primary care services they received, and a list of key themes and suggestions. RESULTS: Patients and carers often bypassed GPs for acute problems but felt that GPs had an important role to play around repeat prescriptions and general health care. These service users believed SCD is often ignored and deemed unimportant by GPs. CONCLUSION: Participants wanted the health service to support primary health-care providers to improve their knowledge and understanding of SCD. Key themes and suggestions from this focus group have been used to help develop an educational intervention for general practice services that will be used to improve SCD management in primary care

Efeito da aplicação de ácido giberélico no crescimento da palmeira-ráfia Effect of gibbeerllic acid application on lady palm growth

A palmeira-ráfia possui grande importância econômica devido ao seu interesse comercial. É uma planta ornamental muito apreciada por sua beleza e utilização em ambiente interno, crescendo bem em locais com sombra e apresentando resistência à exposição solar. O valor econômico dessa planta está relacionado à altura e número de hastes. O objetivo do trabalho foi promover o crescimento da planta, através da aplicação do regulador de crescimento ácido giberélico (GA3). Mudas de palmeira-ráfia com aproximadamente um ano de idade foram aspergidas a cada 21 dias (quatro aplicações) com solução de ácido giberélico nas concentrações de 0; 75; 150; 225; e 300 mg.L-1. Os resultados indicaram que a aplicação do ácido giberélico foi eficiente na promoção do crescimento da espécie, sendo esse incremento significativo nas variáveis: comprimento dos pecíolos, lâminas foliares e altura da planta. Não se observou diferença no acúmulo de matéria seca ou fresca do pecíolo entre os tratamentos, e plantas do tratamento-controle foram superiores às dos tratamentos 225 e 300 mg L-1, nas variáveis diâmetro do colo e massa fresca e seca das raízes. Devido ao incremento na altura das mudas e à alteração da disposição das folhas da palmeira, a utilização do ácido giberélico pode ser recomendada para a produção de mudas de alta qualidade.<br>Lady Palm is of great economic importance due its commercial interest. It is an ornamental plant growing in shadowy places, resistant to sun exposure and very appreciated for its beauty and ornamental value. Its commercial value is associated to plant height and shoot number. The aim of this work was to stimulate lady palm growth by applying the plant growth regulator gibberellic acid. Plantlets of R. excelsa approximately one year old were sprayed every 21 days (4 applications) with gibberellic acid solution at concentrations of 0; 75; 150; 225 and 300 mg L-1. The results showed that gibberellic acid was efficient in promoting the growth of the species and was statistically significant for petioles, leaf length and plant height. Petiole dry and fresh mass did not show any significant difference between treatments for stem diameter, with root dry and fresh mass having a higher value for the control than for the 225 and 300 mg L-1 treatments. Due to the higher height and leaf architecture changes observed, gibberellic acid can be used as a tool to stimulate Lady Palm growth, adding commercial value to the plantlets

Nutrição mineral de mudas de pupunheira sob diferentes níveis de salinidade Mineral nutrition of peach palm seedlings under different salinity levels

O potencial produtivo das plantas pode ser afetado por desordens nutricionais, induzidas pelo estresse salino. O objetivo deste trabalho foi estudar a influência de diferentes níveis de salinidade na nutrição mineral de mudas de pupunheira (Bactris gasipaes H.B.K.), mediante o uso de solução nutritiva, em casa de vegetação. O experimento foi instalado em blocos ao acaso, com sete tratamentos e quatro repetições. Os tratamentos constaram das seguintes doses (mmol L-1): 0,0 de Na e 0,5 de Cl; 1,0 de Na e 0,5 de Cl (controle); e 5,0, 15,0, 30,0, 60,0 e 120,0 de NaCl. Os teores dos macronutrientes variaram em razão da salinidade, e verificou-se que o P e K apresentaram seus teores reduzidos nas raízes, o K e o Ca, nas folhas e o S, nas diferentes partes, enquanto o Na e o Cl apresentaram teores incrementados nas diferentes partes da planta. As relações Na/K, Na/Ca, Na/Mg, Cl/N, Cl/P e Cl/S aumentaram, causando um desbalanço nutricional na planta.<br>The productive potential of plants may be affected by nutritional disorders induced by saline stress. The objective was to study the influence of different salinity levels on mineral nutrition of peach palm (Bactris gasipaes H.B.K.) seedlings in greenhouse conditions with nutritive solution. The experimental design was in randomized blocks, with seven treatments and four replications. The treatments consisted of the following dosages (mmol L-1): 0.0 of Na and 0.5 of Cl; 1.0 of Na and 0.5 of Cl (control); and 5.0, 15.0, 30.0, 60.0 and 120.0 of NaCl. The content of the macronutrients varied with the salinity, there was reduction of P and K in the roots, K and Ca in the leaves, and S in different parts of the plants. Therefore, there was increase of Na and Cl in different parts of the plant. The enhancement of the ratios Na/K, Na/Ca, Na/Mg, Cl/N, Cl/P and Cl/S induced a nutritional imbalance in the plant