Single feature polymorphism discovery using the wheat Affymetrix Gene Chip

PURPOSE: To determine how often medical students are not allowed to perform gynecological examinations during their obstetrics-gynecology clerkship, identify the barriers to participation related to physicians and patients, explore the role of the supervisory physician in not allowing medical student involvement, and explore differences between male and female students' experiences. METHOD: All medical students entering their obstetrics-gynecology clerkship at a medical school in the Netherlands between May and October 2011 were invited to participate in this study's questionnaire, which asked them to report the number of gynecological examinations they were allowed and not allowed to perform during their clerkship. Eighteen questionnaire respondents participated in three focus groups. RESULTS: Of the 139 medical students invited, 76 (55%) completed the questionnaire. Students reported a total of 2,196 instances in which they were not allowed to participate in the examination; 89% (n = 1,956) were related to the supervisory physician. Qualitative data from the focus group interviews showed that female supervisory physicians prioritized patients' autonomy above students' learning needs. Furthermore, female students were less assertive than male students in asking the supervisory physician for permission to participate. CONCLUSIONS: The physician's role in not allowing student involvement is substantial and results in fewer opportunities for students to perform gynecological examinations. For students to develop the necessary gynecological exam skills during their clerkship, medical educators need to improve the learning environment

Calendar 2009

BACKGROUND: Given the increase in skin cancer (SC) it seems inevitable that general practitioners (GPs) will play a larger role in SC care in the near future. OBJECTIVES: To obtain insights into the opinion of GPs with respect to their role in SC care, and their SC knowledge and skills. METHODS: A self-administered questionnaire was sent to GPs in the region of Nijmegen, the Netherlands. RESULTS: In total 268 GPs (49%) responded. An overwhelming majority were willing to extend their role in SC care. Furthermore, we noted the following results: (i) > 50% of GPs requested additional SC knowledge; (ii) GPs often treat actinic keratosis (AK) themselves, primarily with cryotherapy; (iii) > 50% would treat (low-risk) basal cell carcinoma (BCC) after additional training; (iv) only a few GPs are familiar with BCC guidelines; (v) the majority of patients with high-risk SC are referred to dermatologists; (vi) only a few GPs perform total body inspection and palpation of lymph nodes; and (vii) a large number of GPs inform their patients on risk factors in SC development. CONCLUSIONS: Most GPs are willing to extend their role in SC care; however, more training is requested and the usage of guidelines should be encouraged. Those willing to extend their role should focus on improving their clinical diagnosis of skin tumours, treatment of low-risk skin (pre)malignancies, including field-directed treatment of AK and noninvasive treatment of BCC, and on prevention

Perceptions of labour pain management of Dutch primary care midwives : a focus group study

Background: Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour. Methods: We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management. Results: We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role. Conclusion: Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity

Angst voor vernieuwde Transgenderwet is ongegrond

Het argument dat de vernieuwde Transgenderwet seksueel geweld tegen vrouwen in de hand werkt, berust op empirisch aantoonbare misvattingen. Vier gerenommeerde wetenschappers leggen het uit

Gender sensitivity among general practitioners: Results of a training programme

Contains fulltext : 70167.pdf (publisher's version ) (Open Access)BACKGROUND: Gender differences contribute to patients' health and illness. However in current healthcare practices attention to gender differences is still underdeveloped. Recognizing these differences and taking them into account can improve the quality of care. In this study we aimed to investigate whether GPs' gender sensitivity can be stimulated by a training programme. The focus was on three diseases: angina pectoris, depression and urinary incontinence. METHODS: This study had a quantitative, explorative and descriptive design. By means of a training programme 18 GPs were trained to focus on gender-sensitive recommendations for the three diseases. With standardised registration forms, data were collected during a 6-month period. During the registration period, the GPs were visited by the study team to discuss the process of data collection. RESULTS: The GPs filled in registration forms for 100 patients: 39 with angina pectoris (31 women and 8 men), 40 with depression (26 women and 14 men), and 21 with urinary incontinence (20 women and 1 man). The results show that gender sensitivity can be stimulated among trained professionals. The combination of the training programme, clear and practical recommendations, daily discussion of relevant cases between the GP couples, feedback and support during registration by the study team probably contributed to the outcome. CONCLUSION: GPs' gender sensitivity was stimulated by the training programme and the supporting visits. Ideally, structural attention could be realised by embedding gender issues in existing organisational structures of general practices

How GPs value guidelines applied to patients with multimorbidity: A qualitative study

Objectives: To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles. Design: Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached. Setting: Primary care, eastern part of The Netherlands. Participants: Dutch GPs, heterogeneous in age, sex and academic involvement. Results: 25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients’ personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs’ extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their ‘common sense’ to respond to the perceived shortcomings. Conclusions: GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in guideline reporting are necessary to enhance the applicability of guidelines in patients with multimorbidity

Exploring the impact of chronic obstructive pulmonary disease (COPD) on diabetes control in diabetes patients: a prospective observational study in general practice

Background:Little is known about the association between COPD and diabetes control parameters.Aims:To explore the association between comorbid COPD and longitudinal glycaemic control (HbA 1C) and systolic blood pressure (SBP) in a primary care cohort of diabetes patients.Methods:This is a prospective cohort study of type 2 diabetes patients in the Netherlands. In a mixed model analysis, we tested differences in the 5-year longitudinal development of HbA 1C and SBP according to COPD comorbidity (present/absent). We corrected for relevant covariates. In subgroup effect analyses, we tested whether potential differences between diabetes patients with/without COPD were modified by age, sex, socio-economic status (SES) and body mass index (BMI).Results:We analysed 610 diabetes patients. A total of 63 patients (10.3%) had comorbid COPD. The presence of COPD was not significantly associated with the longitudinal development of HbA 1C (P=0.54) or SBP (P=0.33), but subgroup effect analyses showed significant effect modification by SES (P<0.01) and BMI (P=0.03) on SBP. Diabetes patients without COPD had a flat SBP trend over time, with higher values in patients with a high BMI. For diabetes patients with COPD, SBP gradually increased over time in the middle-And high-SES groups, and it decreased over time in those in the low-SES group.Conclusions:The longitudinal development of HbA 1C was not significantly associated with comorbid COPD in diabetes patients. The course of SBP in diabetes patients with COPD is significantly associated with SES (not BMI) in contrast to those without COPD. Comorbid COPD was associated with longitudinal diabetes control parameters, but it has complex interactions with other patient characteristics. Further research is needed