Book Review: Primary Care Ethics

The original can be found at http://www.ijic.org/index.php/ijic/issue/view/27Primary Care Ethics is one of those books that healthcare professionals will share with their colleagues because it brings together a range of experiences that are often discussed informally with their peers, but rarely addressed in clinical training. It is not intended as a textbook of medical ethics, but rather a series of essays that are insightful, thought provoking, and informative in raising awareness of the complex issues we face in our practice, and application of theories and concepts in understanding our decision-making. Reading the chapters is like eavesdropping on an intelligent conversational debate among healthcare practitioners

The health of the aged in India

Because of declining fertility, the proportion of the aged in the Indian population has risen. Although the rise has been modest, as shown by an increase in the population over 60 years of age from 5.5 to 7.0 per cent between 1951 and 1995, by the latter date, India’s experience with 65 million people of this age is unusual. The paper employs data on persons 65+ years of age drawn from the 42nd Round of the National Sample Survey, and for the analysis subdivides them into three age groups, 60-64, 65-69 and 70+. It is shown that, among population over 60 years of age, 10 per cent suffer from impaired physical mobility and 10 per cent are hospitalized at any given time, both proportions rising with increasing age. Of the population over 70 years of age, more than 50 per cent suffer from one or more chronic conditions. The very limited support provided to the old by goverment is brought out by the fact that even in Karnataka, one of the states with the most generous provision, only 15 per cent of persons over 65 years of age receive any type of pension

Primary care ethics

No abstract available

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.<br /

AYURVEDIC MANAGEMENT OF SUBLINGUAL CYST (BLANDIN NUHN MUCOCELE) - A CASE REPORT

Ayurveda has enumerated so many Mukharaogas (diseases of the oral cavity).  Among these Jihwagata rogas (diseases of the tongue) were described separately.  Susruta and Vagbhata had mentioned five Jihwagata rogas.  Upajihwika told by Sushruta and Adhijihwa told by Vagbhata represent the cystic lesions on the ventral aspect of the tongue.  Western science describes a few diseases in which the patient presents with cystic swelling on the under surface of the tongue.  Blandin nuhn mucocele is one such disease.  Mucocele is a cystic lesion or a cavity filled with mucus. They are found on any mucosal surface where underlying accessory glands are present. Mucoceles are commonly found in the lower lip and are very rarely found on the tongue. Cystic lesions or mucoceles on the ventral aspect of the tongue are less frequent. Many modern treatment modalities as surgical excision, cryosurgery and electro-cautery are the only choice of treatment to completely remove the lesion and reduce the chances of occurrence. Herewith we report a case of Adhijihwa (Blandin Nuhn Mucocele) according to Ayurveda.  Ayurvedic internal medicines have provided promising results in reducing the cyst completely without causing any adverse effects within two months. Till this date there is no recurrence of the disease. Ayurvedic treatment helped in complete management without any surgical procedures.

Organisational developmental approaches in primary care

In their Stream Six report, Professors Dunbar and Reddy investigated the contribution of approaches to organisational change in optimising the primary healthcare workforce. Organisational Development (OD) could be thought of as facilitating change for human beings. This Stream Ten report is a story about change and therefore improvement in healthcare. OD forms part of the examples of change we describe. Other important components include use of electronic medical records and performance measurement.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy