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Danczak A.,Education and Research Center | Lea A.,Tameside and Glossop
Education for Primary Care | Year: 2014

Although study courses for AiTs commonly include sessions on the clinical evidence base and the consultation skills needed to manage uncertainty, there is little published about understanding AiTs' experiences of uncertainty and the coping strategies they currently use. This study explored in AiT focus groups the question 'what do you do when you don't know what to do?' Thematic analysis revealed that uncertainly was a common and difficult experience, occurring in a variety of clinical circumstances. We were able to identify both functional and dysfunctional strategies that trainees use in dealing with uncertainty. The resulting classification of uncertainty into the areas of analysing, negotiating, networking and team-working has implications for training, which are discussed. © 2014 Radcliffe Publishing Limited.

Meng J.,Beijing University of Chinese Medicine | Agrawal A.,Royal Infirmary | Whorwell P.J.,Education and Research Center
Nature Reviews Gastroenterology and Hepatology | Year: 2013

Patients with IBD who are apparently in remission - as indicated by normal blood tests, endoscopic findings and ultrasonography results - often continue to experience symptoms. Furthermore, despite these negative findings, there is a temptation to increase their anti-inflammatory medication in the hope that this approach would lead to some improvement. However, this strategy often seems to fail and can sometimes lead to adverse events. Consequently, when evidence of continuing inflammatory activity is lacking it might be appropriate to consider the possibility of co-existent IBS in these patients and to treat them for this condition. Dietary manipulation, antispasmodic agents, antidepressants (especially of the tricyclic variety) and even behavioural treatments might result in a worthwhile improvement of symptoms. © 2013 Macmillan Publishers Limited. All rights reserved.

Humphreys H.,Education and Research Center
The journal of the Royal College of Physicians of Edinburgh | Year: 2010

The increased interest in healthcare-associated infection (HCAI) among the public, patients and politicians has led to the development of potential new approaches to its prevention by industrial concerns and others. Such developments include better methods of assessing hospital hygiene, enhanced decontamination of the healthcare environment, biosynthetic tissue alternatives, antibiotic-impregnated medical devices and information technology that can help improve professional practice. Although promising, many of these have not been adequately evaluated in the clinical setting, highlighting the need for greater collaboration between industry and infection prevention and control practitioners to maximise the benefit of new products and to complement conventional approaches to HCAI prevention such as education, professional practice and the provision of better facilities.

Keefer L.,Mount Sinai School of Medicine | Drossman D.A.,University of North Carolina at Chapel Hill | Guthrie E.,Royal Infirmary | Simren M.,Gothenburg University | And 2 more authors.
Gastroenterology | Year: 2016

Centrally mediated abdominal pain syndrome, formerly known as functional abdominal pain syndrome, can be distinguished from other functional gastrointestinal disorders by its strong central component and relative independence from motility disturbances. Centrally mediated abdominal pain syndrome is a result of central sensitization with disinhibition of pain signals rather than increased peripheral afferent excitability. A newly described condition, narcotic bowel syndrome/opioid-induced gastrointestinal hyperalgesia, is characterized by the paradoxical development of, or increases in, abdominal pain associated with continuous or increasing dosages of opioids. Patients only have relief when opioids are withdrawn. We define both conditions in the context of epidemiology, pathophysiology, clinical evaluation, and treatment, emphasizing the importance of a physician-patient relationship in all aspects of care. © 2016 by the AGA Institute.

Brewer L.,Royal College of Surgeons in Ireland | Brewer L.,Education and Research Center | Bennett K.,St Jamess Hospital | McGreevy C.,Royal College of Surgeons in Ireland | Williams D.,Royal College of Surgeons in Ireland
European Journal of Clinical Pharmacology | Year: 2013

Purpose: Cholinesterase inhibitors and memantine are the mainstay of pharmacological intervention for the cognitive symptoms of Alzheimer's disease (AD). This study assessed the adequacy of dosing and persistence with AD medications and the predictors of these variables in the 'real world' (outside the clinical trial setting). Methods: The Health Service Executive-Primary Care Reimbursement Services prescription claims database in the Republic of Ireland contains prescription information for 1.6 million people. Patients aged >70 years who received at least two prescriptions for donepezil, rivastigmine, galantamine and memantine between January 2006 and December 2010 were included in the study. Rates of dose-maximisation were recorded by examining the initiation dose of each AD drug commenced during the study period and any subsequent dose titrations. Non-persistence was defined by a gap in prescribing of more than 63 consecutive days. Predictors of dose-maximisation and non-persistence were also analysed. Results: Between January 2006 and December 2010, 20,729 patients aged >70 years received a prescription for an AD medication. Despite most patients on donepezil and memantine receiving a prescription for the maximum drug dose, this dose was maintained for 2 consecutive months in only two-thirds of patients. Patients were significantly more likely to have their doses of donepezil and memantine maximised if prescribed in more recent years (2010 vs. 2007). Rates of non-persistence were 30.1 % at 6 months and 43.8 % at 12 months. Older age [75+ vs. <75 years; hazards ratio (HR) 1.16, 95 % confidence interval (CI) 1.06-1.27] and drug type (rivastigmine vs. donepezil; HR 1.15, 95 % CI 1.03-1.27) increased the risk of non-persistence. Non-persistence was lower for those commencing therapy in more recent years (2010 vs. 2007; HR 0.81, 95 % CI 0.73-0.89, p < 0.001) and for those on multiple anti-dementia medications (HR 0.59, 95 % CI 0.54-0.65, p < 0.001). Persistence was significantly higher when memantine was co-prescribed with donepezil (p < 0.0001). Conclusion: Future studies should explore the reasons underlying non-persistence and failure to maintain dose-maximisation in patients on AD medications. There may be scope to improve the dosing and persistence with these medications in the community. © 2013 Springer-Verlag Berlin Heidelberg.

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