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Wellington, New Zealand

Parmentier H.,General Practitioner | Garcia-Campayo J.,University of Zaragoza | Prieto R.,Pfizer
Current Medical Research and Opinion | Year: 2013

Objective: This review aims to summarize meta-analyses and other relevant data relating to the efficacy and safety of the various treatment options for generalized anxiety disorder (GAD) in Europe. In addition, it will provide an overview of the prevalence, burden, and recognition of the disorder, with a view to raise awareness of GAD and inform primary care practitioners. Research design and methods: Relevant research or review articles on psychological or pharmacological treatments for GAD published in the English language between March 2006 and March 2012 were identified via a literature search in PubMed and ISI Web of Knowledge and from the Cochrane Library. Other relevant references/clinical guidelines were individually selected by the authors. Results: Prevalence rates of GAD vary across Europe but its economic and social burden is increasing. A large proportion of patients with GAD present with symptoms in primary care. However, due to the disorder's complexity and the incidence of comorbid diseases, some primary care physicians may lack the knowledge or confidence to effectively recognize, manage, and/or treat the disorder. This is despite psychological and pharmacological treatments being available for the effective management of GAD. Conclusions: GAD remains a difficult disorder to detect and comorbid complications add to its economic and social burden. Early detection and intervention reduces the societal burden and improves GAD patients' quality of life and functional ability. Primary care practitioners play a key role in identifying and treating patients with GAD. © 2013 Informa UK Ltd All rights reserved. Source

Dupont C.,University of Paris Descartes | Campagne A.,General Practitioner | Constant F.,Nestle
Clinical Gastroenterology and Hepatology | Year: 2014

Background and Aims: Little is known about the effects of natural mineral water on constipation in adults. We assessed the effect of a magnesium sulfate-rich natural mineral water (Hépar; Nestlé Waters, Issy-les-Moulineaux, France) on gastrointestinal transit in constipated women. Methods: We performed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of Hépar in outpatients with functional constipation (based on the Rome III criteria). The study included 244 female patients, age 18 to 60 years, identified by 62 general practitioners throughout France. After a washout period, subjects drank 1.5 L natural low-mineral water daily (control, n= 77), 0.5 L Hépar and 1 L natural low-mineral water daily (Hépar 0.5 group, n=85), or 1 L Hépar and 0.5 L natural low-mineral water daily (Hépar 1 group, n= 82) for 4 weeks. We collected information on the number and types of stools, abdominal pain, rescue medications, adverse events, and volume of water consumed. Results: We observed no significant effect at week 1. At week 2, constipation was reduced in 21.1% of patients in the control group, in 30.9% in the Hépar 0.5 group (P= .099 vs controls), and in 37.5% in the Hépar 1 group (P= .013 vs controls). The Hépar 1 group also had a decreased number of hard or lumpy stools (Bristol scale, P= .030 vs baseline) and a substantial decrease in the use of rescue medication (P= .034 vs controls). Patient responses correlated with magnesium sulfate concentrations. Safety was very good; there were no serious adverse events among patients who drank Hépar. Conclusions: In a controlled trial, daily consumption of 1 L Hépar reduced constipation and hard or lumpy stools in a greater percentage of women with functional constipation than natural low-mineral water, as early as the second week of treatment. © 2014 AGA Institute. Source

Dey R.M.,University of Sydney | De Vries M.J.W.,General Practitioner | Bosnic-Anticevich S.,University of Sydney
International Journal of Pharmacy Practice | Year: 2011

Objectives The objective of this research was to gain deeper understanding of the expectations, experiences and perceptions of Australian general medication practitioners (GPs) and pharmacists around collaboration in chronic illness (asthma) management in the primary care setting. Methods A qualitative research methodology utilising a semi-structured interview guide, based on theory and an empirical approach, was used to fulfill the objectives of this study. Face-to-face interviews with pharmacists (n = 18) and GPs (n = 7) were recorded, transcribed and coded for concepts and themes. Relationships between concepts and themes were examined and used to describe the nature of collaborative relationships in the primary care setting. Key findings A relationship between GPs and pharmacists currently exists although there is minimal collaboration and there are several areas of practice and patient care in which the two professional groups are mismatched. At the same time, this research uncovered key aspects of the GP-pharmacist relationship, which could be used to develop more collaborative relationships in the future. The findings from this study were evaluated in light of the Collaborative Working Relationships model and published literature. Conclusions A model for the development of GP-pharmacist relationship has been postulated which articulates the dynamic nature of professional relationship in primary care and highlights a pathway to more collaborative practice. Future research should focus on further developing this model. © 2011 Royal Pharmaceutical Society. Source

Gruffydd-Jonesa K.,General Practitioner | Loveridgeb C.,Specialist Nurse
Primary Care Respiratory Journal | Year: 2011

The UK National Institute for Health and Clinical Excellence (NICE) has produced a 2010 partial update of its original 2004 Guidelines on COPD management. The definition of airflow obstruction has been altered to a post-bronchodilator FEV1/FVC ratio < 0.7 and the severity of airflow obstruction has been similarly aligned with the Global initiative for Obstructive Lung Disease (GOLD) guideline definition. However, patients with GOLD Stage 1 (i.e. FEV1 predicted > 80%) must be symptomatic for a diagnosis of COPD to be made under the new NICE criteria. Recent large scale trials have resulted in a new inhaled pharmacotherapy algorithm which includes early use of inhaled corticosteroid/long-acting β 2-agonist combination therapy for patients with an FEV1 < 50% predicted. In spite of an apparent emphasis on pharmacotherapy, both GOLD and NICE Guidelines emphasise that COPD is a multi-system disease requiring a multidimensional approach to treatment. In particular, the importance of smoking cessation and pulmonary rehabilitation is reiterated, the latter not only being of use in managing stable disease but also following hospital discharge. © 2011 Primary Care Respiratory Society UK. All rights reserved. Source

Ulmer A.,General Practitioner
Heroin Addiction and Related Clinical Problems | Year: 2016

Objective: In this paper the author introduces an evaluation of how good we actually are at treating patients. It could always be shown that patients receiving treatment with long-acting agonist opioid medications (LAAOMs) have a much better outcome than patients left untreated. But, compared with people who have no addiction disease, especially those with some other chronic illness, many patients receiving LAAOM treatment suffer, in fact, from a substantial difference in their quality of life. This comparison is the essential benchmark. Aim is a life that is as unimpaired by any illness as possible. Methods: The status of addiction patients has been documented regularly, through the use of a 15-step impression scale in our practice for >20 years. In this study we followed up by evaluating the average of all recorded ratings of 109 patients of whom we had especially detailed case histories and a development diagram based on these documentations. In addition, our evaluation was divided up into the first and second half of treatment, as well as including a review of the last three years to examine whether the treatment period had exerted an influence. Results: The average of all evaluations was 6.61 ± 2.0 on the 15-step scale, which was on the borderline between “better, but not good” and “not completely good”. The average difference between the average values recorded for the first and second halves was no more than 0.95 ± 1.7. There was no correlation with the length of therapy. No distinctive improvement emerged until the last three years, where the mean value was at 8.61 ± 2.1, 2.45 better than that recorded in the first half of treatment, and only 21.6% of the cases reviewed satisfied the criteria for the evaluation “not good”. Conclusion: The evaluation shows alarmingly bad treatment results, even in a practice that included individual patient guidance. A distinct improvement only emerged in the final years of treatment, after the optimization of several treatment measures. There is a considerable need for improvement in many forms of treatment with LAAOMs. © 2015,Pacini Editore S.p.A.. All rights reserved. Source

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