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Purpose: Patients presenting with multiple problems during a single general practice consultation have been anecdotally referred to as ‘shopping list patients’. The aims of this study were to explore the factors that could help general practitioners develop effective strategies to manage these patients. Methods: This is a questionnaire based study with a total sample size of (n=66). The study timeframe was July 2012 to Jan 2013 and the response rate was 82.5%. Results: Irrespective of age or gender, most patients admitted to presenting to the GP with multiple problems approximately 30% of the time. Lack of timely access to GP appointments was the main reason cited by the majority of patients for presenting with multiple problems. Conclusions: Improving access to GP appointments would reduce patients presenting with multiple problems during a single consultation. The reasons and explanations should be patient centered. The findings from the research above may facilitate GP’s to increase levels of patient/GP satisfaction and safety, optimize rapport, reduce complaints, help to manage time more effectively (reduce late running of appointments) and increase practice productivity.

Purpose The length of the average General Practice (GP) consultation is increasing. In 1990 the average length was 8.33 minutes but by 2003 the median consultation length had increased to 13.3 minutes. The aims of this study were to explore patient’s perceptions of the length of the general practice consultation. Methods This is a questionnaire based study with a total sample size of (n=66). The study timeframe was July 2012 to Jan 2013 and the response rate was 82.5%. The study was conducted at a single six-partner GP training practice with a list size of approximately 13000 patients. Results The majority of patients thought that the consultation length was ten minutes. Approximately two thirds of patients did not wish for any changes to be made to the length of their GP consultations. Approximately one third of patients indicated that they would like the average length of the consultation to be longer Conclusions This research suggests that the majority of patients are happy with the length of their GP consultations and do not wish for any change. Perhaps it is the time taken to document the clinical encounter and ‘house-keeping’ duties which are responsible for the late-running of appointments rather than the face to face time spent with the patient? The patient’s satisfaction with the length of the consultation suggests that they are happy with the prioritization and time-management skills of their GPs.

With scientific advances in medical sciences over the years many new diagnostic as well as treatment modalities are developed with many patients getting quality of life which was not available before. On the other hand it is also observed that with advances in medical sciences the patient care is becoming more and more specialized and many new super specialty services coming up. As result of such fragmented medical services, it is not uncommon for patients to see several specialists who do not communicate with each other. One consequence of this is that the patient becomes a victim of the "findings of examinations" and the side effects [1]. There are few question related to it, first is , how may patient actually need super specialty services and second is whether general practitioners also known as family physician or family doctors, can take care many patient which are needlessly referred to more specialized services.

Demonetarization of currency notes of five hundred rupees and thousand rupees denominations is hailed because of surgical strike against black money, terrorist funding and also corruption. On the comparative lines the Government of India has introduced Jan Aushadhi scheme to give jolt to the uncontrolled medicine prices across all therapeutic category of medicines in India. Although brand medicines in India appear cheap when compared with international prices, however the brand medicines in India are expensive in comparison with generic medicines. The brand medicines despite being expensive are preferred over generic medicines by the prescribers due to exhaustive marketing practices by the manufactures. Although generic medicines are available at affordable prices they are not preferred over brand medicines. The price sensitivity for medicine appears to be very low. Generic medicines are less popular for various reasons, primarily due to marketing techniques of luring the prescribers brand medicines. The medicine prices are bound to get down to the ground levels when enactment of Jan Aushadhi Act is implemented in true spirit with a strong political will.

Background: Epistaxis is common clinical presentation to the emergency department. Initial management in mild anterior epistaxis involves manual compression of the anterior aspect of the nose. However, this step is often not done appropriately. Objective: The purpose of this article is to discuss the benefits of applying nose clips in the management of epistaxis. It can be a simple alternative to providing adequate digital compression in initial management of epistaxis. Discussion: Swimmer’s clips have been previously described in the literature for the management of mild epistaxis. The nose clip described in this article is initially designed for spirometry. This clip is user-friendly, affordable and can be easily applied to provide temporary tamponade.

Aim: To conduct a national survey for the First5 GPs and GP trainees to see what their future career plans are, and their views on the current issues in general practice, on a background of significant workforce problems in general practice. Method: Survey monkey was used to create an online survey that was distributed with the help of RCGP in their AiT bulletin and through their social media accounts. The links were also posted on several GP Facebook groups, Twitter and LinkedIn accounts. The survey ran between 5th of October and the 31st of October 2015. Results: 322 and 249 responses were received from First5 GPs and GP trainees respectively, just over 60% of First5 GPs and 68% of GP trainees are either definitely or possibly considering a move abroad where they feel there is a better outlook for general practice. The most popular destinations were Australia, Canada and New Zealand, a significant proportion are not considering a return to the UK. The main reasons given for early retirement were workload, job related stress, current government health care policies, working long hours, administrative work, high patient demand and risk of litigation. A majority of First5 GPs and GP trainees do not feel 7 day access to general practice is a good idea, they think the future of general practice in the UK is looking bleak and that the NHS is heading towards privatization, which the majority are against. Only about 18% of trainees would still apply for GPVTS even if 7 day GP access working was in place, 34% would consider other careers and 47% would not recommend general practice to juniors. Conclusion: Government policies, patient demands, unsustainable workload and low morale are contributing to GP trainees and newly qualified GPs in significant numbers thinking about leaving the UK general practice permanently, and changing career or retiring early. They are also less likely to recommend a career in general practice. There may need to be an urgent revie

Symptom relief is a commendable goal but no proof that a drug corrects anything. Aspirin can often relieve fever and pain, but it does not treat the causes. Medicines prescribed to treat organic diseases — such insulin for diabetes and digitalis for heart failure — have measurable effects that can and must be monitored. Hundreds of syndromes in the Diagnostic and Statistical Manual only confuse any search for cure, but they give symptoms the appearance of ‘recognized medical disorders’. That allows the pharmaceutical industry to advertise psychoactive drugs — analgesics, stimulants, and sedatives — as if they were medicine. Psychoactive drugs are notoriously addictive, which tends to build life-time customers. That is unfortunate for the wide use of drugs, especially stimulants, may contribute to violence.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States [1]. COPD is a complex disease for which the cause and cure remain elusive. Conventional treatments for COPD have traditionally included medications and surgery. However, these conventional therapies have limitations and have been insufficient to reliably cease disease progression or improve the patient’s quality of life in a meaningful way [2]. Complementary therapies, such as yoga, mindfulness, and tai chi, have emerged that may show promising innovations for improving COPD patient care; however, there is a paucity of studies to demonstrate clinical efficacy. Initial research on complementary therapies has revealed hope that these innovative approaches may help alleviate symptoms, improve quality of life, and reduce depression and anxiety in people with COPD [3]. While there is a growing body of research surrounding complementary therapies for COPD, the weight of the evidence remains limited.

Background: First aid is a simple step that done outside the hospital setting to save someone’s life or prevent condition from worsening until arrival of health care providers. Objective: Assess awareness about first aid knowledge among the female students of health science colleges before and after awareness presentation. Methodology: A cross-sectional study was done among the female students of health science colleges through pre- and post– awareness assessments. Thirteen selected multiple choice questions about various emergency accidents were included in the questionnaire. The awareness presentation contained how to deal with the various emergency accidents was sent to the students via email and the comparison before and after the awareness presentation was analyzed. Results: A total of 110 female students participated in this study. Only, 58 students completed the answers of the questionnaire to compare between pre- and post- awareness with the response rate of 52.7%. There was a statistically significantly improvement in the best dealing with many situations such as checking for any hazards before doing first aid, loss of consciousness if victim can breathe or not, applying pressure in bleeding limb, supporting the fractured bone with a cushion, cooling the burn under cold water, putting the victim in safe place in convulsion and sit the patient and give him the medication in asthmatic attack. Conclusion: This study showed inadequate knowledge about first aid among the female students. Health science students at Taibah University need first aid training program in their curriculum to improve the basic skill about it.

Obstetric hemorrhage is a life-threatening complication which may occur without warning, predictive signs and symptoms, and even in absence of predisposing conditions. It is a major cause of maternal mortality and morbidity almost invariably among all human races. One of the most important strategies in the control of obstetric hemorrhage is hemostatic resuscitation. The speed with which obstetric hemorrhage occurs makes it lifethreatening, but thankfully, it can be successfully managed with blood transfusion protocol based management. Resuscitation of massive hemorrhage has shifted towards the earlier administration of higher doses of fresh frozen plasma (FFP) and reducing serious complications and mortality by limiting the conventional use of crystalloids and colloids. In this article, we explored the leading-edge strategy of use of fibrinogen concentrates, cryoprecipitates, Tranexamic acid and prothrombin complex concentrates, apart from fresh frozen plasma as a promising alternative for obstetric resuscitation and for minimizing the risks and complications of obstetric hemorrhage.

Isolated left ventricular apical hypoplasia (LVAH) is a newly recognized, rare cardiomyopathy which was first described in 2004. Until now, only 20 English-language literatures in relationship with Isolated LVAH were collected from PubMed by the author of this article. We report a case of 50-year-old man by health-examination without any symptom as this patient was first diagnosed in our hospital. This article includes two parts: case report and literature review.

Objective: Constipation is the most common and often most debilitating adverse effect associated with opioid use. Opioid-induced constipation persists for the duration of therapy. The aims of this clinical audit were to investigate the GP management of opioid-induced constipation, gain insights on how to improve its management and determine if the audit could improve the management of opioid-induced constipation. Methods: Using quantitative questionnaires, GPs prospectively evaluated their management of constipation in patients prescribed strong opioid analgesic for chronic non-cancer pain, across two audit cycles. The audited patients completed a quantitative survey after the initial GP visit and returned the completed survey to the GP in a sealed envelope. The patient questionnaire was used to assess consistency between patients’ and GPs’ evaluation and management of constipation. Following each cycle GPs received feedback and a decision support tool. Results: Opioid-induced constipation was reported by 50.5% of patients, but its presence was underestimated by GPs, with GPs failing to recognise opioid-induced constipation in a third of patients. GP management of opioidinduced constipation improved during the audit with improvements in the frequency of assessment and the proactive management of constipation. Conclusion: GPs need to regularly ask all patients taking opioid analgesics about the presence of constipation. Questioning should include both objective and subjective measures to assist the detection and assessment of opioidinduced constipation. The high prevalence of opioid-induced constipation necessitates proactive management at the time of opioid initiation and for the duration of opioid therapy

If you’re a practicing physician in the U.S. like me, April 1 will probably feel no different than any other busy day involved in patient care. But April 1 will be no April fools this year. With its first mandated bundled payment initiative set to start on that date, the Centers for Medicare & Medicaid Services (CMS) has sent with it, the first big signal that hospitals and providers will increasingly be expected to assume financial risk for the healthcare utilization and outcomes of their patients for a period of time after discharge. Huge dollars are at stakes that are meant to incentivize reimbursement for patient outcomes rather than for the quantity of services provided. While our orthopedic colleagues and hospital administrators will be the first to feel these growing pains through CMS’ April 1 launch of the Comprehensive Care for Joint Replacement (CJR) initiative [1], this is a wakeup call to those of us across all other medical specialties. With new value-based programs set to launch under the Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS) of the Medicare Access and CHIP Reauthorization Act (MACRA) [2], CMS is driving a transition away from fee-for-service to value-based reimbursement at an incredible clip. Its goal is to have 30% of Medicare payments in alternative payment models by the end of 2016 and 50% by the end of 2018.

For the past two decades, Canada has been experiencing a decrease in the number of active physicians. Currently, the physician-topopulation ratio is 1:492, or 2.03 physicians per 1000 persons [1], in comparison to other OECD (Organization for Economic Co-operation and Development) countries, Canada has almost 1 less physician per 1000 people. Нis physician-to-population ratio then places Canada in the 26th ranking position out of 34 OECD nations [1]. In the past few years, the ratio began to increase faster. In the 1970s, Canada had an abundant number of physicians to serve the population; however, from the early to mid-1980s, the federal government decided to decrease medical school admissions and available training positions to curtail active physicians who would be available to the population. 6pecificall\, by the 1990s, a report to the Federal/Provincial/Territorial Conference of Deputy Ministers of Health recommended each province to decrease both medical school enrollment and professional training positions by 10% [1]. Also, the government has strict policies in accepting foreign doctors while they comprise about 24% of the current physician composition [1,2].

The role of pharmacological agents is quite minimal in treating PCOS. All the major gynecological societies have issued guidelines recommending only occassional use of progesterone to induce periods, maximum of up to three or four times in a year [3]. But contrary to the guidelines, around the world, millions of girls/women suffering from PCOS are being overloaded with COC (combined oral contraceptive pills) and insulin sensitizers like metformin, which has critical side effects [4,5]. New research on micro biomes and PCOS suggests deleterious effects from COC on the bacteria in the gut [6]. The safety of duration of metformin administration during pregnancy and its effectiveness is still not established [7].

Kingdome of Bahrain is island situated in the middle of the Gulf. The discovery of oil has led to the rapid modernization of the country and its prosperity. Such factors and other affected on the lifestyle of the population and the traditional societal role with the transformation from the large extended families to a nuclear one. One of many consequences of these changes was the increase prevalence of juvenile delinquency. In this study, there was a trial to study this phenomenon and find out the most risk factors that may help in its occurrence. The Parental Acceptance/Rejection Questionnaire, which has been translated into Arabic and was used previously with other Arab populations, was administered to a group of 30 jailed juvenile offenders and compared to a similar cohort and number of high school students with no record of delinquency. The variables, including areas related to the family conditions, were studied comparing the two groups (the delinquent vs. non-delinquent). The results indicate that there are relationships between juvenile delinquency and the parental demographic characteristics. More delinquent subjects had illiterate fathers (47%) (p

Thalassaemia instigates an enormous health problem all over the world, due to the palliative nature of life long treatment and the cost involved. The available preventive strategies are not simple and not universally acceptable. The concept of “safe marriage” proposed for thalassaemia prevention in Sri Lanka recommends to ensure that one partner in a couple be a non-carrier. Thereby the option of screening at least one of the partners becomes the minimal essential requirement for a safe marriage. The process of screening, counselling and decision on selecting partners is voluntary and health education programmes only promote this. However to establish such a practice in society, the wide spread practice of screening and counselling should be established. Stringent monitoring to evaluate and take remedial action in the programme would also be essential.

Muzamil Latief1, Waseem Raja2*, Manzoor Parry1 and Ravi Rao1 1Department of Internal Medicine, University Ambala, Maharishi Markandeshwar, Haryana 2Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Jammu & Kashmir, India *Corresponding author: Waseem Raja, Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Jammu & Kashmir, India, Tel: +918222800676; E-mail: drwaseem.mw@gmail.com

Background: Hidradenitis suppurativa (HS) is a chronic debilitating skin disease with a diagnostic delay of 7 years. The general practitioner (GP) is often the first physician consulted by the HS patients, and often provide the initial treatment. Early diagnosis by GP is of major importance and may help to better control the course of the disease. Aim: To describe GP’s recognition and management of HS. Methods: GPs in Belgium and Denmark were invited to complete a questionnaire constructed to describe general knowledge about HS. Results: 103 Belgian and 51 Danish participated. Demographic characteristics were similar in both groups. Danish GPs estimated the disease to be more common: 0%/21.6% Belgian/Danish GPs seeing more than 20 patients with HS per week and conversely 28.2%/3.9% seeing no patients with HS per week. Belgian GPs were less likely to consider HS a chronic disease than the Danish GPs (41.7%/84.3%), and antibiotics were more commonly associated with HS by Danish GPs (31.4% versus 3.9%). Interestingly, Belgian and Danish GPs consider HS as an inflammatory (respectively 44.7%/58.8%) but also as an infectious disease (respectively 62.1%/64.7%). Conclusions: The early diagnosis and a correct management is a crucial step to improve the prognosis of the disease. This pilot study has attempted to assess the general knowledge about HS of Belgian and Danish GPs. Important differences have appeared, suggesting a need for more information to facilitate the management of the patients. A multidisciplinary approach is suggested for the management of this often debilitating disease. Our pilot study evaluates for the first time the knowledge of GPs about Hidradenitis Suppurativa. Unfortunately the disease is often misdiagnosed and we have reported a mean diagnosis delay of 7 years. An early diagnosis by GPs could greatly improve the course and the management of the disease.

Background: A paucity of information exists in the literature that has seen a single study modeling macroeconomic indicators, murder and health indices (i.e., illness rate, health insurance coverage, health care utilization and mortality) in the English-speaking Caribbean. The current paper fills the gap in the literature. Objective: This paper examines how selected macroeconomic variables influence murder, mortality and illhealth. Methods: The data for this study are taken from publications of different governmental organizations, responsible for the collection of pertinent data for the government to carry out policy planning. Ordinary least square regression analyses were used to establish the model for 1) mortality, 2) murder and 3) ill-health. Results: There is a fluctuation of murder rates between the decades in the study period as evidenced by the fact that the average number of murders in Jamaica between 1969 and 1981 was 266. The following decade (1980-1989) saw an 85.3% increase, which subsequently saw a 43.4% reduction by the third decade of the study period (1990-1999). The last decade (2000-2009) saw a 93.5% increase in murders. For the studied period, there was a geometric progression in murders compared to a cyclical change in mortality. There was a strong correlation between murder and health insurance coverage (rs=0.960; P=0.0001), inflation (rs=-0.861; P=0.0001), exchange rate (rs=0.950; P=0.0001); a moderate relationship between mortality and health care utilization (rs=0.654; P=0.001) and no bivariate relationship existed between murder and illness (rs=-0.411, P=0.090). Conclusion: The reality is government should have a coherent policy in place to address these events, as every life lost through murder is important and represents a reduction in potential contribution to economic growth and development.

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