Three year evaluation of a programme by general practitioners to help patients to stop smoking

A controlled study was undertaken to measure the effectiveness of general practitioners' use of an intensive programme to help patients to stop smoking. Two hundred cigarette smokers who attended a general practice were allocated to either a treatment (n = 100) or a non-intervention control (n = 100) group. After the initial visit treatment consisted of an educational consultation and four follow up visits. Smoking state was assessed biochemically at six months and three years. Thirty five patients in the treatment group were abstinent at three years compared with eight in the control group (p less than 0.001). Sixty four patients attended the educational consultation and first follow up visit; of these, 45 were not smoking at the first follow up visit, 30 maintained abstinence up to six months, and 22 were still not smoking after three years. Among the 37 patients who completed the treatment programme and attended all the follow up visits 57% were abstinent at three years. The results of this study suggest that general practitioners can help patients to stop smoking.     

Participation of French general practitioners in end-of-life decisions for their hospitalised patients

BACKGROUND AND OBJECTIVE: Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs' role assigned to them by hospital doctors in making withdrawal decisions for such patients were surveyed. DESIGN: Questionnaire survey. SETTING: Urban (districts located near Paris) and rural (southern France) areas. PARTICIPANTS: GPs. RESULTS: The response rate was 32.2% (161/500), and it was observed that 70.8% of respondents believed that their participation in withdrawal decisions for their hospitalised patients was essential, whereas 42.1% believed that the hospital doctors were sufficiently skilled to make withdrawal decisions without input from the GPs. Most respondents were found to believe that they had the necessary skills (91.9%) and enough time (87.6%) to participate in withdrawal decisions. The last case of treatment withdrawal in hospital for one of their patients was described by 40% (65/161) of respondents, of whom only 40.0% (26/65) believed that they had participated actively in the decision process. The major factors in the multivariate analysis were the GP's strong belief that his or her participation was essential (p = 0.01), information on admission of the patient given to the GP by the hospital department (p = 0.007), rural practice (p = 0.03), visit to the patient dying in hospital (p = 0.02) and a request by the family to be kept informed about the patient (p = 0.003). CONCLUSION: Strong interest was evinced among GPs regarding end-of-life issues, as well as considerable experience of patients dying at home. As GPs are more closely corrected to patients' families, they may be a good choice for third-party intervention in making end-of-life decisions for hospitalised patients.     

Interaction between diabetic patients, their general practitioners and a hospital diabetic clinic

OBJECTIVE: The aim of this study was to examine the sociodemographic data of diabetic patients referred to our clinic and to correlate these with characteristics of their individual general practitioners. How these factors affect the interaction between patients, general practitioners and a hospital diabetic clinic was evaluated. DESIGN: Prospective recruitment of consecutive referrals. SETTING: The diabetic clinic of a teaching hospital located in the inner city suburbs of Sydney. PATIENTS: Two hundred and forty-six patients with diabetes (10% insulin dependent), aged 20-86 years, participating in our Shared Care Project, a randomised controlled study on various methods of following up diabetic patients. INTERVENTIONS: Data for the study were gathered by interview and questionnaire during first assessment at the clinic. MAIN OUTCOME MEASURES: Clinical and sociodemographic characteristics of patients; the location of general practitioners, their diagnostic equipment and type of practice; and the level of detail recorded in referral letters from general practitioners. RESULTS: Diabetic patients of migrant background who cannot speak English are older and have less formal education. They see their doctors more often and seek out general practitioners who speak their language, even if it means travelling longer distances. Patients referred from 24 hour medical centres are younger, more educated and have less contact with their doctors both in duration and frequency of visits when compared with patients whose general practitioners operate in conventional sole or partnership practices. Many patients have more than one general practitioner, making communication with hospitals difficult. In their referral letters, general practitioners usually concentrate on hypertension, hypercholesterolaemia and metabolic aspects of diabetes, but under-emphasise diabetic complications; they make insufficient use of measurement of the glycosylated haemoglobin level to assess diabetic control while over-using glucose tolerance testing in making the diagnosis. The referral letter often does not contain enough information to help clinical decision making. CONCLUSIONS: Demography of patients and characteristics of general practitioners are important factors which can affect their interaction with public hospitals. Bearing in mind the work load of general practitioners and the diverse nature of patients, hospitals must implement systems which make it easier for general practitioners and patients to interact with them.     

Tuberculosis and general practitioners

In spite of advancement of knowledge in diagnosis and management, tuberculosis is still the biggest health problem. There are more than 400 million people infected with tuberculous bacillus and more than 14 million cases are suffering from the disease. Prevention, control and care of tuberculosis are possible. General practitioners play a major role in combating the disease. Quick and right diagnosis and treating the cases effectively should be the motto. Sputum microscopy is the backbone of diagnosis of tuberculosis. With the availability of modern chemotherapy the outcome of a tuberculosis case has undergone dramatic changes. Short-course chemotherapy is the standard choice while tackling cases of tuberculosis. Results of directly observed treatment (DOT) strategy are very good provided execution is proper. HIV/AIDS, another dreaded disease if becomes co-infected along with tuberculosis, mortality and morbidity become very high. The general practitioners are the major strength of healthcare system in any society. They should be good enough to know all about the control programmes well implemented in the country.     

阿尔茨海默病和全科医师

阿尔茨海默病（Alzheimer disease,AD）是一类以大脑神经元淀粉样变性和神经原纤维缠结为病理特征的神经变性疾病,临床上以痴呆为主要表现.Alzheimer于1907年报告的是一名51岁的痴呆患者,因而有人将之纳入早老性痴呆.以后的研究发现,所谓“老年性痴呆（senile dementia”也呈现同样的病理变化.国际疾病分类第10版（ICD-10）将65岁以前发病者称为“AD,早发型”;65岁以后发病者为“AD,晚发型”.90%以上的AD为晚发型.如果没有特殊说明,一般文献中的AD指的都是晚发型.