Bereavement care in primary care: a systematic literature review and narrative synthesis

Background

Over half a million people die in Britain each year and, on average, a GP will have 20 patients die annually. Bereavement is associated with significant morbidity and mortality, but the research evidence on which GPs and district nurses can base their practice is limited.

Aim

To review the existing literature concerning how GPs and district nurses think they should care for patients who are bereaved and how they do care for them.

Design

Systematic literature review.

Method

Searches of AMED, BNI, CINAHL, EMBASE, Medline and PsychInfo databases were undertaken, with citation searches of key papers and hand searches of two journals. Inclusion criteria were studies containing empirical data relating to adult bereavement care provided by GPs and district nurses. Information from data extraction forms were analysed using NVivo software, with a narrative synthesis of emergent themes.

Results

Eleven papers relating to GPs and two relating to district nurses were included. Both groups viewed bereavement care as an important and satisfying part of their work, for which they had received little training. They were anxious not to ‘medicalise’ normal grief. Home visits, telephone consultations, and condolence letters were all used in their support of bereaved people.

Conclusion

A small number of studies were identified, most of which were >10 years old, from single GP practices, or small in size and of limited quality. Although GPs and district nurses stated a preference to care for those who were bereaved in a proactive fashion, little is known of the extent to which this takes place in current practice, or the content of such care.     

应用同伴教育法对职业人群进行健康管理的研究

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《健康教育》社区实践教学效果探讨

目的 探索高职专科<健康教育>社区实践教学效果,为改革教学方法提供依据.方法 将95名护生随机分为对照班(47名)和实验班(48名),在<健康教育>实践教学中,对照班按常规教学计划实施实践教学,共8学时;实验班利用双休日到社区创建健康教育宣传板报、发放健康教育宣传资料、进行健康咨询、为居民义务体检和进行社会实践调查研究等社区实践教学,共24周.结果 <健康教育>考核成绩及综合能力自我评价,实验班显著优于对照班(均P<0.01);实验班93.75%～100%护生认为社区实践较常规教学更有利于提高健康教育技能和综合能力.结论 社区实践教学有利于提高<健康教育>教学质量,提升护生的综合素质.     

女性生殖道感染实验室检测结果分析

目的:探讨女性生殖道感染常见病原体分布和发病情况,为其防治提供依据。方法:对2007年1月至2008年12月在我院妇产科、皮肤性病科门诊就诊的1626例患者。即以阴道分泌物异常为主诉的患者,取阴道后穹窿及宫颈分泌物,进行有关病原体检测。结果:1626例中检测出病原体者722例,检出率44.40%。其中念珠菌感染检出率最高333例(46.12%),其次是解脲支原体213例(29.50%)。检出率最低的是淋球菌19例(2.63%)。结论:应加强女性生殖道感染的监测,根据检测结果进行针对性治疗。     

以案例导入为基础的教学法在医学微生物学教学中的应用

目前我国高等医学教育招生人数大幅增加,社会对医学人才的培养质量也提出了更高的标准,传统的教学方法已不能适应时代的需求。以案例导入为基础的教学法在保证完成教学任务的同时,对提高学生的综合素质,加强学生在教学中的角色起到了很好的效果。     

Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo

INTRODUCTION: Active case-finding programmes by mobile teams are the cornerstone of West African Human African Trypanosomiasis (HAT) control. Low attendance rates of screening and low uptake of treatment after diagnosis are major problems. The objectives of this survey were to explore community perception of HAT, to assess acceptability of control activities and to identify barriers amenable to intervention. METHODS: In September 2004, we conducted 33 focus group discussions with beneficiaries of the HAT control programme among various ethnic groups in two ecological settings (savannah and fluvial) of the Democratic Republic of Congo. RESULTS: The population had a very detailed knowledge and understanding of HAT transmission, utility of screening, symptoms and treatment. Melarsoprol treatment was feared for its side effects. The sudden death of previously asymptomatic people during treatment was attributed to witchcraft, to which one becomes more vulnerable when the diagnosis is disclosed in public. Lack of confidentiality was also a problem because HAT carries a stigma as a mental disease. Lumbar punctures, especially when performed in public, were disliked but less feared. Financial barriers were a major obstacle for many patients. CONCLUSION: Less toxic drugs, lowering financial barriers and improving confidentiality would have considerable impact on the participation in population screening for HAT.     

Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

OBJECTIVE: To compare the prevalence of dementia in two different time periods and two different studies. METHOD: Representative, random samples of the elderly (>65 years) in the Zaragoza Study or ZARADEMP-0 (n = 1080) completed the previous decade, and now in Wave I of the ZARADEMP Project or ZARADEMP-I (n = 3715) were interviewed. Standardized measures included the Geriatric Mental State and the History and Aetiology schedule. Cases of dementia were diagnosed according to DSM-IV criteria. RESULTS: Adjusted, global prevalence of dementia has not varied significantly: it was 5.2% (95% CI = 3.9-6.6) in ZARADEMP-0 and 3.9% (95% CI = 3.3-4.5) in ZARADEMP-I (prevalence ratio = 0.75; 95% CI = 0.56-1.02). However, the prevalence in ZARADEMP-I was significantly lower among men, particularly in all age groups between 70 and 84 years. CONCLUSION: Stability of the global prevalence of dementia in the elderly population has been documented. However, the decreased prevalence found in elderly men stimulated environmental hypotheses.     

Predictors of violent victimization amongst those with psychosis

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Can health workers diagnose dementia in the community?

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