Exploring the efficacy of replacing linear paper-based patient cases in problem-based learning with dynamic Web-based virtual patients: randomized controlled trial.

Background: Problem-based learning (PBL) is well established in medical education and beyond, and continues to be developed and explored. Challenges include how to connect the somewhat abstract nature of classroom-based PBL with clinical practice and how to maintain learner engagement in the process of PBL over time.

Objective: A study was conducted to investigate the efficacy of decision-PBL (D-PBL), a variant form of PBL that replaces linear PBL cases with virtual patients.

Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.

Background: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare.

Method: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN).

The replacement of 'paper' cases by interactive online virtual patients in problem-based learning.

St George's University of London (SGUL) has a Problem-Based Learning (PBL) curriculum for its undergraduate medicine course, using traditional paper-based patient cases. To counter the limitation that paper cases are linear and do not allow students to explore the consequences of decisions, interactive online virtual patients (VPs) were developed which allowed students to consider options as the cases unfold, and allow students to explore the consequences of their actions. A PBL module was converted to VPs, and delivered to 72 students in 10 tutorial groups, with 5 groups each week receiving VPs with options and consequences, and 5 groups receiving online VPs but without options.

What factors predict potentially inappropriate primary care prescribing in older people? Analysis of UK primary care patient record database.

Background: Potentially inappropriate prescribing (PIP) in older people has been identified as a substantial problem, but few large population-based studies have investigated the underlying factors that predict it.

Objective: To: (i) examine trends in PIP in UK older primary care patients; and (ii) assess factors associated with PIP.

Methods: An analysis of routine, anonymized, computerized patient records of 201 UK general practices providing data to the DIN-LINK database between 1996 and 2005, which included approximately 230 000 registered patients per year aged > or = 65 years.

The UK General Practice Airways Group (GPIAG): its formation, development, and influence on the management of asthma and other respiratory diseases over the last twenty years.

This article describes the formation and development of the UK General Practice Airways Group (GPIAG), from its inception as a small respiratory special-interest group founded by six general practitioners in 1987 through to its transformation into the largest primary care specialist society in the UK. It highlights the historical context in which the GPIAG was founded - at a time when there was increasing concern about under-treatment and under-diagnosis of asthma in primary care - and describes the way in which its foundation was one of the major influences that led to profound innovation in the primary care management of respiratory disease as well as changes across the primary/secondary care interface. The GPIAG is now a registered charity, has an expanding membership, and has acquired a high profile both nationally and internationally as an advisory body on policy and strategy for the management of respiratory disease in primary care.

Trends in potentially inappropriate prescribing amongst older UK primary care patients.

Purpose: To examine trends in UK primary care prescribing of medications potentially inappropriate for older people in the context of published international data.

Methods: Analysis of routinely collected anonymised computerised patient records in 131 UK general practices (approximately 162,000 registered patients annually aged >or=65 years) providing data to the DIN-LINK database between 1994 and 2003. In each year, we identified patients prescribed drugs classified by the 2003 Beers criteria as potentially inappropriate for older people.

Proto-professionalism and the dissecting laboratory.

This essay argues for medical students' dissection of cadavers because this activity offers medical students opportunities to have certain experiences and reflect on them in ways facilitating their development of mature medical professionalism at the time they enter clinical practice. Issues central to professionalism as we envision it are (1) cognitive abilities identified as reflective judgment and principled ethical reasoning as they are exercised in four practice domains and (2) learning to learn in medical settings. We argue further that a key feature of such setting is practitioners' having to deal with ill-structured problems, and so we identify their features and relate their management to the sophisticated cognitive and learning abilities required of medical professionals.

The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): a manual review of 500 medical records.

Background: We conducted a search of 12 practices' routinely collected computer data in three localities across the UK and found that 4.9% of the registered population had an estimated glomerular filtration rate (GFR) of <60 ml/min/1.73 m(2) (equivalent to stages 3-5 CKD).

Identifying patients with chronic kidney disease from general practice computer records.

Background: Chronic kidney disease (CKD) is an important predictor of end-stage renal disease, as well as a marker of increased mortality. The New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) project aimed to assess whether people with undiagnosed CKD who might benefit from early intervention could be identified from GP computer records.

Methods: The simplified Modification of Diet in Renal Disease (MDRD) equation was used to estimate glomerular filtration rate (GFR) and determine stage of CKD in patients from 12 practices in Surrey, Kent and Greater Manchester with SCr recorded in their notes.

Proto-professionalism: how professionalisation occurs across the continuum of medical education.

Introduction: Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training.

Thesis And Discussion: We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility.

Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling.

This study assessed psychological and social factors predicting 12-month changes in fruit and vegetable consumption achieved by 271 men and women from a low-income population randomized to brief behavioral and nutrition education counseling. Greater increases in fruit and vegetable intake were achieved in the behavioral than in the nutrition education condition (1.49 vs.

Does the effect of behavioral counseling on fruit and vegetable intake vary with stage of readiness to change?

Background: We have recently shown that brief behavioral counseling based on the stage of change (SOC) model stimulates greater increases in fruit and vegetable intake over 12 months than nutritional education in adults living in a low-income urban area. We tested the hypothesis that behavioral counseling would overcome the greater obstacles to change in precontemplators and contemplators compared with those initially in the preparation stage.

Method: Two hundred and seventy-one adults took part in a parallel group randomised controlled trial comparing behavioral counseling and nutritional education.

Quality of life and self-rated health in relation to changes in fruit and vegetable intake and in plasma vitamins C and E in a randomised trial of behavioural and nutritional education counselling.

We have carried out a randomised trial comparing brief behavioural counselling with nutritional education counselling to increase fruit and vegetable consumption and associated biomarkers in adults from a low-income neighbourhood. The objective of the present analysis was to assess the impact of interventions on quality of life and health status, and associations between changes in fruit and vegetable consumption, plasma vitamins C and E, and quality of life. Behavioural counselling and nutritional education counselling were carried out in 271 adults in two 15 min sessions in a primary-care setting.

Developing a large electronic primary care database (Doctors' Independent Network) for research.

Background And Objectives: Primary care databases form a unique source of population-based clinical information on the prevalence and management of diagnosed disorders. Historically such databases have lacked individual level socio-economic markers. We describe the development of the Doctors' Independent Network (DIN) database for epidemiological and health services research.

Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Background: The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems.

Student attitudes to undergraduate interprofessional education.

Interprofessional education in health care has been the focus of increasing attention in recent years. However, there is still great debate about when and how to introduce it in undergraduate studies. St George's Hospital Medical School with the Joint Faculty of Health Care Sciences of Kingston University was ideally placed to introduce, as part of its 1996 new curriculum, a Common Foundation Programme (CFP).

Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial.

Objective: To measure the effect of brief behavioural counselling in general practice on patients' consumption of fruit and vegetables in adults from a low income population.

Design: Parallel group randomised controlled trial.

Setting: Primary health centre in a deprived, ethnically mixed inner city area.

Psychological factors associated with fruit and vegetable intake and with biomarkers in adults from a low-income neighborhood.

Fruit and vegetable consumption is below recommended levels in the population, paricularly in low-income groups. This study assessed factors associated with self-reported intake and 2 biomarkers (potassium excretion and plasma vitamin C) in 271 adults living in a low-income neighborhood. Attitudinal barriers to change were negatively related to reported intake and to potassium excretion.

Radiography for low back pain: a randomised controlled trial and observational study in primary care.

Background: Lumbar spine radiography has limited use in diagnosing the cause of acute low back pain. Consensus-based guidelines recommend that lumbar spine x-rays are not used routinely. However there have been no studies of the effect of referral for radiography at first presentation with low back pain in primary care.

Contraceptive use among South Asian women attending general practices in southwest London.

A cross-sectional survey of contraceptive practices was conducted among 180 South Asian women aged 16 to 50 years, attending inner-city general practices. Overall prevalence of contraceptive use was 63% and ranged from 70% in South Asian teenagers, to only 50% in women over 30 who had completed their family. Thirteen per cent of women had had a termination of pregnancy Although contraceptive use in this group is increasing, it has not yet reached national levels.