Notes

Identification involving specific seminal lcd cytokine users associated with male age group along with life-style features throughout mysterious repeated having a baby loss.
Data quality was moderate to low across the studies due to limitations of source data and varying definitions of primary care. Specialist physicians provide primary care to patients in a substantial proportion of clinic visits. Scope inversion is wasteful as it diverts patients to more expensive care without improving outcomes. A systems approach is needed to mitigate scope inversion and its harmful effects on healthcare service delivery. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies. However, whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear. This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms. Design This study was designed as a nationwide cross-sectional survey in Japan. Setting General sample of the Japanese population. Participants Adult Japanese residents were selected by a quota sampling method. Data were analysed from 1788 residents who reported one or more chronic health conditions. Results Among four physical multimorbidity patterns cardiovascular-renal-metabolic (CRM), skeletal-articular-digestive (SAD), respiratory-dermal (RDE) and malignant-digestive-urologic (MDU), multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms (aOR=1.68, 95% CI 1.21se permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective The objective of this study was to test the effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau. Design A quality improvement study based on an evaluation of a before-after intervention trial was conducted in 2017-2018. Interventions comprising feedback from an audit, general practitioner (GP) training via interactive workshops and one-on-one case discussions were implemented. The primary outcome measure was the proportion of patients with reasonable management of dyslipidaemia, and the secondary outcome measure was the proportion of patients with low-density lipoprotein cholesterol (LDL-C) meeting the target recommended by the Adult Treatment Panel III guidelines. Setting This study was conducted at the Sao Lourenco Health Center, one of the health centres in the Macau primary care system; this centre provides primary care services to one-tenth of the residents of Macau. Participants All GPs who worked in the Sao Lourenco Health Center participated in the study. Dinaciclib We systematically reviewed 100 patient records from each participating physician's patient list. In total, 1200 and 1100 patient records were reviewed before and after the intervention, respectively. Results At baseline, 390 (43.5%) patients were eligible for statin therapy, while 411 (47.7%) patients were eligible for statin therapy in the reaudit group (p=0.08). After intervention, the proportion of patients with reasonable management of dyslipidaemia increased from 83.9% to 88.5% (p=0.005), and the proportion of eligible patients with LDL-C levels meeting the target increased from 55.1% to 65% (p=0.004). Conclusions The audits and feedback significantly improved dyslipidaemia management in the Macau primary care setting. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective To understand general practice (GP) residents' attitudes about their residency training in China. Design Mixed methods survey administered cross-sectionally. Setting Two GP training programmes similar in most regards according to current GP training policy of 5 years' undergraduate degree in medicine and 3 years of postgraduate GP residency training-but differing as the Beijing programme has adopted educational innovations beyond the nationally prescribed standard curriculum used by the second Shenzhen programme. Participants 105 (85%) of eligible GP trainees, 35 (90%) in the innovative Beijing programme and 70 (83%) in the standard training Shenzhen programme. Results Overall, residents felt discrimination because of specialty choice, and that they lacked competency as a general practitioner. Many residents commented faculty had negative teaching attitudes. Beijing residents were more satisfied than Shenzhen residents with their training (p=0.001), and felt teaching faculty had sufficient knowledge (p less then 0.001), and appropriate attitudes towards teaching (p=0.004). Beijing residents more strongly agreed on five items about good future job prospects (all p less then 0.05). Conclusion These Chinese GP residents identify areas for improvement in their training as well as strengths. Higher satisfaction with faculty teaching and job optimism in Beijing where GP residents receive training from specifically qualified faculty, and can earn special certification, suggest that the educational innovations enhance training and promote positivity about job prospects. These findings imply that GP residents in China face many training challenges that are similar to other international reports, while also implicating benefits of using an innovative curricular approach. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective The objective of this study was to improve the telephone communication experience for patients in a primary care practice. Design An exploratory survey was conducted that revealed suboptimal patient satisfaction with clinic access due to the telephone triage system. Several interventions were designed a monthly quality meeting was established among clinic staff, all phone interactions were recorded in the electronic medical record (EMR) and clinic appointments were made available several months in advance. A follow-up survey was conducted to evaluate these interventions. Setting The study was conducted in a multispecialty, urban-based, resident-faculty practice from November 2016 to November 2017. Participants Subjects were recruited in a convenience sample from the waiting room. 200 subjects participated in the initial survey and 215 in the second survey. Results After the interventions, patients felt that their questions were answered more frequently than before (p less then 0.01). They also felt that appointments were easier to make (p=0.
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