How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Does primary medical practitioner involvement with a specialist team improve patient outcomes? A systematic review.

Patients with chronic or complex medical or psychiatric conditions are treated by many practitioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms family physicians': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. Seven studies were identified, involving 963 subjects and 899 controls. most health outcomes were unchanged, although some physical and functional health outcomes were improved by formal liaison between GPs and specialist services, particularly among chronic mental illness patients. Some health outcomes worsened during the intervention. Patient retention rates within treatment programmes improved with GP involvement, as did patient satisfaction. Doctor (GP and specialist) behaviour changed, with reports of more rational use of resources and diagnostic tests, improved clinical skills, more frequent use of appropriate treatment strategies, and more frequent clinical behaviours designed to detect disease complications Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice.

Benefits, harms and costs of screening mammography in women 70 years and over: a systematic review

Objective: To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. Data sources and synthesis: (i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over. Results: For women aged 70-79 years, the relative benefit was estimated as 40%-72%, and 18%-62% with adjustment for the impact of screening on quality of life. For women over 80 years the relative benefit was about a third, and with quality-of-life adjustment only 14%, that in women aged 50-69 years. (ii) Of 10 000 Australian women participating in ongoing screening, about 400 are recalled for further testing, and, depending on age, about 70-112 undergo biopsy and about 19-80 cancers are detected. (iii) Cost-effectiveness estimates for extending the upper age limit for mammographic screening from 69 to 79 years range from $8119 to $27 751 per quality-adjusted life-year saved, which compares favourably with extending screening to women aged 40-49 years (estimated at between $24 000 and $65 000 per life-year saved). Conclusions: Women 70 years and over, in consultation with their healthcare providers, may want to decide for themselves whether to continue mammographic screening. Decision-support materials are needed for women in this age group.

Introducing OTseeker (Occupational Therapy Systematic Evaluation of Evidence): A new evidence database for occupational therapists

OTseeker (Occupational Therapy Systematic Evaluation of Evidence) is a new resource for occupational therapists that has been designed with the principle aim of increasing access to research to support clinical decisions. It contains abstracts of systematic reviews and quality ratings of randomized controlled trials (RCTs) relevant to occupational therapy. It is available, free of charge, at www.otseeker.com. This paper describes the OTseeker database and provides an example of how it may support occupational therapy practice.

Systematic characterization of mutations in yeast acetohydroxyacid synthase: Interpretation of herbicide-resistance data

Acetohydroxyacid synthase (AHAS, EC 4.1.3.18) catalyses the first step in branched-chain amino acid biosynthesis and is the target for sulfonylurea and imidazolinone herbicides, which act as potent and specific inhibitors. Mutants of the enzyme have been identified that are resistant to particular herbicides. However, the selectivity of these mutants towards various sulfonylureas and imidazolinones has not been determined systematically. Now that the structure of the yeast enzyme is known, both in the absence and presence of a bound herbicide, a detailed understanding of the molecular interactions between the enzyme and its inhibitors becomes possible. Here we construct 10 active mutants of yeast AHAS, purify the enzymes and determine their sensitivity to six sulfonylureas and three imidazolinones. An additional three active mutants were constructed with a view to increasing imidazolinone sensitivity. These three variants were purified and tested for their sensitivity to the imidazolinones only. Substantial differences are observed in the sensitivity of the 13 mutants to the various inhibitors and these differences are interpreted in terms of the structure of the herbicide-binding site on the enzyme.

Systematic review of the role of pre-oxygenation for tracheal suctioning in ventilated newborn infants

Pre-oxygenation for endotracheal suctioning for mechanically ventilated infants is routine practice in many neonatal intensive care units. In the present systematic review the evidence to support its use is discussed and the authors conclude that no confident recommendations can be made from the results of this review.

Additions to the systematic of the bethylid fauna (Hymenoptera, Chrysidoidea) from Chile

Bethylopsis carinatus sp.n., and Epyris chilensis sp.n., from Chile are described and illustrated. Taxonomic data on Chilepyris herbsti Evans, Lytopsenella herbsti (Kieffer), Lytopsenella testaceicornis (Kieffer) and Pseudisobrachium erythrocephalum Evans are included. Male of Lytopsenella herbsti is recorded for the first time to genus and species.

Additional notes on systematic of Neotropical Dissomphalus Ashmead (Hymenoptera, Bethylidae)

Diagnosis and genitalia description and illustration of Dissomphalus bicavatusEvans, 1979;D. bispinulatusEvans, 1969;D. brasiliensisKieffer, 1910;Z). caviclypeus Evans, 1969; D. cornutus Evans 1964; D. dumosus, Evans, 1966; D. fungosus Evans, 1979; D. gilvipes Evans, 1979; D. incomptus Evans, 1964; D. infissus Evans, 1969; D. mendicus Evans, 1969; D. microstictus Evans, 1969; D. mirabilis Evans, 1966; D. nanellus Evans, 1969; D. napo Evans, 1979; D. plaumanni Evans, 1964; D. punctatus (Kieffer, 1910); D. puteolus Evans, 1969; D. rufipalpis Kieffer, 1910; D. xanthopus Ashmead, 1893 are provided. Female of D. mirabilis is first described. Five synonymies are proposed: D. connubialis Evans, 1966 of D. brasiliensis, D. montanus Kieffer, 1910 of D. punctatus, D. obliquus Evans, 1979 of D. rufipalpis, D. teren Evans, 1969 of D. cornutus and D. hastatus Evans, 1979 of D. bispinulatus. D. microtuberculatus sp.n. from Northern Argentina is described and illustrated.

Accuracy Comparison of Implant Impression Techniques: A Systematic Review

Background: Several studies link the seamless fit of implant-supported prosthesis with the accuracy of the dental impression technique obtained during acquisition. In addition, factors such as implant angulation and coping shape contribute to implant misfit. Purpose: The aim of this study was to identify the most accurate impression technique and factors affecting the impression accuracy. Material and Methods: A systematic review of peer-reviewed literature was conducted analyzing articles published between 2009 and 2013. The following search terms were used: implant impression, impression accuracy, and implant misfit.A total of 417 articles were identified; 32 were selected for review. Results: All 32 selected studies refer to in vitro studies. Fourteen articles compare open and closed impression technique, 8 advocate the open technique, and 6 report similar results. Other 14 articles evaluate splinted and non-splinted techniques; all advocating the splinted technique. Polyether material usage was reported in nine; six studies tested vinyl polysiloxane and one study used irreversible hydrocolloid. Eight studies evaluated different copings designs. Intraoral optical devices were compared in four studies. Conclusions: The most accurate results were achieved with two configurations: (1) the optical intraoral system with powder and (2) the open technique with splinted squared transfer copings, using polyether as impression material.

A systematic procedure to enhance reproducibility of SWASV cycles in the determination of toxic metals in real samples

This work presents for the first time a systematic study on the optimization of the electrochemical cleaning time of a mercury film when it is used as a working electrode material in the analysis of toxic metals, such as Pb2+, used as model metal, in real samples by SWASV. The optimization study for the film’s cleaning time aimed at attaining a Pb2+ minimum value in the film after the re-oxidation step of the pre-concentrated metal, given the impossibility of complete removal of traces of the electroactive species from the film. This value was kept constant in each concentration range studied ensuring thus that all assays were performed in initial identical conditions. An assay performed on a synthetic sample was taken as reference. In it, given the absence of matrix effects, and after the electrochemical cleaning step, a direct proportionality was observed between the residual amounts of Pb2+ in the film (which for the cleaning time used was never completely removed) and Pb2+ concentration in the solution. This fact determined a high correlation between Pb2+ peak current and Pb2+ concentration which was not observed when real samples (tree leaves) were analyzed. This behavior may result from the presence of the interfering surfactants always present in real samples of complex matrix. Cleaning time optimization was performed for the following Pb2+ concentration ranges in the real samples of complex matrix: 0.006-0.020, 0.020-0.080, 0.060-0.200 and 0.100-0.600 ppb. As expected, in order to obtain identical levels of film’s cleaning efficiency, the need for longer cleaning times has been observed for higher concentrations. The optimized cleaning times for the concentration ranges under study were 120, 150, 180 e 300 s, respectively.