AIMTo explore primary care physicians’ perspectives on possible barriers to the use of insulin.METHODSThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched (between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers’ perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients’ perspectives were excluded.RESULTSA total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement.CONCLUSIONPrimary care physicians’ known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.
Objective To investigate the role of job demands and job control as predictors of job satisfaction in general practice. Design and setting A descriptive postal survey of general practitioners in Victoria selected at random from the Health Insurance Commission's database. Participants 353 of 562 GPs (63%) participated in the study. The demographic details of the respondents were similar to those for all GPs in Victoria. Main outcome measures Job demands of general practice; job control in general practice; job satisfaction in general practice; effect of demands and control on job satisfaction; interactive effect of demands and control on job satisfaction. Results The “average” GP in this study perceived their work as characterised by high demands and low control. In addition, only 50% of respondents were satisfied with their work. The major determinants of job satisfaction were gender, job demands, hours worked and job control. Of these, job control was the most powerful predictor of job satisfaction. Although no evidence was found for a modifying effect of control on the relationship between demands and satisfaction, an interaction between hours worked and control was evident. Conclusions The low level of job satisfaction in general practice is, to a degree, a reflection of the beliefs held by the “average” GP that their ability to control their work is low. As GPs who are satisfied with their work provide a higher standard of medical care, policymakers should consider the importance of maintaining professional autonomy for GPs when implementing changes aimed at achieving policy objectives.
IntroductionThe use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals.Materials and MethodsA set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed.ResultsNone of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR-145 correlated with nadir CD4+ T cell count.DiscussionNo associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection.
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