Practical implications These findings have implications for the strategies used to encourage general practitioners to base their practice on clinical evidence. Teaching general practitioners critical appraisal skills and developing guidelines may redress identified skill deficiencies and distil trial data in accessible form, but universal awareness and acceptance of trial findings alone may not lead to their integration into everyday practice. Strategies to maximise evidence based practice may not work if they fail to recognise the judgments general practitioners already make about trial data and the process by which trial data become practically applicable. Our findings confirm that strategies are more likely to be effective if they recognise and build on developing informal consensus about trial data. Imminent organisational changes within the NHS 1 2 provide the impetus to manage this process purposefully so that it links individual general practitioners' application of trial data to effective use of local resources, chiefly cash limited prescribing budgets, to meet local needs. This requires cooperation and negotiation among important local players-for instance, primary care groups (local health care cooperatives in Scotland), primary and secondary care trusts, and local health authorities-so that this consensus is formalised and made transparent. We thank all the participating general practitioners, consultants, and health board staff who generously gave of their time and knowledge, and Sally Wyke, senior research fellow for her support, advice, and theoretical input throughout the study. Contributors: KF initiated the project. KF and GH designed the study, collected and analysed the data, and wrote the paper. KF and GH are joint guarantors of the work.
Coronary artery steal via a large unligated intercoastal side-branch of the internal mammary artery graft has been previously described in two case reports. We report a series of 7 patients with post-operative angina in whom microcoil embolization of such branch was performed. In 5 patients in whom complete occlusion of the branch was achieved, anginal symptoms were relieved; in contrast the 2 patients with persistent flow through the intercostal branch remained symptomatic despite all their grafts being widely patent. We conclude that large unligated intercostal branches of the IMA graft may be related with post-operative angina and their embolization is a simple, safe, and effective procedure.
General practitioners and maternal, child and family health nurses have a central role in postpartum primary health care for women and their infants. Positive client-provider relationships are particularly important for women experiencing mental health problems or unsettled infant behaviour. However, little is known about their experiences of postnatal primary health care. The study aimed to describe views of postnatal primary health care among women completing a residential early parenting programme and to identify potential strategies to enhance provider-patient interactions. Participants (n=138) were women admitted with their infants to a private or a public early parenting service in Melbourne, Australia. Women completed a detailed self-report survey, including open-ended questions about experiences of primary health-care services, and a structured psychiatric interview to diagnose anxiety and depression. Survey responses were analysed thematically. Womens' experiences of primary health care were influenced by their perceptions of provider competence and the quality of interactions. While similar positive characteristics of doctor and nurse care were valued, medical and nursing practices were judged in different ways. Women described GPs who listened, understood and were thorough as providing good care, and maternal, child and family health nurses were valued for providing support, advice and encouragement. Threats to therapeutic relationships with doctors included feeling rushed during consultations, believing that GPs were not mental health-care providers and the clinician not being 'good' with the infant; with nurses, problems included feeling judged or given advice that was inconsistent or lacked an evidence-base. Postpartum primary health care will be improved by unhurried consultations, empathic recognition, encouragement, evidence-informed guidance and absence of criticism.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.