ABSTRACT
Genomic technologies are having an increasing impact across medicine, including primary care. To enable their wider adoption and realize their potential, education of primary health-care practitioners will be required. To enable the development of such resources, understanding where GPs currently access genomic information is needed. One-hundred fifty-nine UK GPs completed the survey in response to an open invitation, between September 2017 and September 2018. Questions were in response to 4 clinical genomic scenarios, with further questions exploring resources used for rare disease patients, direct-to-consumer genetic testing and collecting a family history. Respondents were most commonly GP principals (independent GPs who own their clinic) (64.8%), aged 35-49 years (54%), worked as a GP for more than 15 years (44%) and practiced within suburban locations (typically wealthier) (50.3%). The most popular 'just in time' education source for all clinical genomic scenarios were online primary care focussed resources with general Internet search engines also popular. For genomic continuous medical education, over 70% of respondents preferred online learning. Considering specific scenarios, local guidelines were a popular resource for the familial breast cancer scenario. A large proportion (41%) had not heard of Genomics England's 100,000 genome project. Few respondents (4%) would access rare disease specific Internet resources (Orphanet, OMIM). Twenty-five percent of respondents were unsure how to respond to a direct-to-consumer commercial genetic test query, with 41% forwarding such queries to local genetic services. GPs require concise, relevant, primary care focussed resources in trusted and familiar online repositories of information. Inadequate genetic education of GPs could increase burden on local genetic services.
ABSTRACT
The authors developed and tested a dual stress magnetic resonance (MR) imaging protocol to evaluate myocardial perfusion, function, and hibernation. The technique was well tolerated, and high-quality images were achieved. The comprehensive information obtained can be used to guide clinical management decisions regarding coronary artery revascularization procedures. This protocol offers a one-stop assessment of patients with coronary artery disease with use of a clinical MR imager.
Subject(s)
Coronary Circulation/physiology , Coronary Disease/diagnosis , Magnetic Resonance Imaging/methods , Myocardial Contraction/physiology , Myocardial Stunning/diagnosis , Adenosine , Adrenergic beta-Agonists , Contrast Media/administration & dosage , Coronary Angiography , Coronary Disease/physiopathology , Coronary Disease/therapy , Data Display , Decision Making , Dobutamine , Female , Gadolinium DTPA/administration & dosage , Humans , Image Enhancement/methods , Injections, Intravenous , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Myocardial Revascularization , Observer Variation , Patient Care Planning , Vasodilator Agents , Ventricular Function, Left/physiologyABSTRACT
We elucidated the mechanism and clinical significance of precordial ST depression in patients with an inferior myocardial infarction using first-pass, contrast-enhanced, myocardial perfusion magnetic resonance imaging (MRI). Forty-seven patients with acute inferior myocardial infarction underwent first-pass contrast-enhanced MR studies within 2-6 days postinfarction. Patients were followed-up for a minimum of 1 year after infarct (range, 12-32 months). Total perfusion deficit scores derived qualitatively from MRIs were compared in patients with (group 1, n = 30) and without (group 2, n = 17) ST depression precordially. Perfusion remote from the infarct zone was also compared. The combined end points of adverse clinical events and/or the need for further intervention were assessed for each group. Total perfusion deficit scores were significantly higher in group 1 than group 2 (medians 9.7 versus 4.5, p < 0.005). Posterolateral basal extension of hypoperfusion was greater in group 1 versus group 2 (1.23 versus 0.42, p < 0.02), with no evidence of remote anterior perfusion abnormalities. There were more patients with an adverse clinical end point in group 1 versus group 2 (18 versus 1, p < 0.01). Furthermore, in patients with ST depression (group 1), there was a significant increase in number of adverse clinical end points in patients with a global deficit score > 15 versus 0-5 (7/7 versus 1/7, p < 0.01). MRI shows that precordial ST depression in inferior myocardial infarction is a marker for a larger global perfusion abnormality with posterolateral basal extension and an increase in adverse clinical end points. Furthermore, the magnitude of the perfusion deficit correlates with an increase in the number of adverse clinical end points, highlighting the potential of MRI perfusion studies as a research and clinical tool in myocardial infarction.
Subject(s)
Magnetic Resonance Imaging/methods , Myocardial Infarction/physiopathology , Contrast Media , Coronary Circulation , Female , Gadolinium DTPA , Humans , Male , Middle Aged , Myocardial Infarction/enzymology , Statistics, NonparametricABSTRACT
Standards in clinical research are laid down in the Nuremberg Code, the Declaration of Helsinki and EC directives on good clinical practice. Clinical research may relate to the causes of disease, improvement in diagnosis, improvement in treatment, and mechanisms of human biology. The patient has the right to informed consent, to withdrawal without prejudice and to confidentiality.
Subject(s)
Patient Advocacy/legislation & jurisprudence , Research/legislation & jurisprudence , Research/standards , Confidentiality , Humans , Informed Consent , United KingdomABSTRACT
Nurses need to be alert to the risks inherent in blood transfusion. This paper outlines the observations and nursing interventions necessary during blood component therapy.
Subject(s)
Blood Transfusion/nursing , Blood Transfusion/methods , Humans , Nursing Assessment , Transfusion ReactionABSTRACT
Until recently diagnostic radiology has been restricted to X-ray, computerised tomography (CT) and ultrasound. These techniques exploit the absorption of reflection of waves passed into or through the body. Magnetic resonance imaging (MRI) actually stimulates the body to produce a signal itself.
Subject(s)
Brain Neoplasms/diagnosis , Brain/anatomy & histology , Magnetic Resonance Imaging , Brain/pathology , Humans , Magnetic Resonance Imaging/adverse effectsABSTRACT
This article concerns the Medicare/Medicaid anti-kickback law and the recently promulgated "safe harbor" regulations. The author analyzes the proposed regulations and concludes they are an inadequate response to the Congressional directive to clarify the meaning of this law.
Subject(s)
Crime/legislation & jurisprudence , Fraud/legislation & jurisprudence , Hospital Administration/legislation & jurisprudence , Hospital-Physician Joint Ventures/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , Referral and Consultation/legislation & jurisprudence , United StatesABSTRACT
Bordetella bronchicanis is a common respiratory tract commensal of mammals. Rarely it causes whooping cough in children. Compromised adults in hospitals may be colonised, and one terminal pneumonia is on record. The fatal pneumonia of a malnourished alcoholic described here was contracted at home.