Revista de práctica general

Introduction: Point of care ultrasound is used in several medical specialties but has not yet been widely adopted in primary care in Ireland. This study explored the attitudes of GP training scheme program directors towards POCUS. This included views on clinical use and implications for postgraduate GP training.
Methods: This was a mixed methods study. A survey was distributed to all GP training scheme program directors in the Republic of Ireland. The survey included questions regarding clinical use and current provision of education in point of care ultrasound to GP trainees in individual schemes. A focus group examining similar themes was also done.
Results: 50% of PDs responded to the survey. No scheme had an established training program in POCUS, and only one was considering starting one. Reasons cited included perceived lack of trainee interest, lack of faculty expertise, and lack of time and resources, including equipment. Potential uses for POCUS included basic obstetric examinations for detection of foetal heart activity, and right upper quadrant ultrasound for investigation of biliary colic. Facilitators to the use of ultrasound included rapidity of diagnosis and patient satisfaction, while barriers included lack of expertise and equipment, and concerns about clinical indemnity. The focus group corroborated these findings. PDs participating in the focus group also raise concerns about time and resource constraints both in practice and in training programs, the lack of a critical mass of expertise in the GP training community, the risk of over diagnosis, and concerns around quality assurance. The potential for “creep” effect was recognized. The group saw POCUS as having a limited potential role in a small number of clinical scenarios. Facilitators to use included patient satisfaction and increasing miniaturization and affordability of equipment.
Conclusions: There are currently no established training programs in POCUS for GP trainees in Ireland and there are no immediate plans to establish any. There is limited interest in its use in clinical practice, with multiple barriers identified.

Objective: Study aimed to clarify the effect of educational activities on same students in their pre-med students and medical students standing point about patient centred care.
Methods: The PPOS questionnaire used to examine patient-centredness and has been used in pre-med student and medical student samples. We surveyed students in their first month in undergraduate medical education following their enrolment in 2010. Three years later in 2013-2014 educational year same group included to same questionnaire, when they are 4th year students. Same 128 students filled questionnaire forms in two different years. The survey utilized the patients practitioners orientation scale (PPOS) to measure students’ changing attitudes.
Results: 59% of respondents were female and mean age was 18.52 in their 1st year. In total PPOS scores were 55.58 for Year 4 students and 62.41 for Year 1 students. We found that sharing and caring domains scores lowered when students finished their basic medical science education including empathy, communication and ethics lectures.
Conclusion: Despite encouraging patient-centred attitudes of undergraduate medical students by curricular models, our findings showed that in their further level, students became less patient centred. Depending on respondents’ score, curriculum organisers should re-check their curricular aim and educational program or activities. Feedback in medical education can be accepted as “specific information about the students’ perception and attitudes”. These findings give great information concerning effectiveness of program on specific areas with the clues to improve the program’ performance”.

The Steven-Johnson Syndrome (SJS) is a rare immune complex mediated hypersensitivity condition. Here we report the case of Steven-Johnson Syndrome due to the co-administration of aceclofenac and cefixime. NSAIDs are the rare type of medication that causes SJS and cefixime is a traditional medication that causes the condition. A 22- years-old patient was admitted in the hospital with a complaint of fever for 15 days and he was treated by giving aceclofenac, cefixime and general symptomatic treatment. On the 4th day of treatment erythromatous patches were observed throughout the body. Laboratory investigations were performed and the case was identified as Steven-Johnson Syndrome. The treatment was withdrawn and he was administered with steroids, amoxicillin, metronidazole and general symptomatic treatment. The patient has recovered after a week.

Background: Globally, respiratory diseases are common causes of medical admissions. Our objective was to determine the causes and outcome of respiratory diseases in our facility for health planning, policy formulation and allocation of resources.
Method: A retrospective study of all respiratory-related admissions between January 2011 and December 2015. Classification of diseases was based on the ICD-10 coding system.
Results: Respiratory-related admissions accounted for 460 (12%) of all medical cases with a slight male preponderance of 1.4 to 1. Mean age of patients was 50.4 ± 20.8 years. The majority 342 (74.3%) of these admissions were due to communicable respiratory diseases. Pulmonary tuberculosis (44.1%) and pneumonia (28.9%) accounted for the highest admissions which were closely followed by COPD (11.1%) and asthma (7.2%). The commonest co-morbidity was HIV/AIDS (12.3%) which also coexisted with other diseases in most cases of mortality. The median hospital-stay was 7 days. Most diseases had peak presentations during the dry season except bronchial asthma with rainy and dry peak seasons. The overall mortality was 17.6% and the highest mortalities were recorded in patients who had pulmonary tuberculosis (55.5%), pneumonia (20.9%) and COPD (8.6%).
Conclusion: Communicable respiratory diseases are the leading causes of morbidity and mortality. Scaling up on coverage of the control programmes as well as the methodical integration of non-communicable diseases into already existing control programmes will further strengthen the health-care systems in resource-limited settings.

Botulinum toxin Type A (BTA) is the most popular nonsurgical aesthetic treatment worldwide. With the constantly evolving injection techniques, what was considered state-of-the-art 5-10 years ago are no longer represents the standard approach. The indication and dosages of botulinum toxin injection vary among different ethnic group. The consensus and guidelines for Caucasian population may not be applicable to Asian patients. Different dilutions, dosages and injection techniques to forehead have been practiced. The aim of this article is to describe the techniques in the Asian consensus agreement and author’s personal experience. The main objectives are to avoid complications and help reaching clinical efficacy.

A simple and readable patient information leaflet has been developed to access the socio-demographic, biological features, clinical profiles as well as biochemical parameters of HIV patients. The main objectives are to provide dual visual/textual information on HIV testing that will be helpful to improve the patient’s knowledge. This patient information leaflet secures the HIV test in leaflet format rather than verbal counseling. This patient information leaflet will be helpful in describing the patient’s characteristics by written information and the final document would be prepared for analysis of biological and clinical features in a target population study. To identify, recommend and implement of this patient information leaflet is the best practices of this type of patient information design. Acquired immuno-deficiency syndrome is a highly chronic disease caused by human immunodeficiency virus. The patient follow-up antiretroviral therapy treatment during acquiring the AIDS leads to treatment failure is the cause of the emergence of drug resistance. The human immuno-deficiency virus-infected person management requires the depth collection history, physical examination, laboratory testing etc. Such kind of information is required to develop a patient information leaflet to follow up the clinical features of HIV patients during each visit. This patient information leaflet is divided into four parts. In part-1 contains the social features, risk factors opportunistic infections, various signs and symptoms of HIV infection. In part-2 contains the CD4 counts, part-3 contains patient follow- up visits during ART, part-4 contains the biochemical features of the HIV-infected patients. The patient information leaflet is required based on knowledge, attitudes and practices on data collection during focus on human immuno-deficiency virus study.

• Differentiating Takotsubo’s versus AMI on the basis of an Electrocardiogram

• Discuss the management of Takotsubo’s with pre-existing anxiety disorder