The European journal of general practice
-
Case Reports
Multimorbidity's research challenges and priorities from a clinical perspective: the case of 'Mr Curran'.
Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. ⋯ Interventions have to be complex and multifaceted, and their evaluation poses numerous methodological challenges in study design, outcome measurement and analysis. Overall, it can be seen that complexity is a main underlying theme. Moreover, flexible study designs, outcome parameters and evaluation strategies are needed to account for this complexity.
-
Several studies have shown that vitamin D supplementation could be useful for treating diffuse musculoskeletal (DMS) pain in adults. ⋯ In this small before-and-after study, vitamin D supplementation decreased pain scores in adult patients with diffuse musculoskeletal pain and vitamin D deficiency. These results must be confirmed by further studies.
-
Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. ⋯ Dutch physicians perceive a difference between euthanasia and PAS. Although they believe PAS underlines patient autonomy and responsibility, the option of PAS is rarely discussed with the patient. The more psychosocial in nature the patient's suffering, the more physicians choose PAS. In these cases, PAS seems to fulfil physicians' preferences to emphasize patient autonomy and responsibility. Expected technical problems and unfamiliarity with PAS also play a role. Paradoxically, the choice for PAS is predominantly a physician's one.
-
Clinical encounters in daily practice can provide a fertile ground for identifying uncertainties that require further investigation. Addressing such uncertainties by undertaking a Cochrane review can be a rewarding educational process and result in important contributions to health care policy. This paper describes the experiences of a UK GP undertaking a Cochrane review whilst working in clinical practice. It outlines some of the practical issues when starting a review, the importance of effective mentorship and collaboration, the power of the modern medical media (BMJ, Wikipedia) and engaging with policy makers (WHO).