Articles: professional-practice.
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Multicenter Study
Decisions about referrals for psychological therapies: a matched-patient qualitative study.
Psychological therapies are effective treatments for common mental health problems, but access is limited. GPs face difficult decisions as to whom to refer, but little is known about this decision-making process. ⋯ GPs gave accounts of themselves acting as rational decision makers, judging how effective they thought a referral would be based on a patient's clinical presentation and motivation, compared with the GPs' own ability to help.
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Multicenter Study
Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice.
Critics of air ambulance doctors question their contribution and believe on-scene time is prolonged. Two helicopter emergency medical service (HEMS) models operate in the West Midlands, one with doctors and the other without. A study was undertaken to compare on-scene time, management and decision-making between the two units. ⋯ Appropriately trained HEMS doctors provide advanced management and decision-making. This is without a negative effect on on-scene time, even when performing complex procedures. They are more likely to declare death or discharge patients at the scene, increasing the availability of this limited resource.
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Multicenter Study
Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing.
Although studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. ⋯ An association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.
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A questionnaire survey examining rapid sequence induction techniques was sent to all anaesthetists in Wales. The questionnaire presented five common clinical scenarios: emergency appendicectomy; elective knee arthroscopy with a symptomatic hiatus hernia; elective knee arthroscopy with an asymptomatic hiatus hernia; elective Caesarean section; and emergency laparotomy for bowel obstruction. ⋯ Rapid sequence induction was chosen by 398/400 respondents (100%) for bowel obstruction, 392/399 (98%) for Caesarean section, 388/408 (95%) for appendicectomy, 328/395 (83%) for symptomatic hiatus hernia but only 98/399 (25%) for asymptomatic hiatus hernia (p < 0.001). Trainees were more likely to use a rapid sequence induction technique than consultants and staff grades for the appendicectomy (p = 0.025), symptomatic hiatus hernia (p = 0.004) and asymptomatic hiatus hernia (p = 0.001) scenarios and were also more likely to use a thiopental-suxamethonium combination for rapid sequence induction (p < 0.001).
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Multicenter Study
The views of doctors on their working lives: a qualitative study.
To describe doctors' views on, and responses to, their professional working lives in the UK National Health Service (NHS). ⋯ These insights into doctors' views of their working lives might usefully inform those involved in the planning and overseeing of changes to health service structures and systems.