Management In Primary Care Setting Research Articles

Risk factors of chronic kidney diseases in Chinese adults with type 2 diabetes

In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017. We collected the individual data of 31,574 subjects, with mean age of 63.0 (±10.8) years and mean DM duration of 7.4 (±6.4) years. Of them 9,386 (29.7%) had CKD and 7,452 (23.6%) had micro- or macro-albuminuria. After adjustment for multiple demographic and lifestyle confounders, we identified several modifiable risk factors associated with higher rate of CKD: obesity (OR = 1.54), current smoking (OR = 1.33), higher systolic blood pressure (OR = 1.01), dyslipidemia (OR = 1.32 and 0.61 for triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)), hyperglycemia (OR = 1.11 for HbA1c), diabetic retinopathy (OR = 1.36 and 2.60 for non-sight and sight threatening retinopathy), and stroke (OR = 1.43). The risk factors of lower dialytic blood pressure and coronary heart disease were identified only in men, whereas peripheral arterial disease only in women. In conclusion, several modifiable and gender specific risk factors were significantly associated with higher prevalence of CKD in Chinese adults with T2DM. The high-risk populations identified in this study shall receive regular screening for renal functions to achieve better patient management in primary care settings.

A snapshot of type two diabetes mellitus management in general practice prior to the introduction of diabetes Cycle of Care.

Diabetes is associated with complications, including coronary heart disease, stroke, kidney failure, blindness and amputation, and ultimately is a major cause of disability and death worldwide. Adherence to best practice guidelines is limited in unstructured diabetes management in primary care settings. This study aims to establish what data was being collected in general practice prior to the introduction of the Cycle of Care, which is a proactive model of diabetes management introduced in Ireland. Medical students in general practices with the University of Limerick Graduate Entry Medical School and their supervisors used practice software to collect quantitative data from the clinical records of patients with T2DM. The sample included 2696 patients with T2DM who had visited their GP in the previous year. During the 12months studied, 18.5% of patients with T2DM attended an emergency department and 24% were admitted to hospital. The results of the documentation of three modifiable risk factors associated with T2DM were as follows: 49.5% had BMI documented, 51.7% had smoking status documented and 33.9% had alcohol consumption documented. Two hundred and fifty people were diagnosed with T2DM in the previous 12months. Of these, 19% had been referred to a chiropodist and 23% to a dietician. This study provides a comprehensive snapshot of care in Irish general practice for patients with T2DM prior to the introduction of the Cycle of Care. Future research must investigate the impact of Cycle of Care on patient care in general practice.

Symptom Burden and Palliative Care Among Patients with Multi-Morbidity (S746)

•Identify patient-level predictors of high symptom burden.•Describe strategies to implement and evaluate standardization of symptom assessment and management protocols in primary care settings. Palliative care research has largely focused on patients with disease specific conditions. As patients age, they often accumulate diseases that increase their risk of death that is not attributable to a single condition. We assessed symptom burden and quality of life among patients with >3 chronic conditions to determine whether patients receive assessment and treatment consistent with palliation of symptoms. We hypothesized a higher number of comorbidities would be associated with greater symptom burden and poorer quality of life. We identified patients at high risk of hospitalization or death using a prognostic model. We administered cross-sectional surveys (Memorial Symptom Assessment Scale and Veterans-Rand 12) to randomly selected patients enrolled in primary care clinics in the VA Health Care System from May-December 2015. We asked patients if their most bothersome symptom was addressed and being treated during their recent appointment. Regression models identified patient-level predictors of high symptom burden and poor self-perceived health status. Patients (n=503) were white (74%), males (97%), aged 71+11.2 years. Patients reported 10.6+5.5 active symptoms and poor quality of life (28.6+11.4) (physical component scale 0-100, higher score=better health). Pain and dyspnea were the most burdensome symptoms (n=145, 29%; n=57, 11%) respectively. Among patients, 348 (74%) perceived their clinician assessed their most bothersome symptom and 330 (70%) reported they were receiving treatment for it. Younger patients (p=0.01) and those with a greater number of multi-morbidities (p<0.001) reported higher symptom burden than older patients and those with fewer multi-morbidities. Younger patients (p=0.002) and those with a greater number of multi-morbidities (p<0.001) perceived themselves as having worse physical health than older patients and those with fewer multi-morbidities. Our findings support standardization of symptom assessment and management in primary care settings for patients with multi-morbidities. Ameliorating symptoms may result in patients’ higher perceived quality of life.

Provider views on childhood obesity management in primary care settings: a mixed methods analysis

BackgroundPediatric providers are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. The goal of this study was to examine the views of pediatric providers on conducting obesity management in the primary care setting, and identify potential resources and care models that could facilitate delivery of this care.MethodsA mixed methods approach was utilized. Four focus groups were conducted with providers from a large pediatric network in San Diego County. Based on a priori and emerging themes, a questionnaire was developed and administered to the larger group of providers in this network.ResultsBarriers to conducting obesity management fell into four categories: provider-level/individual (e.g., lack of knowledge and confidence), practice-based/systems-level (e.g., lack of time and resources), parent-level (e.g., poor motivation and follow-up), and environmental (e.g., lack of access to resources). Solutions centered around implementing a team approach to care (with case managers and health coaches) and electronic medical record changes to include best practice guidelines, increased ease of documentation, and delivery of standardized handouts/resources. Survey results revealed only 23.8% of providers wanted to conduct behavioral management of obesity. The most requested support was the introduction of a health educator in the office to deliver a brief behavioral intervention.ConclusionWhile providers recognize the importance of addressing weight during a well-child visit, they do not want to conduct obesity management on their own. Future efforts to improve health outcomes for pediatric obesity should consider implementing a collaborative care approach.

Using the theoretical domains framework to identify barriers and enablers to pediatric asthma management in primary care settings

ABSTRACTObjectives: This study aimed to apply a theory-based approach to identify barriers and enablers to implementing the Alberta Primary Care Asthma Pediatric Pathway (PCAPP) into clinical practice. Phase 1 included an assessment of assumptions underlying the intervention from the perspectives of the developers. Phase 2 determined the perceived barriers and enablers for: 1) primary care physicians' prescribing practices, 2) allied health care professionals' provision of asthma education to parents, and 3) children and parents' adherence to their treatment plans. Methods: Interviews were conducted with 35 individuals who reside in Alberta, Canada. Phase 1 included three developers. Phase 2 included 11 primary care physicians, 10 allied health care professionals, and 11 parents of children with asthma. Phase 2 interviews were based on the 14 domains of the Theoretical Domains Framework (TDF). Transcribed interviews were analyzed using a directed content analysis. Key assumptions by the developers about the intervention, and beliefs by others about the barriers and enablers of the targeted behaviors were identified. Results: Eight TDF domains mapped onto the assumptions of the pathway as described by the intervention developers. Interviews with health care professionals and parents identified nine TDF domains that influenced the targeted behaviors: knowledge, skills, beliefs about capabilities, social/professional role and identity, beliefs about consequences, environmental context and resources, behavioral regulation, social influences, and emotions. Conclusions: Barriers and enablers perceived by health care professionals and parents that influenced asthma management will inform the optimization of the PCAPP prior to its evaluation.

Factors associated with ambulatory care sensitive emergency department visits for South Carolina Medicaid members with intellectual disability.

Ambulatory care sensitive conditions (ACSCs) can be seen as failure of access or management in primary care settings. Identifying factors associated with ACSCs for individuals with an Intellectual Disability (ID) provide insight into potential interventions. To assess the association between emergency department (ED) ACSC visits and a number of demographic and health characteristics of South Carolina Medicaid members with ID. A retrospective cohort of adults with ID was followed from 2001 to 2011. Using ICD-9-CM codes, four ID subgroups, totalling 14650 members, were studied. There were 106919 ED visits, with 21214 visits (19.8%) classified as ACSC. Of those, 82.9% were treated and released from EDs with costs averaging $578 per visit. People with mild and unspecified ID averaged greater than one ED visit per member year. Those with Down syndrome and other genetic cause ID had the lowest rates of ED visits but the highest percentage of ACSC ED visits that resulted in inpatient hospitalisation (26.6% vs. an average of 16.8% for other subgroups). When compared with other residential types, those residing at home with no health support services had the highest ED visit rate and were most likely to be discharged back to the community following an ED visit (85.2%). Adults residing in a nursing home had lower rates of ED visits but were most likely to be admitted to the hospital (38.9%) following an ED visit. Epilepsy and convulsions were the leading cause (29.6%) of ACSC ED visits across all subgroups and residential settings. Prevention of ACSC ED visits may be possible by targeting adults with ID who live at home without health support services.

Drivers of Continuing Education Learning Preferences for Veterans Affairs Women's Health Primary Care Providers.

Documented gaps in health professionals' training in women's health are a special concern for continuing education (CE). In the Veterans Affairs (VA) health care system, women veterans are a numerical minority, preferably assigned to designated women's health primary care providers (DWHPs). DWHPs need to maintain their knowledge and skills in women's health topics, in addition to general internal medicine topics. We explored drivers of VA DWHPs' learning preferences for women's health topics-ie, factors which influence greater and lesser learning interest. We conducted semistructured telephone interviews with DWHPs across six VA health care systems. Interviews were audio recorded, transcribed, and coded in ATLAS.ti. We synthesized results by grouping relevant coded sections of text to form emergent themes. Among the 31 DWHPs interviewed, reported drivers of learning interests among women's health topics were (1) high frequency of clinical incidence of particular issues; (2) perceived appropriateness of particular issues for management in primary care settings; and (3) perceived appropriateness of particular issues for partial management in primary care. Lower interest in particular women's health topics was associated with (1) perceived existing competency or recent training in an issue and (2) perceived need for specialty care management of an issue. Understanding drivers of DWHPs' CE learning priorities lays a foundation for developing CE programming that will be of interest to women's health primary care providers. Attention to drivers of learning interests may have applicability beyond women's health, suggesting a general approach for CE programming that prioritizes high-volume topics within the practice scope of target providers.

Bridging Research, Education and Practice across disciplines: Need for Nutrition Education/Innovation Programme (NNEdPro)

ObjectiveTo build and evaluate a multidisciplinary network to translate and integrate nutrition knowledge into clinical practice and policy for health professionals in clinical, research, industry and policy settings.BackgroundMany illnesses are preventable by early recognition and appropriate management in primary care settings. However, due to lack of training and difficulty accessing reliable nutritional evidence, health professionals find it difficult to incorporate nutrition effectively into practice. The Need for Nutrition Education/Innovation Programme (NNEdPro) developed a multidisciplinary network of health professionals to: (1) identify knowledge gaps in nutrition medical practice through primary research studies, (2) develop and deliver education and training interventions through a training academy, (3) evaluate and assess delivery methods and healthcare impact by influencing health care policy.Model of ChangeNNEdPro uses the knowledge‐to‐action cycle to translate nutrition evidence across the following domains: researchers, policymakers, practitioners, patients and the public. In particular, NNEdPro 1) incorporated clinical and public health nutrition into University of Cambridge's medical curriculum; 2) organised the First Annual International Summit on Medical Education Research to foster knowledge and innovation exchange; 3) established global network hubs in India, Australia/New Zealand, and Canada to support local professionals on research methodology and 4) delivered an accredited Summer School in Applied Human Nutrition to train allied‐health professionals on integrating nutrition in practice.EvaluationNNEdPro's success of its multidisciplinary model of change is illustrated through over 100 peer‐reviewed quality publications. NNEdPro introduced and edited the Special Issue on Public Health by the Royal Society of Public Health where current work on medical nutrition education and research has been displayed. NNEdPro also won the Complete Nutrition National Award for Outstanding Achievement in 2015 and designation as an Education Team of the Year by the BMJ Awards in 2016.Conclusions and ImplicationsNNEdPro continues to develop self‐sustaining knowledge, skills and capacity in nutrition and health through: 1) A Global Training Academy delivering nutrition education to impact knowledge, attitudes and practices; 2) Consultancy services and action‐orientated research to design and conduct education and implementation programmes; 3) the NNEdPro Cambridge Foundation to facilitate public understanding of nutrition; 4) the Consortium of Research Laboratories to combine Non Communicable Disease Prevention (including Cardiovascular aspects of Nutrition) and Dietary Bioactives research capabilities. Using these four sections of specialist capability, knowledge and skills NNEdPro employs the education of health professionals as a sustainable intervention tool to enable primary research studies, generation of new evidence and translation into policy and practice.More information NNEdPro's model of change can be found at nnedpro.org.ukSupport or Funding InformationNNEdPro's strategic partners are: Cambridge University Health Partners, Wolfson College Cambridge, British Dietetics Association, Ulster University, Society for Nutrition Education and Behaviour, and GODAN (Global Open Data for Agriculture and Nutrition)

Frontline experiences of a practice redesign to improve self-management of obesity in safety net clinics.

Teamlets of physicians and medical assistants may help improve obesity management in primary care settings. We aimed to understand the barriers and facilitators of implementing a teamlet approach to managing obesity in 3 safety net clinics. Key stakeholder interviews (n = 21) were conducted both during early implementation of practice change and 6 months later. Patient surveys (n = 393) examined obese patient activation and health status. Insufficient program resources and limited patient engagement due to external factors were implementation barriers despite fairly high patient activation. Staff members need time and resources to execute new responsibilities to support obesity management in safety net settings. Because of high turnover, multiple supporters may improve sustainability.

Patient's experience with comorbidity management in primary care: a qualitative study of comorbid pain and obesity.

The aim of this research is to examine perceptions of those with comorbid chronic pain and obesity regarding their experience of comorbidity management in primary care settings. Chronic pain and obesity are common comorbidities frequently managed in primary care settings. Evidence suggests individuals with this comorbidity may be at risk for suboptimal clinical interactions; however, treatment experiences and preferences of those with comorbid chronic pain and obesity have received little attention. Semi-structured interviews conducted with 30 primary care patients with mean body mass index=36.8 and comorbid persistent pain. The constant comparative method was used to analyze data. Participants discussed frustration with a perceived lack of information tailored to their needs and a desire for a personalized treatment experience. Participants found available medical approaches unsatisfying and sought a more holistic approach to management. Discussions also focused around the need for providers to initiate efforts at education and motivation enhancement and to show concern for and understanding of the unique difficulties associated with comorbidity. Findings suggest providers should engage in integrated communication regarding weight and pain, targeting this multimorbidity using methods aligned with priorities discussed by patients.

Palliative care case management in primary care settings: A nationwide survey

BackgroundIn case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. ObjectivesTo investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. SettingPrimary care. Design and participantsA nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). ResultsWe identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. ConclusionsIn the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management.

Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: a cross-sectional study of primary care in Japan.

BackgroundThe role of a patient’s functional health literacy (HL) has received much attention in the context of diabetes education, but researchers have not fully investigated the roles of communicative and critical HL, especially in primary care. Communicative HL is the skill to extract health information and derive meaning from different forms of communication, and to apply this information to changing circumstances. Critical HL allows the patient to critically analyze information and to use this information to achieve greater control over life events and situations. We examined how HL, particularly communicative and critical HL, is related to the patient’s understanding of diabetes care and self-efficacy for diabetes management in primary care settings. We also examined the impact of patient–physician communication factors on these outcomes, taking HL into account.MethodsWe conducted a cross-sectional observational study of 326 patients with type 2 diabetes who were seen at 17 primary care clinics in Japan. The patients completed a self-administered questionnaire that assessed their HL (functional, communicative, and critical), understanding of diabetes care, and self-efficacy for diabetes management. We also examined the perceived clarity of the physician’s explanation to assess patient–physician communication. Multivariate regression analyses were performed to determine whether HL and patient–physician communication were associated with understanding of diabetes care and self-efficacy.ResultsA total of 269 questionnaires were analyzed. Communicative and critical HL were positively associated with understanding of diabetes care (β = 0.558, 0.451, p < 0.001) and self-efficacy (β = 0.365, 0.369, p < 0.001), respectively. The clarity of physician’s explanation was associated with understanding of diabetes care (β = 0.272, p < 0.001) and self-efficacy (β = 0.255, p < 0.001). In multivariate regression models, HL and perceived clarity of the physician’s explanation were independently associated with understanding of diabetes care and self-efficacy.ConclusionsCommunicative and critical HL and clear patient–physician communication were independently associated with the patient’s understanding of diabetes care and self-efficacy. The potential impact of communicative and critical HL should be considered in communications with, and the education of, patients with diabetes in primary care settings.

CKD Management in Primary Care Setting

CKD Management in Primary Care Setting

Primary Care Physician Attitudes and Practice Patterns in the Management of Obese Adults: Results from a National Survey

Purpose: Obesity remains a serious public health problem. The purpose of this study was to identify the current attitudes and practices of primary care physicians (PCPs) with respect to obesity. Methods: A survey was systematically developed and administered electronically to PCPs, who received a small honorarium for their time. Results were analyzed to identify specific attitudes and practices and their associations with each other and with demographic and other variables. Results: Physicians expressed little confidence in their ability to manage obesity. In general, however, they believed that obesity could be successfully managed. Lifestyle changes were perceived to be the most effective available method for patients to lose weight, and respondents were more likely to recommend this approach over pharmacotherapy or bariatric surgery. Respondents perceive the greatest barrier to managing obese patients to be a lack of patient motivation. Physicians were significantly more likely to initiate discussions with obese patients about their weight if they believed they had positive attitudes about and knowledge of weight management, and adequate resources to manage the problem. Conclusions: Physicians report a lack of confidence in managing obesity. Lack of patient motivation is perceived to be the greatest barrier. Physicians with greater knowledge, more positive attitudes toward obesity management, and access to more resources are more likely to provide weight management in primary care settings.

Innovative MH Programs Win APA Achievement Awards

Back to table of contents Previous article Next article Association NewsFull AccessInnovative MH Programs Win APA Achievement AwardsMary WardMary WardSearch for more papers by this authorPublished Online:17 Dec 2010https://doi.org/10.1176/pn.45.24.psychnews_45_24_019AbstractAPA presented its annual Psychiatric Services Achievement Awards at the 2010 Institute on Psychiatric Services in Boston in October to innovative programs that deliver services to mentally ill or disabled persons, have overcome obstacles, and can serve as models for other programs. The award competition was supported by Pfizer Inc. The awards have been given since 1949.Following a video shown at the Opening Session about the Achievement Awards program and the 2010 winning programs, the awards were presented by Jill Williams, M.D., chair of the Achievement Awards Committee. All winning programs participated in a workshop at the institute highlighting their unique efforts.Seated, from left: Jill Williams, M.D., chair, Achievement Awards Committee; Linda Bueno, American Psychiatric Foundation; Pam Pietruszewski, the DIAMOND Program; Ilise Lombardo, M.D., Pfizer Inc.; Beatrice Kovasznay, M.D., Ph.D., Achievement Awards Committee. Second row, from left: Mary Ward, APA; Van Yu, M.D., Project for Psychiatric Outreach to the Homeless; Howard Osofsky, M.D., and Joy Osofsky, Ph.D., St. Bernard Family Resiliency Project; Michael Trangle, M.D., the DIAMOND Program; James Tew, M.D., Behavioral Health Laboratory at Philadelphia and Pittsburgh VA Medical Centers; Mark Williams, M.D., the DIAMOND Program; Johanna Klaus, Ph.D., Behavioral Health Laboratory at Philadelphia and Pittsburgh VA Medical Centers; and Gerard Gallucci, M.D., Achievement Awards Committee.Credit: Ellen DallagerTwo Gold Award winners each received a $10,000 check and a plaque. Silver and Bronze Award winners were presented with a $7,500 and $5,000 check, respectively, and a plaque.Gold Achievement Awards•. St. Bernard Family Resiliency Project of the Louisiana State University Health Sciences Center's Department of Psychiatry in New Orleans won in the category of academically or institutionally sponsored programs. The program was recognized for successful integration of mental health services into the school system and youth leadership and community outreach for children and families recovering from the traumatic effects of Hurricane Katrina. Howard Osofsky, M.D., program director, and Joy Osofsky, Ph.D., program co-director, accepted the award.•. The DIAMOND Program (Depression Improvement Across Minnesota, Offering a New Direction) of the Institute for Clinical Systems Improvement won the Gold Award for community-based programs. The award was accepted by Pam Pietruszewski, M.A., Michael Trangle, M.D., and Mark Williams, M.D.The program was recognized for its innovative, evidence-based collaborative treatment model, which integrates psychiatric consultation and care management into the treatment of major depression in primary care clinics.Silver Achievement Award•. The Project for Psychiatric Outreach to the Homeless of the Center for Urban Community Services in New York City was recognized for its efforts and innovative approaches to bringing psychiatric treatment services to homeless adults and individuals living in supportive housing. Van Yu, M.D., director of the center, accepted the award.Bronze Achievement Award•. The Behavioral Health Laboratory at the Philadelphia and Pittsburgh Veterans Affairs Medical Centers in Pennsylvania received the Bronze Award in recognition of its leadership in the dissemination of psychiatric expertise and evidence-based behavioral health management in primary care settings. The award was accepted by Johanna Klaus, Ph.D., and James Tew, M.D.More information about the 2010 winners can be accessed at <http://ps.psychiatryonline.org/content/vol61/issue10/index.dtl> by scrolling down to “APA Achievement Awards.” A video about the winning programs is posted at <www.psych.org/achievementawards>. Information about the 2011 competition is available from Mary Ward at (202) 907-8592 or [email protected]org.Mary Ward is a staff member of APA's Office of Healthcare Systems and Financing. ISSUES NewArchived

Restless legs syndrome: literature review.

Restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. The overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. Misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. Presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.

Satisfacción del paciente con migraña que acude a consultas de neurología: resultados del proyecto CIEN-mig (II)

Migraine is the most common neurological consultation in our country. AIM. To analyse the satisfaction level of the patient with migraine attending our clinics. A total of 160 neurologists asked 10 consecutive migraine patients to fill in a satisfaction questionnaire. The questionnaire was answered by 1330 patients. The most important factors they considered for their neurologists were professional experience and kindness. Patients thought neurologist should improve in time to explain treatment and accessibility. Almost 90% of patients considered that treatments for migraine had improved, but almost half of them were not satisfied with the management in primary care setting. Patients were more satisfied with symptomatic treatment (69.1%) than with preventatives (50.4%). More than half had a neuroimaging study due to their headaches. Only half thought that such an study would improve their satisfaction. The level of satisfaction of the migraine patient attending our clinics has improved in the last years. In patients' opinion the aspects which should be improved are the time to explain migraine and its treatment, accessibility and preventive treatment.

Factors Influencing Health-related Quality of Life in Patients with Benign Prostatic Hyperplasia

This study was done to examine the relationship of low urinary tract symptoms (LUTS), depression, sexual function, and health-related quality of life (HRQoL), and to identify factors influencing HRQoL in patients with benign prostatic hyperplasia (BPH) living in the community. A total of 218 patients with BPH were recruited into the study. The data were collected by personal interviews using questionnaires and were analyzed with SPSS (version 17.0) computer program, and included descriptive statistics, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression analysis. The relationship between HRQoL and LUTS with depression had a significant negative correlation, whereas the relationship between HRQoL and sexual function had a significant positive correlation. Depression, age, LUTS, number of chronic disease, and excercise were found to be significant predictors (35.6%) of the Physical Component Summary of HRQoL. Depression, stress, smoking, LUTS, and sexual function were found to be significant predictors (48.2%) of the Mental Component Summary of HRQoL. To improve HRQoL of patients with BPH, nurses should focus on the factors identified in this study when doing nursing assessments, and should develop nursing intervention programs for BPH prevention and symptoms management in primary care settings.

Buprenorphine prescription, misuse and service provision: a global perspective

SummaryBuprenorphine, a partial μ-opioid agonist and κ-opioid antagonist, is recommended as safe and effective maintenance treatment for opioid dependence. It offers the possibility of management in primary care settings. However, its prescription has led to diversion for illicit recreational use and resulted in medical complications and, rarely, fatal overdose in combination with other sedatives. The outcome of buprenorphine maintenance programmes varies from country to country and it is determined by the local therapeutic traditions, regulatory restrictions and existing service provision for opioid misusers. This article addresses the pharmacology of buprenorphine, the benefits and drawbacks of its prescription, service provision for opioid misuse around the world, policy recommendations, and prescribing training requirements.

Health Care Reform and Adolescents—An Agenda for the Lifespan: A Position Paper of the Society for Adolescent Medicine

Health Care Reform and Adolescents—An Agenda for the Lifespan: A Position Paper of the Society for Adolescent Medicine