Ongoing negotiations on the general practitioner contract raise the question of remunerating general practitioners for increased workload resulting from the shift from secondary to primary care. A ...review of the literature shows that there is little evidence on whether a shift of services from secondary to primary care is responsible for general practitioners' increased workload, and scope for making generalisations is limited. The implication is that general practitioners have little more than anecdotal evidence to support their claims of greatly increased workloads, and there is insufficient evidence to make informed decisions about remunerating general practitioners for the extra work resulting from the changes. Lack of evidence does not, however, mean that there is no problem with workload. It will be increasingly important to identify mechanisms for ensuring that resources follow workload.
Examines existing definitions and uses of the term primary health care, focusing on their usefulness in health policy, clinical practice and research relating to health care systems. First, examines ...the principal types of definition and identifies core features. Second, discusses the application of these criteria to a range of services in the UK NHS. Lastly, examines the ways in which policy makers, health professionals and lay people use the term. Concludes by reflecting on the likelihood of achieving a single unambiguous definition and the usefulness of the term for different purposes. (Original abstract - amended)
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract Ongoing negotiations on the general practitioner contract raise the question of remunerating general practitioners for increased workload resulting from the shift from secondary to primary ...care. A review of the literature shows that there is little evidence on whether a shift of services from secondary to primary care is responsible for general practitioners' increased workload, and scope for making generalisations is limited. The implication is that general practitioners have little more than anecdotal evidence to support their claims of greatly increased workloads, and there is insufficient evidence to make informed decisions about remunerating general practitioners for the extra work resulting from the changes. Lack of evidence does not, however, mean that there is no problem with workload. It will be increasingly important to identify mechanisms for ensuring that resources follow workload.
Full text
Available for:
BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Even though supplemental oxygen is used for the treatment of patients with hypoxemic respiratory failure, the most effective oxygenation targets are not known. In this randomized trial, a lower ...oxygenation target did not result in lower mortality than a higher target.
Haloperidol for the Treatment of Delirium in ICU Patients Andersen-Ranberg, Nina C.; Poulsen, Lone M.; Perner, Anders ...
New England journal of medicine/The New England journal of medicine,
12/2022, Volume:
387, Issue:
26
Journal Article
Peer reviewed
Open access
In this randomized trial involving ICU patients with delirium, treatment with haloperidol did not lead to a greater number of days alive and out of the hospital than placebo.
Aims
Psoriasis is a common inflammatory disease that is associated with increased risk of cardiovascular disease, including myocardial infarction. Heart failure (HF) is independently associated with ...several cardiovascular risk factors and is a major cause of cardiovascular morbidity and mortality. The association between psoriasis and HF is unclear and we therefore investigated the risk of new‐onset HF in a nationwide cohort of psoriasis patients compared with the background population.
Methods
The study included the entire Danish population aged ≥18 years followed from 1 January 1997 until HF, death or 31 December 2011. Information on comorbidity and concomitant medication was identified by individual‐level linkage of administrative registers. New‐onset HF was defined as first hospital admission for HF. Incidence rates of new‐onset HF were calculated and adjusted hazard ratios were estimated by multivariable Cox regression models adjusted for age, gender, comorbidity and cardiovascular medications.
Results
A total of 5 485 856 subjects were eligible for analysis. In the study period 66 389 patients with new‐onset psoriasis, including 11 242 patients with severe psoriasis, were identified. The overall incidence rates of new‐onset HF were 2.82, 4.22 and 4.70 per 1000 person‐years for the reference population, mild psoriasis and severe psoriasis, respectively. Compared with the reference population, the fully adjusted hazard ratios for new‐onset HF were increased in patients with psoriasis with a hazard ratio 1.22 (95% confidence interval 1.16–1.29) and hazard ratio of 1.53 (95% confidence interval 1.34–1.74) for those with mild and severe disease, respectively.
Conclusion
In this nationwide cohort, psoriasis was associated with a disease severity‐dependent increased risk of new‐onset HF.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
In this trial, a restrictive approach to intravenous fluid administration in critically ill patients with septic shock did not reduce deaths at 90 days.
IMPORTANCE: Supplemental oxygen is ubiquitously used in patients with COVID-19 and severe hypoxemia, but a lower dose may be beneficial. OBJECTIVE: To assess the effects of targeting a Pao2 of 60 mm ...Hg vs 90 mm Hg in patients with COVID-19 and severe hypoxemia in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS: Multicenter randomized clinical trial including 726 adults with COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 11 ICUs in Europe from August 2020 to March 2023. The trial was prematurely stopped prior to outcome assessment due to slow enrollment. End of 90-day follow-up was June 1, 2023. INTERVENTIONS: Patients were randomized 1:1 to a Pao2 of 60 mm Hg (lower oxygenation group; n = 365) or 90 mm Hg (higher oxygenation group; n = 361) for up to 90 days in the ICU. MAIN OUTCOMES AND MEASURES: The primary outcome was the number of days alive without life support (mechanical ventilation, circulatory support, or kidney replacement therapy) at 90 days. Secondary outcomes included mortality, proportion of patients with serious adverse events, and number of days alive and out of hospital, all at 90 days. RESULTS: Of 726 randomized patients, primary outcome data were available for 697 (351 in the lower oxygenation group and 346 in the higher oxygenation group). Median age was 66 years, and 495 patients (68%) were male. At 90 days, the median number of days alive without life support was 80.0 days (IQR, 9.0-89.0 days) in the lower oxygenation group and 72.0 days (IQR, 2.0-88.0 days) in the higher oxygenation group (P = .009 by van Elteren test; supplemental bootstrapped adjusted mean difference, 5.8 days 95% CI, 0.2-11.5 days; P = .04). Mortality at 90 days was 30.2% in the lower oxygenation group and 34.7% in the higher oxygenation group (risk ratio, 0.86 98.6% CI, 0.66-1.13; P = .18). There were no statistically significant differences in proportion of patients with serious adverse events or in number of days alive and out of hospital. CONCLUSION AND RELEVANCE: In adult ICU patients with COVID-19 and severe hypoxemia, targeting a Pao2 of 60 mm Hg resulted in more days alive without life support in 90 days than targeting a Pao2 of 90 mm Hg. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04425031
We and others have shown central roles of the Na+/H+ exchanger NHE1 in cell motility. The aim of this study was to determine the roles of NHE1 and of the Na+, HCO3- cotransporter NBCn1 in motility of ...serum-starved MCF-7 breast cancer cells expressing constitutively active ErbB2 (ΔNErbB2). ΔNErbB2 expression elicited NBCn1 upregulation, Ser703-phosphorylation of NHE1, and NHE1-inhibitor (EIPA)-sensitive pericellular acidification, in conjunction with increased expression of β1 integrin and ERM proteins. Active ERM proteins and NHE1 colocalized strongly to invadopodial rosettes, the diameter of which was increased by ΔNErbB2. Adhesion and migration on collagen-I were augmented by ΔNErbB2, unaffected by the NBC inhibitor S0859, and further stimulated by EIPA in a manner potentiated by PI3K-Akt-inhibition. These findings demonstrate that NHE1 inhibition can enhance cancer cell motility, adding an important facet to the understanding of NHE1 in cancer.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Psoriasis is associated with increased risk of cardiovascular events and increased prevalence of cardiovascular risk factors. Diabetes mellitus (DM) is a major contributor to cardiovascular morbidity ...and mortality that may be associated with psoriasis, but conflicting results have been presented and nationwide data on the risk of new-onset DM in patients with psoriasis have not been reported.
The study comprised a Danish population ≥ 10 years of age on 1 January 1997 who were followed until new-onset DM, death, or 31 December 2009. Information on comorbidity, concomitant medication, and socioeconomic status was linked on an individual level. The primary study end point was DM requiring pharmacotherapy. Incidence rates for the development of DM events per 1,000 observational years were calculated and adjusted. Incidence rate ratios (IRRs) were estimated by Poisson regression.
A total of 4,614,807 subjects were eligible for analysis, with a maximum follow-up of 13 years. In the study period, 52,613 patients with psoriasis, including 6,784 patients with severe psoriasis, were identified. The overall incidence rates for new-onset DM were 3.67 (CI 3.65-3.69), 6.93 (6.63-7.25), and 9.65 (8.68-10.73) for the reference population, mild psoriasis, and severe psoriasis, respectively. Compared with the reference population, the IRR of new-onset DM was increased in all patients with psoriasis, i.e., IRR 1.49 (CI 1.43-1.56) and 2.13 (1.91-2.37) for those with mild and severe psoriasis.
In this nationwide cohort, psoriasis was associated with increased incidence rates of new-onset DM. The association remained statistically significant after adjustment for confounding factors.
PDF
