Search

Background:Menstrual disorders are a common presentation in primary care. Heavy menstrual bleeding is the most common concern, and is often treated by medical and surgical means despite lack of pathology.Aim:To explore women's experiences of menstrual disorders.Design of study:Two qualitative studies using semi-structured interviews.Setting:Inner-city London.Method:An initial study recruited women with heavy menstrual bleeding via their GPs. A follow-up study recruited women with a variety of menstrual problems via general practice and the community. Interviews were taped and transcribed then analysed using the constant comparative method.Results:Management of menstruation was a prominent theme in interviews. Women acted to comply with a strong social message that menstruation should be concealed, although this behaviour was often 'taken for granted.' The need to conceal evidence or reminders of menstrual bleeding was particularly important. Onset of menstrual symptoms often challenged established strategies for menstrual management. Menstrual management then became a conscious problem and a source of continuing stress. The breakdown of management strategies, by real or threatened episodes of leaking or staining, influenced consultation behaviour and decisions about treatment.Conclusion:The social pressure to maintain concealment of menstruation is a strong influence on women's health-related behaviour in response to menstrual concerns. Women's choices may be better understood if attention is paid to the social context in which they live. [ABSTRACT FROM AUTHOR]

Objective: To explore primary care practitioners approach to and management of menstrual disorders using a sociological perspective. Methods: Semi-structured interviews of primary care practitioners with an iterative approach to recruitment and analysis informed by grounded theory. Results: Two broad approaches to patient care were described-a biomedical approach, which concentrated on medical history taking and the search for disease, and a patient-as-person approach where a patient's individual ideas and concerns were elicited. Practitioners believed they had a role in integrating these approaches. Activities intrinsic to the biomedical approach such as the performance of examinations, the ordering of tests and making decisions about biomedical aspects of care were however not available for shared decision-making. The exercise of these decisions by medical practitioners was necessary for them to achieve their professional identity. Conclusion: While practitioners accepted the ideology of patient-centred care the biomedical approach had the advantage of providing practitioners with a professional identity, which protected their status in relation to patients and colleagues. Practice Implications: The adoption of shared decision-making by medically qualified primary care practitioners is limited by practitioners need to achieve their medical identity. At present, this identity does not involve significant sharing of power and responsibility. A shift in perception of medical identity is required before more shared decision-making is seen in practice. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine women's experience of the consent process for involvement in medical education in a teaching hospital. DESIGN: Questionnaire survey. PARTICIPANTS: The study involved 181 (90% response rate) women aged 17-79 years who attended 1 gynaecology clinic. SETTING: A gynaecology clinic in an inner London teaching hospital. RESULTS: Women were broadly positive about the presence of students in gynaecology clinics. The current process relies on implied consent and women actively opting out of involvement. Despite hospital policy to inform all outpatients in their appointment letter that students may be present at the clinic, 58% of patients did not recall being informed in this way. Although 91% of women did not object to student presence, only 65% reported having been asked if they wanted it. Subjective feeling of choice about the student presence was associated with advance notice, either by letter or previous experience of students at clinics. Women differentiated between consent for different aspects of interaction with students. CONCLUSION: Notification of the presence of students in standard appointment letters does not adequately inform patients. Clinical teachers need to ensure that the measures in place to inform women and to seek their active consent about involvement in teaching are robust. [ABSTRACT FROM AUTHOR]

Menorrhagia is a common presentation in primary care. The gynaecological literature defines menorrhagia, as the loss of 80 ml or more of blood per period and guidelines for treatment are based on this definition. There is extensive evidence that the majority of women who complain of heavy bleeding do not fit the medical definition. We interviewed women presenting with menorrhagia to explore their perceptions and their initial interaction with the medical profession. A distinct illness model emerged. Women had a precise understanding of their complaint, so that a change in her cycle was indicative of a problem to many women, without reference to outside criteria. Women attached particular importance to how they felt and to their ability to function and they rejected the medical emphasis on blood loss evaluation. Many women were dissatisfied with the consultation and experienced doctors as being dismissive of their problem. They were seeking an explanation for why their periods had changed and had concerns that related to their understanding of menstrual bleeding. Interviewees were unsure whether period problems could be described as illness, and what range of disturbance was normal. It is suggested that the disease model of menorrhagia is not relevant to the majority of women with this complaint. It is proposed that the disease model be replaced with illness models. [ABSTRACT FROM AUTHOR]

Objectives: Clinical practice guidelines (CPGs) are often created through collaboration among organizations. The use of inconsistent terminology may cause poor communication and delays. This study aimed to develop a glossary of terms related to collaboration in guideline development., Study Design and Setting: A literature review of collaborative guidelines was performed to develop an initial list of terms related to guideline collaboration. The list of terms was presented to the members of the Guideline International Network Guidelines Collaboration Working Group, who provided presumptive definitions for each term and proposed additional terms to be included. The revised list was subsequently reviewed by an international, multidisciplinary panel of expert stakeholders. Recommendations received during this pre-Delphi review were implemented to augment an initial draft glossary. The glossary was then critically evaluated and refined through two rounds of Delphi surveys and a virtual consensus meeting with all panel members as Delphi participants., Results: Forty-nine experts participated in the pre-Delphi survey, and 44 participated in the two-round Delphi process. Consensus was reached for 37 terms and definitions., Conclusion: Uptake and utilization of this guideline collaboration glossary by key organizations and stakeholder groups may facilitate collaboration among guideline-producing organizations by improving communication, minimizing conflicts, and increasing guideline development efficiency., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: We declare the following interests based on NICE’s policy on conflicts of interests (available at www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/code-of-practice-for-declaring-and-managing-conflicts-of-interest.pdf). MC and NO’F have no relevant interests to declare. SNF provides a full statement in the NICE guideline (www.nice.org.uk/guidance/NG95).

The general election in the United Kingdom in May 2010 resulted in the election of a new government, a coalition between Conservative and Liberal Democrat parties. Six weeks after the election, a white paper, "Equity and Excellence: Liberating the NHS," that proposed profound changes to the structure and organization of the health service was published. The change that generated the most discussion was the proposal that general practitioners be placed at the center of the system and given control of about 80% of the National Health Service's £100 billion budget. The proposals were greeted with considerable concern by many health care professionals, patient representatives, and the media. In response, the government organized an independent review, and proposals have been altered in response. This article outlines the current organization of the National Health Service, the rationale for change, and government proposals.

Background: Menstrual disorders are a common presentation in primary care. Wide variations in management as well as discordance between patient and practitioners in relation to presenting problems have been described., Aims: To explore the model of menstrual disorders used by practitioners in practice., Design of Study: Semi-structured interviews with primary care practitioners., Setting: One inner London health authority area., Method: Constant comparative analysis., Results: Medical practitioners were critical of the guidance provided by gynaecological definitions and texts. Practitioners put more emphasis on defining normality than on defining disorder. Practitioners used a wide range of criteria to judge their patients' complaints and decide on a course of action. Female practitioners had access to personal and professional experience and used this to develop an understanding of women's complaints. Male practitioners in particular were limited by problems in discussing menstruation in detail. Because of the difficulties in assessing patient history, other non-gynaecological factors such as patient age and consulting behaviour informed practitioners' judgements., Conclusion: This study draws attention to practitioners' problems in using current definitions of menstrual disorders. The combination of unhelpful medical definitions, lack of standards of normality and difficulties in discussing menstruation resulted in individual practitioners making judgements in idiosyncratic ways. In the absence of a useful gynaecological model, practitioners develop individual, often subjective and gendered models to use in practice.

Headache is a common presentation in primary care. The classification of headache was overhauled by the International Headache Society (IHS) in 1988, and the past decade has seen rapid growth in the understanding of headache disorders. The IHS places particular importance on precise headache diagnosis. This paper discusses the relevance of such an approach to primary care. A review of the literature revealed a dearth of evidence regarding headache management in primary care settings. The evidence from other settings is considered and gaps in the literature highlighted.

Background: General practice differs from hospital medicine in the personal nature of the doctor-patient relationship and in the need to address social and psychological issues as well as physical problems. Recent changes in undergraduate medical education have resulted in more teaching and learning taking place in general practitioner (GP) surgeries., Aim: To explore patients' experiences of attending a surgery with a medical student present., Method: A questionnaire was designed, based on semi-structured interviews. Questionnaires were posted to patients who had attended teaching surgeries in London and Newcastle-upon-Tyne., Results: Four hundred and eighty questionnaires were sent; of these, 335 suitable for analysis were returned. The response rate in Newcastle was 79%, and in London 60%. Ninety-five per cent of responders agreed that patients have an important role in teaching medical students. Patients reported learning more and having more time to talk, however, up to 10% of responders left the consultation without saying what they wanted to say and 30% found it more difficult to talk about personal matters., Conclusion: The presence of a student has a complex effect on the general practice consultation. Future developments in medical education need to be evaluated in terms of how patient care is affected as well as meeting educational aims.

The autoradiographic distribution of binding sites for 60 pM [125I]Bolton-Hunter substance P (BHSP) was investigated in slide-mounted sections of rat footpad skin. BHSP binding sites were found over dermal papillae, postcapillary venules, sweat glands and arterioles. No binding was seen over mast cells, sebaceous glands or pacinian corpuscles. Specific BHSP binding was inhibited by substance P greater than neurokinin A greater than neurokinin B, indicating binding to an NK1 (substance P-preferring) site. The NK1 binding sites over postcapillary venules and arterioles probably represent receptors mediating plasma extravasation and vasodilatation, respectively. There was no apparent change in distribution or number of BHSP binding sites after neonatal capsaicin pretreatment, indicating a probable absence of NK1 receptors on sensory terminals. No binding sites were observed for 100 pM [125I]iodohistidyl neurokinin A (INKA).