The British journal of general practice : the journal of the Royal College of General Practitioners
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GPs regularly prescribe lifelong treatments for long-term conditions, supported by clinical guidelines and encouraged by performance measures. However, GPs have a poor understanding of the absolute benefits and harms of these treatments, impairing their ability to engage in genuine shared decision making or optimally manage polypharmacy. There are few easily accessible and understandable sources of this kind of quantitative information. ⋯ It is possible to communicate quantitative information about the clinical evidence base behind treatments in a way that will be usable in practice and that complements existing clinical guidelines and normative practice. This has the potential to support shared decision making, improve the management of polypharmacy, and increase GPs' confidence in this area of practice.
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The diagnosis and management of psychogenic non-epileptic seizures (PNES) is often challenging. This literature review was done to investigate available data on PNES to make recommendations for its management. ⋯ The unmasking of the masquerade of PNES is challenging for clinicians in primary and tertiary care. Raising awareness of the condition reduces the burden on health care. Definitive guidelines and more control trials are required. Provocative measures to establish the diagnosis are limited. The feasibility of using the tilt table as a provocative measure is discussed.
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The unadjusted gender pay gap in general practice is reported to be 33.5%. This reflects partly the differential rate at which women become partners, but evidence exploring gender differences in GPs' career progression is sparse. ⋯ There are some long-standing gendered barriers that continue to affect the career decisions of women GPs. The relative attractiveness of salaried, locum, or private roles in general practice appears to discourage both men and women from partnerships presently. Promoting positive workplace cultures through strong role models, improved flexibility in roles, and skills training could potentially encourage greater uptake.
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Integrated care pathways can help to avoid unnecessary admissions to hospital and improve the overall quality of care for frail older patients. Although these integrated care pathways should be coordinated by GPs their level of commitment may vary. ⋯ The level of interest in the PAERPA ICP for frail older adults varied widely among GPs. These findings suggest that commitment to an integrated care pathway could be increased by customising the recruitment strategy as a function of the GP's profile.
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Urinary incontinence (UI) impacts patients and society in many ways. There are good treatment options, but healthcare delivery and processes are often suboptimal. ⋯ Poor UI identification in primary care and a lack of patient guidance through the healthcare system hamper continence care provision.