Effectiveness of Simulated Clinical Teaching in General Practice: Randomised Controlled Trial.

Effectiveness of simulated clinical teaching in general practice: randomised controlled trial.

Filed under: Depression Treatment

J Prim Health Care. 2012; 4(4): 281-7
Elley CR, Clinick T, Wong C, Arroll B, Kennelly J, Doerr H, Moir F, Fishman T, Moyes SA, Kerse N

There are shortages in community-based general practice placements for medical students. Innovative ways to teach the skills required in general practice are needed.To assess the effectiveness of ‘simulated’ general practice clinics using actors, compared with standard community-based general practice attachments in medical undergraduate education.Randomised controlled trial involving medical students. Outcome measures included self-reported knowledge, clinical confidence, communication skills, and attitudes within general practice assessed at baseline and after one week. Intervention students participated in 24 simulated consultations with actor-patients over four days. Control students spent four days working with community-based general practitioners and real patients.Of 138 eligible medical students in the first clinical year, 128 (93%) participated and 106/128 (82%) completed the study. Those participating in simulated clinics improved in confidence in history-taking (p=0.03), communication skills (p=0.04), and ability to detect depression (p<0.001) compared with those undertaking community attachments. Those in community-based attachments felt more confident in managing upper respiratory tract infections (p<0.001), giving injections (p<0.001), screening in general practice (p=0.03) and managing illness in the patient's home (p=0.04). There was no difference between the groups in other measures.Simulated clinics may assist with development of communication skills within the general practice consultation and may also be used to supplement community-based attachment with real patients. Even so, confidence in the management of common conditions and procedures improves more with real patients. HubMed – depression


Excessive daytime sleepiness in sleep disorders.

Filed under: Depression Treatment

J Thorac Dis. 2012 Dec; 4(6): 608-16
Slater G, Steier J

Excessive daytime sleepiness is a significant public health problem, with prevalence in the community estimated to be as high as 18%. Sleepiness is caused by abnormal sleep quantity or sleep quality. Amongst others, multiple neurological, psychological, cardiac and pulmonary disorders may contribute. Risk factors for excessive sleepiness include obesity, depression, extremes of age and insufficient sleep. In the clinical setting, two of the most commonly encountered causes are obstructive sleep apnoea and periodic limb movement disorder. There is continuing discussion of the mechanisms by which these disorders cause daytime symptoms, with intermittent nocturnal hypoxia, sleep fragmentation and autonomic dysregulation identified as important factors. The increased prevalence of obstructive sleep apnoea in obese subjects does not fully account for the increased rates of daytime sleepiness in this population and there is evidence to suggest that it is caused by metabolic factors and chronic inflammation in obese individuals. Sleepiness is also more common in those reporting symptoms of depression or anxiety disorders and significantly impacts their quality of life. Clinicians should be aware of factors which put their patients at high risk of daytime sleepiness, as it is a debilitating and potentially dangerous symptom with medico-legal implications. Treatment option should address underlying contributors and promote sleep quantity and sleep quality by ensuring good sleep hygiene. However, stimulant medication may be indicated in some cases to allow for more normal daytime functioning.
HubMed – depression


Correction: “There Are Too Many, but Never Enough”: Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression.

Filed under: Depression Treatment

PLoS One. 2012; 7(10):
Cresswell K, Morrison Z, Kalra D, Sheikh A

[This corrects the article on p. e43831 in vol. 7.].
HubMed – depression


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