General Practice

Greenhalgh and Wong's editorial 1 on revalidation is timely and important. I have just completed a so-called 'Strengthened Medical Appraisal' or SMA, and found the experience not only infuriatingly clumsy in terms of its online functionality, but pathetically irrelevant to my own sense of what it is to be, I hope, an adequate GP. And, just as Greenhalgh and Wong foresee, the requirement for this annual exercise is very likely to dissuade me from continuing in practice part-time following my retirement in May. At the heart of the appraisal process is the matching of 'supporting information' to 12 'attributes' clustered into four

Objectives: The purpose of this research was to explore the value of reflection and its application to practice through the implementation of educational modules within a new Diabetes Care and Education Master Degree Programme in Kuwait, and to realise how this teaching intervention informs changes in practice. Methods: A small exploratory case study was conducted within the Dasman Diabetes Institute, Kuwait. A qualitative approach using focus group interviews was carried out with seventeen participants all of whom are studying on the Diabetes Care and Education Master Degree Programme in Kuwait. An inductive approach to thematic analysis, which focused on examining themes within data, was performed. Results: The results indicate that participants value the opportunity to study through organised, structured and assessed reflection. The learning provides useful information and support to the participant by highlighting the role which reflection plays to enhance personal and professional development, the value of educational theory, continuing professional development, collaboration and enhancing patient education and practice. Conclusions: The significance of reflection is often seen in the literature as an important aspect of professional competence. This research has highlighted the value of reflection as a key component within a new educational programme.

Trainers play a crucial role in developing the professional character of trainees. By asking the ‘right’ question at particular points, they can directly influence individual trainees’ awareness of and ability to maximise their learning from their work-based experiences and probe and develop their professional character.

The purpose of this research was to explore the value of workplace based projects within a University of Dundee Educational Postgraduate Certificate/Diploma/Master Degree Programme in Kuwait: students' views and experiences. Methods A small scale exploratory case study was conducted. A qualitative approach using narrative analysis, online questionnaire and focus group interviews were carried out with participants all of whom are studying on the University of Dundee Postgraduate Certificate/Diploma/Master programme in Diabetes Care and Education in Kuwait. An inductive thematic analysis was performed which focused on examining topics within the data. Results The results imply that the positive implementation of workplace based learning, with implications for patient care by practitioners, with a corresponding satisfactory review from course tutors, is important from an educational and clinical perspective. Practitioners in this study valued the opportunity to both work and study in order to improve their performance by implementing their new found knowledge and so educate others and change practice. Conclusion Workplace based learning is important as it enhances the students' knowledge and understanding due to their having to apply this within a practical setting.' In turn this allows them the opportunity to reflect on that practical experience and so inform further learning. ' The merit of workplace based learning in this study is emphasised as a key part of a Masters educational programme in Kuwait.

Objective To assess intermittent treatment over 12 months in patients with symptomatic gastro-oesophageal reflux disease. Design Randomised, multicentre, double blind, controlled study. Patients with heartburn and normal endoscopy results or mild erosive changes received omeprazole 10 mg or 20 mg daily or ranitidine 150 mg twice daily for 2 weeks. Patients remaining symptomatic had omeprazole 10 mg or ranitidine dose doubled for another 2 weeks while omeprazole 20 mg was continued for 2 weeks. Patients who were symptomatic or mildly symptomatic were followed up for 12 months. Recurrences of moderate or severe heartburn during follow up were treated with the dose which was successful for initial symptom control. Setting Hospitals and primary care practices between 1994 and 1996. Subjects 677 patients with gastro-oesophageal reflux disease. Main outcome measures Total time off active treatment, time to failure of intermittent treatment, and outcomes ranked from best to worst. Results 704 patients were randomised, 677 were eligible for analyses; 318 reached the end of the study with intermittent treatment without recourse to maintenance antisecretory drugs. The median number of days off active treatment during follow up was 142 for the entire study (281 for the 526 patients who reached a treatment related end point). Thus, about half the patients did not require treatment for at least 6 months, and this was similar in all three treatment groups. According to outcome, 378 (72%) patients were in the best outcome ranks (no relapse or one (or more) relapse but in remission until 12 months); 630 (93%) had three or fewer relapses in the intermittent treatment phase. Omeprazole 20 mg provided faster relief of heartburn. The results were similar in patients with erosive and non-erosive disease. Conclusions Intermittent treatment is effective in managing symptoms of heartburn in half of patients with uncomplicated gastro-oesophageal reflux disease. It is simple and applicable in general practice, where most patients are seen.

overspill of work into home life; and role conflict.5 Indeed, the dynamics of a practice will alter as more women enter the profession as women are more likely to work part time than men.4 Thus it is important that the impact of change is carefully monitored to avoid adverse impact on this profession. Ideally, a survey using both subjective and objective data is needed to determine the ongoing nature of these findings. I Karasek RA Jr. job demands, job decision latitude and mental strain:

The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty. As our case is new, we must think anew and act anew.' (Abraham Lincoln) 'Essence: that which constitutes the being of a thing; that by which it is what it is.' (Oxford English Dictionary, page 896.) General practice as a discipline has made considerable strides forward over the past three decades. There is good evidence that welldeveloped general practice and primary care systems can improve quality of care within a health system. 1 The discipline of general practice has been closely examined and defined, 2 and in the UK a training curriculum proposed by the Royal College of General Practitioners (RCGP) 3 has been approved by the Postgraduate Medical Education Training Board (PMETB). 4 A new entry examination, nMRCGP, based on the new curriculum, has been established. The new general medical services (nGMS) contract is largely evidence based, 5 in that most of the targeted areas within the Quality and Outcomes Framework (QOF) are directly or indirectly supported by evidence from randomised controlled trials and, if achieved, are expected to improve individual and population health. Contrary to expectations, practices have responded to its introduction by achieving high scores in the QOF. This development, unique in general practice, is being watched with interest in many other countries. 6 Although the QOF covers many important aspects of care, GPs also recognise that the inherent strength and complexity of the doctor-patient relationship supports quality at a much deeper level. 7,8 There are growing anxieties that the focus on the QOF, driven by financial incentives, may lead to the loss of something important but hard to measure in general practice. [8][9][10][11] This is an unsettling environment for patients and doctors. In addition, recent devolution and political changes in the UK mean that four widely

The al-adrenoceptor antagonist doxazosin has been compared with placebo in 40 elderly hypertensive patients (mean age 71.4 years). At the end of 10 weeks once daily treatment with doxazosin the mean 24-h post-dose changes in standing and supine blood pressure compared with placebo were-6. 9 /-5.6 mmHg (systolic/diastolic) and-6. 2 /-5.5 mmHg respectively. The reductions in standing and supine diastolic blood pressures were statistically significant compared with placebo. At the end of treatment steady-state pharmacokinetics were evaluated in 18 patients. The plasma elimination half-life during the dose interval in these patients was 16.1 h (range 10.1-27.1 h) and the median time to peak plasma concentration was 3 h (range 1-4 h). One patient was withdrawn because of adverse effects (headache, weakness, and sweating) during doxazosin treatment. Once daily doxazosin reduced diastolic blood pressure and was well tolerated in these elderly hypertensive patients.

The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date. The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system. The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level...

Objective To assess intermittent treatment over 12 months in patients with symptomatic gastro-oesophageal reflux disease. Design Randomised, multicentre, double blind, controlled study. Patients with heartburn and normal endoscopy results or mild erosive changes received omeprazole 10 mg or 20 mg daily or ranitidine 150 mg twice daily for 2 weeks. Patients remaining symptomatic had omeprazole 10 mg or ranitidine dose doubled for another 2 weeks while omeprazole 20 mg was continued for 2 weeks. Patients who were symptomatic or mildly symptomatic were followed up for 12 months. Recurrences of moderate or severe heartburn during follow up were treated with the dose which was successful for initial symptom control. Setting Hospitals and primary care practices between 1994 and 1996. Subjects 677 patients with gastro-oesophageal reflux disease. Main outcome measures Total time off active treatment, time to failure of intermittent treatment, and outcomes ranked from best to worst. Results 704 patients were randomised, 677 were eligible for analyses; 318 reached the end of the study with intermittent treatment without recourse to maintenance antisecretory drugs. The median number of days off active treatment during follow up was 142 for the entire study (281 for the 526 patients who reached a treatment related end point). Thus, about half the patients did not require treatment for at least 6 months, and this was similar in all three treatment groups. According to outcome, 378 (72%) patients were in the best outcome ranks (no relapse or one (or more) relapse but in remission until 12 months); 630 (93%) had three or fewer relapses in the intermittent treatment phase. Omeprazole 20 mg provided faster relief of heartburn. The results were similar in patients with erosive and non-erosive disease. Conclusions Intermittent treatment is effective in managing symptoms of heartburn in half of patients with uncomplicated gastro-oesophageal reflux disease. It is simple and applicable in general practice, where most patients are seen.