Graham Worrall

Diabetes Management in Canada: Baseline Results of the Group Practice Diabetes Management Study

ABSTRACT BACKGROUND There exists a considerable gap between best practice as rec-ommended by diabetes guidelines and actual practice. The objective of this study was to determine the level of care being provided to patients with type 2 diabetes by family physicians in group practices in 4 regions of Canada. METHODS Baseline characteristics from a cluster-randomized trial using chart audits were recorded to assess glycemic control and rates of physician adherence to guidelines-recommended practice. Intracluster correlation coefficients (ICCs) were calculated using the physician practice as the cluster. RESULTS Fifty-six physicians in 16 group practices provided 549 charts. Glycosylated hemoglobin (A1C) was measured in 71.8% of patients (mean: 7.7%). A total of 82.3% received antihyperglycemic medication, but only 35.3% achieved an A1C INTERPRETATION Despite high rates of screening for glycemia and macrovascu-lar complications, treatment was not sufficiently intensive for most patients. Family physicians performed poorly in microvascular complication screening.

Attachment characteristics and behavioural problems in rural and urban juvenile delinquents

Self-reported attachment characteristics, substance use and behavioural problems were assessed in 68 male juvenile delinquents from rural and urban areas. As was predicted, insecure attachment characteristics were related to behavioural problems, substance use, and poor family functioning. Urban delinquents reported more substance use and more interpersonal problems with peers and family members than their rural counterparts. Contextual influences on adolescent attachment relationships and adjustment problems may have implications for the administration and delivery of psychological treatments in youth correctional settings.

Cognitive function and glycosylated hemoglobin in older patients with type II diabetes

The purpose of this study was to assess whether there is a relationship between diabetes control and cognitive function in older persons with type II diabetes. Seventy-seven patients with type II diabetes mellitus-none of whom were taking insulin-were given two cognitive function tests (the Modified Mini-Mental State and the Delayed Word Recall Test) and a HbA1C assay. All patients were living independently at home in rural communities, and under the care of their family doctor. The mean age of the subjects was 67.6 years; the sample consisted of 23 males and 54 females. The mean glycosylated hemoglobin (HbA1C) level was 8.4 (range from 3.1 to 20.0). There was a nonsignificant trend for persons with extreme lower or higher HbA1C levels to have poorer cognitive function as assessed by the Modified Mini-Mental State but not the Delayed Word Recall Test. The effect of glycemic control on cognitive function may not be as clinically relevant as other factors in elderly persons with type II diabetes.

Acyclovir in recurrent herpes labialis

Recurrent herpes labialis is one of the most common skin complaints general practitioners see; in his meticulous record of all patients seen in his NHS practice Hodgkin estimated the incidence to be about 10 cases per 1000 patients seen per year.1 After the initial attack of herpes labialis, herpes simplex virus type 1 is thought to remain latent in the trigeminal ganglion and to be reactivated by various types of stress.2 Although things such as fever, upper respiratory tract infections, ultraviolet light, and psychological stress are thought to trigger recurrence, the condition is variable and unpredictable in most patients, as is the extent and duration of each attack.3 Recurrent attacks are usually shorter and less painful than the original attack. The discovery of acyclovir seemed to offer great promise in the treatment of herpes labialis. Acyclovir acts as a substrate for the thymidine kinase …

Behavioural and substance use problems in rural and urban delinquent youths.

Objective: To examine rates of behavioural and substance use problems in incarcerated young offenders and to explore rural and urban differences in the expression and severity of these problems. Method: We assessed a sample of 68 confined male young offenders (63.3% rural and 35.3% urban), using the Drug Use Screening Inventory (DUSI) and the Youth Self-Report (YSR). Results: Based on clinical cut-offs, data showed high rates of externalizing behavioural problems (75.4%) and substance use problems (95.7%). Urban delinquent youths showed higher rates of attention problems, delinquent behaviours, and externalizing behaviours than those in rural communities. Conclusions: Incarcerated young offenders show elevated rates of psychological problems that require treatment. Rural and urban differences in the rates of these problems may reflect differences in community service availability in these areas or in environmental influences on the development of child behavioural problems.

Clinical practice guidelines: Questions family physicians should ask themselves

ConclusionIf practice guidelines are to be effective and useful in primary care, they should consist of sensible advice that can prevent unsatisfactory practices, provide better coordination, and serve as blueprints for simple measures to improve the current state of health care. Practice guidelines should take into account the unique nature of family practice, in which patients often have multiple problems and present with various vague and nonspecific complaints.Practice guidelines are still relatively crude summaries of implicit and subtle clinical skills.25,26 They should be used not to dictate practice but to improve clinical judgment. It is clear that the perspective of the family physician is essential to the development, dissemination, implementation and audit of practice guidelines in the community. Family physicians should resist any wholesale rush to uncritically adopt practice guidelines. In a sense, guidelines can be considered a new medical technology or treatment; therefore, physicians should be as skeptical about guidelines as they are about any other medical innovation, until good evidence confirms that they are of definite benefit.

Review: some screening tests for dementia in older persons are accurate and practical for use in primary care.

Source Citation Holsinger T, Deveau J, Boustani M, Williams JW Jr. Does this patient have dementia? JAMA. 2007;297:2391−404. 17551132